Heather H. Burris, MD, MPH and Eric Gibson, MD
To what extent could racial disparities in birth outcomes be explained by disproportionate exposure to adverse physical environments? Dr. Burris explains how intersecting social and environmental factors can account for population level health differences.
Adverse birth outcomes such as preterm birth and infant mortality continue to disproportionately affect black and poor individuals in the United States. Improvements in healthcare quality and access have not succeeded in eliminating these disparities. While some individual choices may increase these risks, exposures that are not modifiable on an individual level persist. Dr. Burris proposes that environmental exposures such as neighborhood depravation, violent crime, and air pollution, when combined with stress, can culminate in significant racial disparities in birth outcomes. This notion of “structural racism” and inequity suggests that the primary prevention of adverse birth outcomes and elimination of disparities will require a societal approach to improve education quality, income equity, and neighborhoods.