Bay Area

Study: Racism Plays Role in Premature Birth Among Black Americans

That statistic bears alarming and costly health consequences, as infants born prematurely are at higher risk for breathing, heart and brain abnormalities, among other complications.

Published

4 years ago

October 5, 2021

Christy Price

September 15, 2020 Redwood City / CA / USA - Kaiser Permanente Hospital in San Francisco Bay Area; Kaiser Permanente is an American integrated managed care consortium, based in Oakland/ iStock

The tipping point for Dr. Paula Braveman came when a longtime patient of hers at a community clinic in San Francisco’s Mission District slipped past the front desk and knocked on her office door to say goodbye. He wouldn’t be coming to the clinic anymore, he told her, because he could no longer afford it.

It was a decisive moment for Braveman, who decided she wanted not only to heal ailing patients but also to advocate for policies that would help them be healthier when they arrived at her clinic. In the nearly four decades since, Braveman has dedicated herself to studying the “social determinants of health” — how the spaces where we live, work, play and learn, and the relationships we have in those places, influence how healthy we are.

As director of the Center on Social Disparities in Health at the University of California-San Francisco, Braveman has studied the link between neighborhood wealth and children’s health, and how access to insurance influences prenatal care.

A longtime advocate of translating research into policy, she has collaborated on major health initiatives with the health department in San Francisco, the federal Centers for Disease Control and Prevention and the World Health Organization.

Braveman has a particular interest in maternal and infant health. Her latest research reviews what’s known about the persistent gap in pre-term birth rates between Black and white women in the United States. Black women are about 1.6 times as likely as whites to give birth more than three weeks before the due date.

That statistic bears alarming and costly health consequences, as infants born prematurely are at higher risk for breathing, heart and brain abnormalities, among other complications.

Braveman co-authored the review with a group of experts convened by the March of Dimes that included geneticists, clinicians, epidemiologists, biomedical experts and neurologists. They examined more than two dozen suspected causes of preterm births — including quality of prenatal care, environmental toxics, chronic stress, poverty and obesity — and determined that racism, directly or indirectly, best explained the racial disparities in preterm birth rates.

In the review, the authors make extensive use of the terms “upstream” and “downstream” to describe what determines people’s health. A downstream risk is the condition or factor most directly responsible for a health outcome, while an upstream factor is what causes or fuels the downstream risk — and often what needs to change to prevent someone from becoming sick.

For example, a person living near drinking water polluted with toxic chemicals might get sick from drinking the water. The downstream fix would be telling individuals to use filters. The upstream solution would be to stop the dumping of toxic chemicals.

Kaiser Health News spoke with Braveman about the study and its findings. The conversation has been edited for length and style.

Q: You have been studying the issue of preterm birth and racial disparities for so long. Were there any findings from this review that surprised you?

The process of systematically going through all of the risk factors that are written about in the literature and then seeing how the story of racism was an upstream determinant for virtually all of them. That was kind of astounding.

The other thing that was very impressive: When we looked at the idea that genetic factors could be the cause of the Black-white disparity in preterm birth. The genetics experts in the group, and there were three or four of them, concluded from the evidence that genetic factors might influence the disparity in pre-term birth, but at most the effect would be very small, very small indeed. This could not account for the greater rate of pre-term birth among Black women compared to white women.

Q: You were looking to identify not just what causes pre-term birth, but also to explain racial differences in rates of pre-term birth. Are there examples of factors that can influence pre-term birth that don’t explain racial disparities?

It does look like there are genetic components to preterm birth, but they don’t explain the Black-white disparity in pre-term birth. Another example is having an early elective C-section. That’s one of the problems contributing to avoidable pre-term birth, but it doesn’t look like that’s really contributing to the Black-white disparity in pre-term birth.

Q: You and your colleagues listed exactly one upstream cause of pre-term birth: racism. How would you characterize the certainty that racism is a decisive upstream cause of higher rates of preterm birth among Black women?

It makes me think of this saying: A randomized, clinical trial wouldn’t be necessary to give certainty about the importance of having a parachute on if you jump from a plane. To me, at this point, it is close to that.

Going through that paper — and we worked on that paper over a three- or four-year period, and so there was a lot of time to think about it — I don’t see how the evidence that we have could be explained otherwise.

Q: What did you learn about how a mother’s broader lifetime experience of racism might affect birth outcomes versus what she experienced within the medical establishment during pregnancy?

There were many ways that experiencing racial discrimination would affect a woman’s pregnancy, but one major way would be through pathways and biological mechanisms involved in stress, and stress physiology. In neuroscience, what’s been clear is that a chronic stressor seems to be more damaging to health than an acute stressor.

So, it doesn’t make much sense to be looking only during pregnancy. But that’s where most of that research has been done: stress during pregnancy and racial discrimination, and its role in birth outcomes. Very few studies have looked at experiences of racial discrimination across the life course.

