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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.

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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.

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Activism

Through Ads and Advocates, Battle Over Calif. Gambling Propositions Heat Up

A statewide survey by the Public Policy Institute of California (PPIC), conducted between Sept. 2 and 11 and released on Sept. 15, revealed that 54% of California voters would vote “no” for Prop 27, while 34% would vote “yes.” Twelve percent of the respondents were “unsure.” The survey’s authors wrote that a strong majority of Republicans wouldn’t vote for the proposition, compared to half of Democrats and independents.

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The dueling propositions have raised a combined $400 million for advertising leading up to Election Day this November.
The dueling propositions have raised a combined $400 million for advertising leading up to Election Day this November.

By McKenzie Jackson | California Black Media

Clint Thompson, a Santa Monica resident in his 30s, wouldn’t say he has been inundated with advertisements supporting or denigrating Propositions 26 and 27, but he sees an ad focused on one of the legislations each time he turns on his television.

“I usually watch the news during the day — NBC — and on NBC, Prop 26 or Prop 27 comes on every other commercial break per show,” said Thompson, an actor, who admitted he hasn’t researched the sports gambling propositions. “Both of the props seem to have good things with them. The commercials seem to have reasons why you should say ‘yes,’ or ‘no.’”

Prop 26 would legalize roulette, dice games, and sports betting on Native American tribal lands if approved by voters in the Nov. 8 election. It is backed by over 50 state Native American tribes.

Prop 27, supported by sportsbooks DraftKings, FanDuel, BetMGM, Fanatics, PENN Entertainment, and WynnBet, would give those sports betting companies the reins in sports gambling in the Golden State and allow online gambling.

If people like Thompson feel the advertisements from the campaigns for and against the propositions seem to be flooding the television and radio airwaves — and to be ever-present on social media (Watched a YouTube video lately?) — they might be right.

The dueling propositions have raised a combined $400 million for advertising leading up to Election Day this November. That has led to ads backing and slamming the two propositions to be front and center in all forms of media Californians consume.

Dinah Bachrach of the Racial Justice Allies of Sonoma County, a group supporting Prop 26, said the proliferation of ads supporting Prop 27 is concerning.

“They are all over the place,” Bachrach said. “Gambling is already a pretty big business, but to be able to do sports gambling online is dangerous because it hurts what tribal casinos have been able to do for their communities in the state.”

According to Bachrach, Prop 26 protects the sovereignty of native tribes. “It’s a really important racial justice issue,” she said. “Indian casinos provide a tremendous amount of financial support for the casino tribes and the non-casino tribes, and they contribute a lot locally and to the state.”

Bachrach’s organization is one of several civil rights or African American organizations that have thrown its support behind Prop 26.

Santa Clarita NAACP spokesperson Nati Braunstein said in an email, “The NAACP supports Prop 26, which would legalize retail sports betting at California tribal casinos only and opposes Prop 27 which would allow online sports betting via mobile sportsbooks.”

Kathy Fairbanks, speaking for the Yes on 26/No on 27 coalition, composed of California Indian tribes and tribal organizations, and other partners, said winning the approval of every potential voter, including Black Californians, is their goal.

Yes on 27 – Californians for Solutions to Homelessness, the campaign arm of Prop 27 backers, had not returned California Black Media’s requests for comment for this story as of press time. Prop 27 proponents say in ads and the Yes on 27 website repeats that the initiative would help solve California’s homelessness crisis.

Prop 27 imposes a 10% tax on adjusted gross gaming revenue. Eighty-five percent of the taxes go toward fighting California’s homeless and mental health challenges. Non-gaming tribes get the remaining 15% of tax revenue.

Organizations such as Bay Area Community Services, Sacramento Regional Coalition to End Homelessness, San Diego Regional Task Force on Homelessness, and individuals including Long Beach Mayor Robert Garcia, Oakland Mayor Libby Schaaf, Bay Area Community Services CEO Jamie Almanza, and Middletown Rancheria of Pomo Indians Chairman Jose “Moke” Simon are listed as Prop 27 supporters on the Yes on 27 website.

On the campaign’s Facebook page, commenter Brandon Gran wrote under an advertisement photo that voting for Prop 27 was a “no brainer.”

“People are already gambling using offshore accounts,” he typed. “Why not allow CA to get a piece of the pie … money that will (hopefully) go to good use.”

However, a statewide survey by the Public Policy Institute of California (PPIC), conducted between Sept. 2 and 11 and released on Sept. 15, revealed that 54% of California voters would vote “no” for Prop 27, while 34% would vote “yes.” Twelve percent of the respondents were “unsure.”

