HEALTH CARE/Joan Retsinas

Rich-Poor Newborn Gap Slowly Closing

The word for the year is “unremitting.” Internationally, we’ve been awash in genocide, wars and mayhem. Domestically, poverty, racism, xenophobia, political gridlock – all persist, with no glimmer of hope for surcease. Optimistically, the arc of history promises relief. Eventually Europe’s hundred-plus-year war ended; today England and France are at peace, as are Denmark and Sweden, once bitter enemies. In the first century after the founding of the United States, and after a bitter civil war, we outlawed slavery. The past century of social programs, including Social Security, Food Stamps, welfare, and housing subsidies, coupled with laws forbidding child labor, bolstered life for millions of people (including the huddled masses that Emma Lazarus, perhaps reluctantly, welcomed to our shores).

Yet that historical arc bends ever so slowly, often imperceptibly.

On the health front, the country divides into schisms: insured and uninsured, healthy and sick – mirroring the social divide between rich and poor that continues to widen. In fact, the crucial “elephant in the room” of public health is truly an elephant: our rates of obesity. Even here the disparity in rates mirrors the disparity in income. Not surprisingly, diabetes and high blood pressure reflect the same schism. As for longevity, one study (http://content.healthaffairs.org/content/31/8/1803.abstract) pegged the gap in terms of life expectancy: a woman who dropped out of high school is expected to live six years less than her college-educated counterpart. (Twenty years ago the gap was 2 years).

That is why, in this year’s unremitting barrage of grimness, everybody should cheer one unexpected snippet of progress on the health care front: the gap in low birth weights for poor and richer babies is closing, slowly. (Washington Post, July 20) Astoundingly, even while the wealth gap in this country expands, the disparity in outcomes for newborns shrinks.

Low birth weight is pegged at 5 and a half pounds. While it is not a disease per se, it can lead to problems with respiration, vision, the heart, intestines and brain. The key determinants of low birth weight revolve around the mother. (Does she smoke? Drink? Take drugs – both licit and illicit? Eat a nutritious diet? Take vitamins? Get regular prenatal care? Does she suffer from domestic abuse? Is she exposed to harmful pollutants? How young is she?). Her socioeconomic status plays a role. In countries with universal health insurance, and a subsidized income-threshold, some groups of women are still more likely to have tinier babies.

In the United States, the disparity between rich and poor among newborns has been startling. Two economists (“The intergenerational transmission of inequality: Maternal disadvantage and health at birth,” Anna Aizer and Janet Currie, <http://www.princeton.edu/~jcurrie/publications/Science-2014-Aizer-856-61.pdf>) compared black, unmarried, high school dropouts – considered poor — with white, married, college graduates – considered rich. In 1989, 1 in 6 babies born to poor mothers were “low birth weight,” versus 1 in 32 babies of rich mothers. Twenty years later, the rate for poor women fell to 1 in 8. A gap persists, but it is shrinking.

We don’t know definitively what happened. But we have plausible heroes. Public health clinics can take a bow – they accept all patients, even those without insurance. So can State Medicaid offices, especially those that have been most generous in extending insurance to more uninsured women. Food subsidies, including the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program that gives food as well as nutritional counseling, can join in the parade. Those public health departments that run billboards urging pregnant women not to drink or smoke can join in the credit. Maybe those billboards countered the barrage of fast food advertisements. Efforts to combat domestic abuse may have helped. Ditto for pollution control policies. And the mothers themselves deserve credit: they took responsibility for their lives, for their babies’ lives.

The rich-poor gap in this country is widening. But on at least one important measure of health, the gap is shrinking. One small step?

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, September 15, 2014