My colleagues and I have published a paper where we asked African American women about their experiences of racism, and we didn’t even define what we meant. Women did not talk a lot about the experiences of racism during pregnancy from their medical providers; they talked about the lifetime experience, and particularly experiences going back to childhood. And they talked about having to worry, and constant vigilance, so that even if they’re not experiencing an incident, their antennae have to be out to be prepared in case an incident does occur.

Putting all of it together with what we know about stress physiology, I would put my money on the lifetime experiences being so much more important than experiences during pregnancy. There isn’t enough known about pre-term birth, but from what is known, inflammation is involved, immune dysfunction, and that’s what stress leads to. The neuroscientists have shown us that chronic stress produces inflammation and immune system dysfunction.

Q: What policies do you think are most important at this stage for reducing pre-term birth for Black women?

I wish I could just say one policy or two policies, but I think it does get back to the need to dismantle racism in our society. In all of its manifestations. That’s unfortunate, not to be able to say, “Oh, here, I have this magic bullet. And if you just go with that, that will solve the problem.”

If you take the conclusions of this study seriously, you say, well, policies to just go after these downstream factors are not going to work. It’s up to the upstream investment in trying to achieve a more equitable and less racist society. Ultimately, I think that’s the take-home, and it’s a tall, tall order.

This article is provided to California Black Media partners by KHN (Kaiser Health News).

KHN is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Christy Price

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Bay Area

CITY OF SAN LEANDRO STATE OF CALIFORNIA PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION NOTICE TO BIDDERS FOR ANNUAL STREET OVERLAY/REHABILITATION 2019-21 – PHASE III

WORK DESCRIPTION: The work to be done consists of roadway paving, base cement stabilization, concrete curb ramps, driveways, sidewalks, curbs and gutters, traffic detection loops and pavement striping, and doing all appurtenant work in place and ready for use, all as shown on the plans and described in the specifications with the title indicated in Paragraph 1 above, and on file in the office of the City Engineer. Reference to said plans and specifications is hereby made for further particulars.

Published

16 hours ago

February 20, 2026

Oakland Post

PROJECT NO. 2020.0050

BID NO. 25-26.011

BID OPENING: The bidder shall complete the “Proposal to the City of San Leandro” form contained in the Contract Book. The proposal shall be submitted in its entirety. Incomplete proposals will be considered non-responsive. Sealed bids containing the completed Proposal Section subject to the conditions named herein and in the specifications for ANNUAL STREET OVERLAY/REHABILITATION 2019-21 – PHASE III/PROJECT NO. 2020.0050 addressed to the City of San Leandro will be received at City Hall, 835 East 14^th Street, 2^nd Floor San Leandro at the office of the City Clerk up to 3:00 p.m. on Thursday, March 19, 2026, at which time they will be publicly opened and read.
WORK DESCRIPTION: The work to be done consists of roadway paving, base cement stabilization, concrete curb ramps, driveways, sidewalks, curbs and gutters, traffic detection loops and pavement striping, and doing all appurtenant work in place and ready for use, all as shown on the plans and described in the specifications with the title indicated in Paragraph 1 above, and on file in the office of the City Engineer. Reference to said plans and specifications is hereby made for further particulars.
OBTAINING THE PROJECT PLANS AND CONTRACT BOOK: The project plans and Contract Book may be obtained free of charge from the City’s website at:https://www.sanleandro.org/Bids.aspx Bidders who download the plans are encouraged to contact the City of San Leandro Public Works Department Engineering division at 510-577-3428 to be placed on the project planholder’s list to receive courtesy notifications of addenda and other project information. Project addenda, if any, will be posted on the website. A bidder who fails to address all project addenda in its proposal may be deemed non-responsive.Bidders may also purchase the Project Plans and Contract Book from East Bay Blueprint & Supply Co., at 1745 14^th Street, Oakland, CA 94606; Phone Number: (510) 261-2990 or email: ebbp@eastbayblueprint.com.
PRE-BID CONFERENCE: A mandatory pre-bid conference will be held on Tuesday, February 24, 2026, at 2:00 PM and on Wednesday, February 25, 2026, at 10:00 AM as follows:
Tuesday, February 24, 2026, at 2:00 PM
Zoom Meeting ID: 883 8752 6074
Passcode: 502955
Zoom Link: https://sanleandro-org.zoom.us/j/88387526074?pwd=hZ5rjB8AWdLAUem3CtByFiZxqKarHj.1
And
Wednesday, February 25, 2026, at 10:00 AM
Zoom Meeting ID: 898 2672 0472
Passcode: 091848
Zoom Link: https://sanleandro-org.zoom.us/j/89826720472?pwd=JgZX2nXMpLSRM5xDPr7EJUxl7QIznr.1The information presented at the conferences will be identical, all bidders must attend one of the pre-bid conference and sign the attendance sheet. A firm that didn’t attend the pre-bid conference isn’t qualified to bid on the project.Questions regarding the plans and specifications may be submitted in writing to the project engineer until 5:00 p.m. five (5) days before, excluding Saturdays, Sundays and Holidays, bids must be received by the City. The City will not respond to oral questions outside of the pre-bid conference. The response, if any, will be by written addendum only. Oral responses do not constitute a revision to these plans or specifications.
VALUE OF WORK: The Engineer has estimated that the value of work is between $1,000,000 and $5,000,000.
SAN LEANDRO BUSINESS PREFERENCE AND PARTICIPATION GOALS: The work performed under this contract is subject to Section 1-6-225 of the San Leandro Municipal Code regarding local business preference and participation. A list of companies that hold a San Leandro business license is located on the City webpage under the finance department, here: https://www.sanleandro.org/340/Business-License
SAN LEANDRO COMMUNITY WORKFORCE AGREEMENT: The work performed under this contract is subject to the Community Workforce Agreement adopted by City Council Resolution 2015-104. Contractors attention is directed to Section 10.