The survey’s authors wrote that a strong majority of Republicans wouldn’t vote for the proposition, compared to half of Democrats and independents.

“Regionally, majorities in the Inland Empire, Orange/San Diego, and the San Francisco Bay Area would vote ‘no,’ while likely voters in the Central Valley and Los Angeles are divided,” they wrote. “At least half across most demographic groups would vote ‘no.’ Likely voters age 18 to 44 (52%) and renters (51%) are the only two demographic groups with a slim majority voting ‘yes.’”

The survey, titled “PPIC Statewide Survey: Californians and Their Government,” did not ask participants about Prop 26. The Yes on 26/No on 27 coalition, said in a news release that the PPIC’s research confirmed what Prop 26 supporters have said for some time.

“Despite raising more than $160 million for a deceptive advertising campaign, California voters are clearly not buying what the out-of-state online gambling corporations behind Prop 27 are selling,” the statement read.

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Why Sarah Syed Is My Choice for AC Transit Board of Directors, Ward 3.

As the AC Transit board president, a challenge I am confronted with is that traditional transit planning practice has ignored the pervasive issues of segregation, displacement, and exclusion from opportunity. Although the impacts of redlining can be felt in almost every aspect of life: from access to high quality education, to job opportunities and even healthy food options, our region doesn’t invest in transit service to repair past harms.  

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Elsa Ortiz is the AC Transit board president and the retiring Ward 3 director, which includes Oakland, San Leandro, and Alameda.
Elsa Ortiz is the AC Transit board president and the retiring Ward 3 director, which includes Oakland, San Leandro, and Alameda.

By Elsa Ortiz, President of AC Transit Board

The challenge of inequitable transportation access is felt by tens of thousands of residents in inner East Oakland and communities of color across the Bay Area.

These challenges are compounded by the legacy of redlining, which systematically denied Black and Brown residents access to homeownership and lending programs. Ultimately, the American dream of homeownership, investment in communities and building generational wealth was blocked.

As the AC Transit board president, a challenge I am confronted with is that traditional transit planning practice has ignored the pervasive issues of segregation, displacement, and exclusion from opportunity. Although the impacts of redlining can be felt in almost every aspect of life: from access to high quality education, to job opportunities and even healthy food options, our region doesn’t invest in transit service to repair past harms.

Last week, aboard an AC Transit bus, U.S. Transportation Secretary Pete Buttigieg toured Oakland as part of his new effort to repair the damage done by large federal transportation projects, like freeways, which divided neighborhoods where people of color were the majority of the population.

Residents of underserved communities are the experts in understanding what they need. Unfortunately, the number of local political leaders who are ready to invest in transportation equity are few and far in between. Therefore, we have important ballot choices on Tuesday, Nov. 8.

Sarah Syed, a candidate for AC Transit Board Ward 3, is the leader our region needs to turbocharge equitable cities. As a mixed-race woman, Sarah understands that access to transit is a question of equity. Through her work with the Bay Area Rapid Transit, the Valley Transportation Authority, and the Los Angeles County Metropolitan Transportation Authority, as a transportation planner and engineer of 20 years, Syed worked to help underserved communities.

In Los Angeles, where 88% of riders are people of color, Sarah took on a heavily bureaucratic system and planned enhancements to the routes disadvantaged riders were already using, including improving service frequency to every 10 minutes on two lines, new bus shelters at nearly 400 locations, and improvements along six different streets to extend the sidewalk and improve street safety and accessibility to bring better bus service.

Through her work with UC-Berkeley’s Othering and Belonging Institute, Syed is helping community-based organizations and local government agencies in eight communities across the state of California so that local equity leadership can drive the agenda of transportation planning to meet the priority concerns of underserved residents

As your next AC Transit Director for Ward 3, Syed will champion policy-based interventions to close equity gaps, equitable hiring and personnel practices.

She will work to build broad, ethnically inclusive coalitions to stand up for bus transit and communicate its value in ways that inspire members of the public and potential political allies.

When we improve bus service, we make our cities better places to live and help address some of America’s deepest problems.

Please join me, State Senator Nancy Skinner, Supervisor Nate Miley, the Alameda County Democratic Party, the three Mayors in Ward 3, and three BART Directors in supporting Sarah Syed for AC Transit Ward 3.

Elsa Ortiz is the AC Transit board president and the retiring Ward 3 director, which includes Oakland, San Leandro, and Alameda.

