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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.

Published

5 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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Activism

Diabetes in Black California: Turning the Tide from Crisis to Control

According to the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System data, nearly 17.9% of Black adults in California have been diagnosed with diabetes — above the national Black adult average of 16.8%, and nearly five points higher than California’s overall adult rate of 12.6% across all races. California ranks 24th out of 39 states with available data for Black adult diabetes rates.

Published

2 days ago

July 5, 2026

Oakland Post

Dr. Khadijah Lang is a family physician with a clinic in Los Angeles who specializes in several family medical practices, including prenatal care. Lang believes in family medicine. She says it is important to treat all members of a family. Thursday, June 5, 2026. Photo by Solomon O. Smith/California Black Media.

By Charlene Muhammad, California Black Media

Crystal Lambert knew something was terribly wrong with her three-year-old granddaughter as she sped down the street trying to get her to the hospital.

“I thought she got a hold of some poison,” Lambert recalled.

Doctors found Lambert’s granddaughter had a blood sugar level over 800, diagnosing her with Diabetic Ketoacidosis(DKA), a state in which the body, starved of insulin, begins to shut down.

Lambert said she was born with a pancreas that was not fully functioning — it lacked the specialized cells required to produce insulin.

Her granddaughter survived and is five years old today. Now, she gives herself insulin shots, asks endless questions about her condition, and runs like the spirited child she is. But the terror of that night transformed Lambert — and ultimately inspired her to launch the We Fight Back Organization, a mobile health and food access initiative serving underserved communities across California. Lambert is the executive director.

The Crisis by the Numbers

According to the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System data, nearly 17.9% of Black adults in California have been diagnosed with diabetes — above the national Black adult average of 16.8%, and nearly five points higher than California’s overall adult rate of 12.6% across all races. California ranks 24th out of 39 states with available data for Black adult diabetes rates.

Nationally, according to the U.S. Department of Health and Human Services, Black Americans were 24% more likely than the overall U.S. population to have diabetes in 2024. They also died from diabetes 78% more often than the general population in 2022. Black Americans are also more than twice as likely as the overall population to develop kidney failure caused by diabetes.

According to the California Health Care Foundation’s 2024 Health Disparities Almanac, Black Californians have the shortest life expectancy in the state at just 74.6 years — due in part to chronic conditions like diabetes and its devastating complications.

Leon Rock, co-founder of the African American Diabetes Association, believes statistics, though revealing, only tell part of the story.

“There are a whole bunch of Black folks that don’t tell you that they have diabetes — or don’t know,” he said.

And the disease itself, Rock is careful to note, is not what kills. “They die from the complications. That’s heart attack, that’s stroke, that’s amputations of legs, of feet. Going blind. All those complications are inherent in a system that has impacted Black folks with diabetes in California and across America.”

Crystal Lambert, creator and executive director of We Fight Back. She started the organization out of a need to learn more about diabetes on behalf of her granddaughter. Now she is looking to spread the impact of her organization to the valley. Friday, June 6, 2026. Photo by Solomon O. Smith/California Black Media.

Crystal Lambert, creator and executive director of the We Fight Back Organization, started out of a need to learn more about diabetes on behalf of her granddaughter. Now she is looking to spread her organization to the valley, on Friday, June 6, 2026 Photo by Solomon O. Smith/ California Black Media

An Information Gap Fuels the Crisis

For Rock, part of the solution is diagnosis. He says the medical and public health systems are failing Black Californians by the absence of information designed for them.

“That is the bottom line. We need good information. Information that is culturally specific,” said Rock.

Telling people to eat healthy or exercise, he added, falls short when culturally specific alternatives are not provided, and when many residents of urban communities do not feel safe exercising in some neighborhoods – or outside at night.

Dr. Khadijah Lang, a family medicine physician and president of the Golden State Medical Association, agrees that the roots of the crisis run deeper than individual behavior — and blaming patients misses the point.

“We are not genetically predisposed to diabetes,” Lang said. “But the system under which we live increases the likelihood that we will develop it.”