Dated: February 13, 2026 Sarah Bunting, City Clerk

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Oakland Post: Week of February 11 = 17, 2026

The printed Weekly Edition of the Oakland Post: Week of – February 11 – 17, 2026

Published

5 days ago

February 16, 2026

Oakland Post

To enlarge your view of this issue, use the slider, magnifying glass icon or full page icon in the lower right corner of the browser window.

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Rising Optimism Among Small And Middle Market Business Leaders Suggests Growth for California

“Business leaders across the Pacific region continue to demonstrate a unique blend of resilience and forward-thinking, even in the face of ongoing economic uncertainty,” said Brennon Crist, Managing Director and Head of the Pacific Segment, Commercial Banking, J.P. Morgan. “Their commitment to innovation and growth is evident in the way they adapt to challenges and seize new opportunities. It’s this spirit that keeps our region at the forefront of business leadership and progress. We look forward to helping our clients navigate all that’s ahead in 2026.”

Published

7 days ago

February 14, 2026

Oakland Post

Super Scout / E+ with Getty Images.

Sponsored by JPMorganChase

Business optimism is returning for small and midsize business leaders at the start of 2026, fueling confidence and growth plans.

The 2026 Business Leaders Outlook survey, released in January by JPMorganChase reveals a turnaround from last June, when economic headwinds and uncertainty about shifting policies and tariffs caused some leaders to put their business plans on hold.

Midsize companies, who often find themselves more exposed to geopolitical shifts and policy changes, experienced a significant dip in business and economic confidence in June of 2025. As they have become more comfortable with the complexities of today’s environment, we are seeing optimism rebounding in the middle market nationwide – an encouraging sign for growth, hiring, and innovation. Small businesses, meanwhile, maintained steady optimism throughout 2025, but they aren’t shielded from domestic concerns. Many cited inflation and wage pressures as the top challenges for 2026 and are taking steps to ensure their businesses are prepared for what’s ahead.

Overall, both small and midsize business leaders are feeling more confident to pursue growth opportunities, embrace emerging technologies and, in some cases, forge new strategic partnerships. That bodes well for entrepreneurs in California. Here are a few other key findings from the Business Leaders Outlook about trends expected to drive activity this year:

Inflation remains the top concern for small business owners. Following the 2024 U.S. presidential election, many anticipated a favorable business environment. By June 2025, however, that feeling shifted amid concerns about political dynamics, tariffs, evolving regulations and global economic headwinds.
Going into 2026, 37% of respondents cited inflation as their top concern. Rising taxes came in second at 27% and the impact of tariffs was third at 22%. Other concerns included managing cash flow, hiring and labor costs.

For middle market leaders, uncertainty remains an issue. Almost half (49%) of all midsize business leaders surveyed cited “economic uncertainty” as their top concern – even with an improved outlook from a few months ago. Revenue and sales growth was second at 33%, while tariffs and labor both were third at 31%.
And tariffs are impacting businesses costs. Sixty-one percent of midsize business leaders said tariffs have had a negative impact on the cost of doing business.
Despite challenges, leaders are bullish on their own enterprises. Though the overall outlook is mixed, 74% of small business owners and 71% of middle market companies are optimistic about their company’s prospects for 2026.
Adaption is the theme. For small business owners surveyed across the U.S., responding to continuing pressures is important in 2026. Building cash reserves (47%), renegotiating supplier terms (36%) and ramping up investments in marketing and technology are among the top priorities.
Big plans are on the horizon. A majority midsized company leaders expect revenue growth this year, and nearly three out of five of (58%) plan to introduce new products or services in the coming year, while 53% look to expand into new domestic and/or international markets. Forty-nine percentsay they’re pursuing strategic partnerships or investments.

The bottom line

Rebounding optimism among U.S. business leaders at the start of the year is setting the stage for an active 2026. With business leaders looking to implement ambitious growth plans that position themselves for the future, momentum in California could be beneficial for leaders looking to launch, grow or scale their business this year.