Focus should shift from blaming victim to racism's 'lived disadvantage.'
Researchers from Chicago’s Center for Community Health Equity who compared the rates of low birth weight infants in Chicago and Toronto neighborhoods suggest the findings are further proof that racism – not race – is a fundamental driver of unequal health outcomes.

Comparing publicly available community health data revealed that the incidence of children born in Chicago weighing fewer than 2,500 grams is strongly associated with residing in a segregated neighborhood. But in Toronto – a city about the same size as Chicago – rates of low birth weight babies did not vary significantly across communities, segregated or not. Many public health experts consider the percentage of babies born weighing fewer than 2,500 grams is a fundamental measure of community health.

While many previous studies have documented the link between poverty and low birth weight, the research has typically been conducted within a single city. But by analyzing birth weight inequities by neighborhood racial segregation and then comparing those outcomes across cities, public health experts can better uncover the reasons behind these disparate health outcomes.

“Are infant low birth weights the result of social position gradients? Or are they the result of unequal distribution of resources caused by the social position gradients? While both may play a contributing role, this study suggests that it is the latter.” says Raj C. Shah, MD, co–director of the Center for Community Health Equity, a collaboration of DePaul University and Rush University Medical Center. The reason for disparities in low birth weight is too often ascribed to race and not racism, suggest the authors of Racial/ethnic minority segregation and low birth weight: a comparative study of Chicago and Toronto community–level indicators. The study cites the tendency in previous research to categorize race as the essential risk factor for LBW delivery. “From this perspective, ‘black race’ becomes a biological or genetic risk factor alongside cigarette smoking and drug abuse,” says Dr. David Ansell, senior vice president of Community Health Equity at Rush University Medical Center and a co–author.

But by analyzing how low birth weight varies in neighborhoods as a function of concentration of minority residents, researchers can more effectively tease out the health impact of the social gradient created by race from how people make choices regarding distribution of resources based on the social gradient. Both cities have a social gradient based on the concentration of minority residents in a neighborhood (although the distribution is more muted in Toronto than Chicago). However, this gradient is associated with low birth weight outcomes in Chicago but not in Toronto.

“From these studies, we can infer that it is not race that determines birth outcomes, but rather the lived experience of minority status in a discriminatory society and the legacy of concentrated disadvantage that result in unequal birth outcomes,” lead author Fernando De Maio, PhD, writes. De Maio is an associate professor in the Department of Sociology at DePaul University and co–director of the Center for Community Health Equity.

De Maio emphasizes that the study does not attempt to reveal the causes of low birth weight in either city, but hopes the uncommon approach of comparing neighborhoods from two cities will accelerate the shift in focus among public health policy makers from blaming the victim towards a better understanding of how structural determinants of health drive inequities.