Health problems faced by people who are disadvantaged cannot be solved with medicine alone

The Center for Preterm Birth at Cincinnati Children’s has teamed with experts in the University of Cincinnati (UC) Department of Sociology to gain insight into how social factors – particularly social disparities – affect the incidence of prematurity.

UC sociologist Jennifer Malat, PhD, studies racial and economic inequality in health. She says factors that lead to a poor pregnancy outcome can occur long before a baby is conceived.

“From the sociological perspective, women’s health – all people’s health – is shaped by a lifetime of experiences – a lifetime of exposure to stress, to toxins, whether people have access to healthy food,” Malat says. “Healthcare usually focuses on behaviors and the choices people make. Sociologists look at the opportunities or obstacles people face that affect those behaviors and choices.”

In the United States, long-standing economic and social advantages give whites a distinct health edge over African Americans.

“In understanding preterm birth or any health disparities, it is important that we think about advantage as well as disadvantage,” says Malat. “There are vast social and economic differences that allow white people to better protect their health. Instead of saying, ‘People don’t have access to healthy food,’ we should ask, ‘How is it that some people do, while others don’t?’ There are much bigger questions we should be looking at.”

Behind the Higher Mortality Rates

Malat offers a concept called the “weathering hypothesis,” developed by sociologist Arline Geronimus, to help explain why infant mortality in this country is more than twice as high among African American women. 

“The idea is that in our society, the health of African American women begins to deteriorate earlier in adulthood as a consequence of a lifetime of economic and social disadvantage. And this can affect birth outcomes. Birth outcomes are affected not only by disadvantage during the nine months a woman is pregnant, but by experiences before pregnancy, too.”

Bigger Changes are Needed

Malat is quick to point out that she is a researcher and teacher, not a clinician. “My role is to provide organizations like Cincinnati Children’s with information about bigger patterns and trends that I hope will help inform their work.” 

And although she acknowledges that clinicians’ work is vitally important to making a difference, Malat says reducing prematurity and infant mortality will require changes in social policy and economics at a national level.

“The doctors’ job is to pull drowning people out of the river, and it is admirable work. But we need to ask, ‘Why do all these people need to be rescued downstream? What is happening upstream?’ It’s the upstream questions that make us uncomfortable. What are the big picture things we can do to make a difference?”