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We Will Not Incarcerate Our Way Out of This

Housing is a human right. We can use public resources to ensure everyone has a safe place to live and effective mental health and substance use treatment. Instead, we’ve gutted our social programs to the point where they don’t function and assume this lack of functionality means there’s no solution.

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As we’ve overfunded police and underfunded housing, treatment, and other essential services, we’ve seen more policing but less safety.
Last week, California Highway Patrol (CHP) and CalTrans violently evicted the Wood Street community, the largest encampment in the Bay Area.

People Are Liberating Public Spaces to Fight the Criminalization of Poverty

By Cat Brooks

How many times have you walked by an unhoused neighbor and told yourself it’s their fault, that they made the wrong life choices?

But the truth is that our unhoused crisis is the result of decades-long policies that criminalize poverty, addiction and mental health disabilities and treat human beings like garbage to be swept away with Friday’s trash while ignoring root causes.

Every city in the U.S. responds to visible poverty with fences, fines, cops, courts, and cages. These shortsighted responses make great photo ops, and let politicians pontificate, but all only accomplish terrorizing the most vulnerable, who move into new neighborhoods and reestablish their right to exist.

No matter how many arrests or evictions, the people will continue to be, and as part of that being — reclaim public spaces.

When San Francisco Supervisor Hillary Ronen called for the erection of fences around the 24th Street Bart Plaza, the community struck back and retook the plaza. @MissionDeFence_SF posted a statement in solidarity with other current public land struggles, including: People’s Park in Berkeley, Parker Elementary in Oakland, Echo Park in Los Angeles and Mystic Garden in Daly City.

These struggles are proof positive that the power lies with the people who will rise up, resist and reclaim the people’s space.

Last week, California Highway Patrol (CHP) and CalTrans violently evicted the Wood Street community, the largest encampment in the Bay Area. CHP (the 4th most murderous law enforcement agency in California) descended on the camp for phase one of an armed eviction that will cost hundreds of thousands of dollars.

Wood Street’s estimated 200-300 residents are being offered little relocation support or resources. Only a fraction has been given shelters or RV spots. Two were arrested for non-violent civil disobedience amidst an outpouring of community support.

Most of the Wood Street folks are Black, several are elders, many extremely vulnerable, and almost all are victims of gentrification and criminalization.

I was there to bear witness as the state demolished a tiny home, towed RVs, and destroyed lives. No effort was made to move their homes and belongings. Mayor Libby Schaaf doesn’t believe the city has any obligation to do so.

In an open letter to Schaaf, Governor Gavin Newsom, and others, residents offered concrete solutions and laid out their needs. They’ve been asking for sanitation services and fire safety for years. They’ve been ignored.

In their letter, they wrote, “The Wood Street community stands strong in our determination to keep our community together. We plan to continue organizing and fighting for long-term and permanent housing solutions.”

For now, they’ll be forced to move into residential areas where NIMBYS will call cops to protect their fragile senses from the brutality of visible poverty. Wash. Rinse. Repeat.

This story is playing out across California.  Instead of meeting people’s basic needs, the state legislature does things like “CARE Courts” — to force unhoused people into court-ordered treatment that will cost millions and target Black and brown folks. The bill is Governor Newsom’s brainchild and a continuation of criminalizing the unhoused under the guise of “care” which he’s done since his days as mayor of San Francisco.

Housing is a human right. We can use public resources to ensure everyone has a safe place to live and effective mental health and substance use treatment. Instead, we’ve gutted our social programs to the point where they don’t function and assume this lack of functionality means there’s no solution.

Poverty is a political choice. Oakland’s unhoused population increased 24% since 2019 (thank you Libby), yet the Town spends 10 times as much on police as it does on housing.

As we’ve overfunded police and underfunded housing, treatment, and other essential services, we’ve seen more policing but less safety. We are less safe when we build walls to keep unhoused neighbors out of public spaces. We are less safe when we respond to mental health crises with a badge and gun.

We are less safe when the treatment plan for substance use problems is a cage.

If seeing unhoused people makes us uncomfortable, then we should invest in housing for all. If public drug use offends us, then we should invest in safe injection facilities (a proven public health intervention that Newsom just vetoed).

If watching someone experience a mental health crisis is distressing, then we should invest in community-driven approaches to support individuals in crisis.

Until we do these things, no matter how much our elected officials try to sanitize the crises we face, the people will keep knocking down fences to liberate public spaces.

Cat Brooks is co-founder of the Anti Police-Terror Project, executive director of the Justice Teams Network and host of Law & Disorder on KPFA, a new show that exposes the cracks in our system and agitates for resistance.

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