Wednesday, June 13, 2007
America's health-care delivery system is riddled with racial and economic disparities—certainly old news. But here in the South, these words resound with a troubling new accuracy as the youngest members of our communities are dying.
It is tragic that those hit hardest by the inaccessibility of health care are among the most vulnerable of our population: children. The United States has one of the highest infant mortality rates in the industrialized world—a whopping 6.4 deaths out of every thousand live births. Compare this with Norway's 3.6 and Japan's 3.2.
The numbers are even starker when we consider race and geographic location. Here in Mississippi, overall infant mortality rates have risen to over 11 deaths per thousand live births, and African American newborns suffer death rates over twice as high. These rates bear a disturbing resemblance to those of third-world countries, where poverty and low levels of education for women threaten their children's survival.
How can we get to the bottom of this baffling problem? And why should we care in the first place? Clearly, there is moral incentive—hearing that newborn deaths are on the rise isn't exactly a mood-lifter, especially when it is occurring in nearby communities. Even so, it is often both easy and comforting to turn a blind eye to such a devastating dilemma. Unless we are directly affected by the death of an infant, the problem seems abstract and distant, ultimately none of our concern.
Luckily, many have taken notice of rising infant mortality rates and are beginning to analyze the problem. Cutbacks in Medicaid and low incomes are largely at fault. But many newborn deaths result from something tangible, something we can change now: personal behavior. If we can prevent infant mortality, we have an ethical obligation to do so.
First, as responsible citizens, we must ask exactly what types of personal behavior are culpable. Shifting our gaze toward the proximal causes of infant mortality in Mississippi, we find Sudden Infant Death Syndrome, premature births and congenital defects among the top, according to the Centers for Disease Control. Here is the shocker: Most of these conditions result from inadequate prenatal care—something many of us take for granted. A range of behaviors that have come to seem unthinkable, such as smoking and drinking during pregnancy, are at the root of these illnesses.
Tempted to point your fingers at the mothers-to-be? Not so fast. Assuming that poor women of the South are unmotivated and apathetic just feeds back into the attitude that got us here in the first place. The poverty of these women goes hand-in-hand with the real culprit: inadequate education.
So where to begin our search for a solution? I suggest we peer inside the clinician's office itself, where poor health literacy takes its toll on the poor and uneducated. As defined by the U.S. Department of Health and Human Services, health literacy is the ability to function in the health care environment and act on information provided by physicians. Though taking our doctors' advice may seem straightforward, social and cultural barriers between patient and physician can markedly hinder this ability.
We should all be embarrassed to learn that simply living in the South is correlated with low health literacy, according to government studies. This fact alone should urge us toward a change for the better. Because of the strong correlation between health literacy and healthy behaviors (including proper prenatal care), improving this form of education is a practical and effective target for reform.
The window of opportunity is open wide for improving health literacy among Mississippi's poor. Our chance to mend our situation lies in the growing recognition of lifestyle medicine: an emerging clinical discipline that aims to educate patients about practicing healthy behaviors. Doctors have even established an organization with the sole purpose of integrating lifestyle medicine with basic medical training. To let this opportunity slip through our fingers would be immoral and irresponsible.
Unfortunately, lifestyle medicine is costly for physicians, as Medicaid does not provide compensation for this service. Urgent policy reform is needed so that doctors will be encouraged to take the time to educate their patients.
Policy changes are one way to address the problem, but unless the public expresses outrage, politicians won't feel any pressure to make needed changes. We have the potential to be activists—all of us—even if all we do is voice our determination that Mississippi can and must do better. The more we talk about infant mortality and the health education that can prevent it, the more we commit ourselves to our basic humanity.
Do not turn away from the problem of infant mortality in Mississippi. Join together to increase awareness, because improving health literacy will not only benefit these women, but also their children—our future.
Nina Fainberg is a native of Washington, D.C. She is currently studying human biology at Stanford University.