What the Body Needs — What Communities Are Denied

Type 2 diabetes, which accounts for 90 to 95% of all diabetes cases, according to the CDC, develops when the body can no longer use insulin effectively to regulate blood sugar. Left unmanaged, it damages nerves, kidneys, eyes, and the cardiovascular system. The hemoglobin A1C test is a blood draw that reveals how the body has processed sugar over the previous three months — not just at the moment of the test. It is the standard tool for both diagnosis and ongoing monitoring.

That distinction matters, Lang emphasized, because patients cannot manipulate three months of blood sugar history the way they might fast for a day before a single blood draw.

“The pill is not meant to undo or control a sugar level that’s being constantly stressed,” Lang said. “It’s meant to work in conjunction with a low-carbohydrate diet and exercise.” She recommended at minimum 30 minutes of physical activity five days a week — breakable into 10-minute sessions for those who need it.

Lang stressed that education must be delivered in language people recognize and can relate to. The goal is to inform them of the choices that serve their health best, she said.

But for many Black Californians, even those informed choices remain out of reach, Lambert said.

“They need access to healthy foods and medication, too” she said.

California has made some critical policy advances. The state has expanded access to the Continuous Glucose Monitor (CGM), which has transformed diabetes care for state residents. Assembly Bill 365, introduced in 2024, proposed requiring Medi-Cal to cover the costs of CGM and other related medical equipment but it failed in the State Senate. Since then, the California Department of Health Care Services (DHCS) reports that the core Medi-Cal CGM benefit now available to eligible patients was solidified through previous budget actions and pharmacy policy updates.

These measures, while meaningful, have not closed the gap for the communities most at risk, according to advocates.

Control Through Community

Health care advocates conclude that the solution must be communal, culturally grounded, and sustained — not a fad, not a celebrity moment, not a single clinic visit. For example, observed Lang, lifestyle shaped by shared values and collective accountability can move the needle where individual prescriptions have not.

Rock is building infrastructure to match the urgency, establishing local chapters of the African American Diabetes Association across the country, with California next.

“We have to do for self, period,” he said. “Health is wealth. We have to eat to live.”

And Lambert, whose granddaughter unknowingly started all of this for her, keeps showing up.

“Diabetes advocacy is about dignity, education, prevention, and hope,” she said.

Video: Diabetes Disparity Exposed in California

This article is supported by the California Health Care Foundation

(CHCF). Visit www.chcf.org

Oakland Post

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Activism

Oakland Post: Week of July 1 – 7, 2026

The printed Weekly Edition of the Oakland Post: Week of July 1 – 7, 2026

Published

2 days ago

July 5, 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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Arts and Culture

Prescott Circus Theatre Presents Free Summer Performance Series

Now in its 41st year, the Prescott Circus Theatre is a nationally recognized performing arts education program for Oakland youth. The circus offers safe environments that challenge Oakland youth, through circus arts training, to develop the skills and confidence to thrive on stage, in school, and in life.

Published

2 weeks ago

June 26, 2026

Oakland Post

Prescott Circus showcase pathways pyramid. Photo courtesy of Prescott Circus.

By Post Staff

The Prescott Circus, Oakland’s longest-running youth circus, is returning this summer with its free shows. Join the Prescott Circus’s young stars as they share their joys and talents through stilt-dancing, tumbling, juggling, and more.

At the heart of this one-hour show, which demonstrates teamwork, pride, and joy, are Oakland Unified School District students ages 8 – 17 from more than 10 different schools

This is accomplished through no-cost school and community programs for more than 300 Oakland youth each year. Performing company members from Prescott, where the program began, perform and make appearances at as many as 40 Bay Area events each year.

The summer program is funded in part by Oakland Fund for Children and Youth, California Arts Council, Port of Oakland, and the West Davis & Bergard Foundation.

Performances will be held Tuesday, July 14, 11 a.m. and 1:30 p.m. (ASL interpreted) and Wednesday, July 15, 11 a.m., at the Malonga Casquelourd Center for the Arts, 1428 Alice St., Oakland. For free reservations go to

https://PrescottCircusSummerShows.eventbrite.com

For group reservations for camps, childcare centers, senior centers, go to www.prescottcircus.org

A community show will be held Saturday, July 18, 2 p.m. to 3 p.m., at DeFremery Park,1651 Adeline St., Oakland.