The Black-White Disparity in Preterm Birth: Race or Racism?

Abstract

Policy Points Racism is an upstream determinant of health that influences health through many midstream and downstream factors. This Perspective traces multiple plausible causal pathways from racism to preterm birth. Although the article focuses on the Black-White disparity in preterm birth, a key population health indicator, it has implications for many other health outcomes. It is erroneous to assume by default that underlying biological differences explain racial disparities in health. Appropriate science-based policies are needed to address racial disparities in health; this will require addressing racism.

Keywords: preterm birth; racial disparities; racism and health.

Figure 1

Racism Plausibly May Affect PTB As an Upstream Cause, Acting Through Midstream and Downstream Causes That More Directly Trigger the Physiologic Mechanisms Resulting in Racial Disparities in Preterm Birth Abbreviations: GDM, gestational diabetes mellitus; HDP, hypertensive disorders of pregnancy; HTN: hypertension. ^a Health‐harming (or lack of health‐promoting) exposures/conditions. ^b Epigenetic effects are not displayed; they may occur through exposures at each step along the causal pathways.