Infant mortality in the United States is very high in comparison to other industrialized countries. In the U.S., infant mortality for blacks is twice as high as for white infants. The article explores possible reasons for this phenomenon. Trends in infant mortality rates from 1950 to 1987 are presented and compared with rates in other industrialized countries.

From 1950 to 1987, US infant mortality rate declined in international standing from the 6th lowest to 22nd lowest rank. During the same time period, the ratio of black to white infant mortality increased from 1.61 to 2.08, which represents an increase of 29%. Black infants are born smaller and have higher rates of death compared with white infants.

Two possible explanations are either that genetic and biological differences exist between the races or that social and environmental differences between the races are responsible for the differential in mortality rates. Mortality rates for blacks, adjusted for age and sex, are higher in every major disease category, including non-biological events such as accidents. In contrast, the mortality rate for congenital abnormalities is the only category in which the rates are similar for all races. However, if genetic variability existed between the races, one would definitely expect to observe a difference in this category. This observation discredits the genetic and biological hypothesis.

Concerning the socio-environmental hypothesis, if economic and environmental factors contributed toward the racial disparity, then a narrowing of the black-white infant mortality gap should be observed among black and white groups that are comparable with regard to measurable socioeconomic status. But, paradoxically, the gap has been shown to widen as maternal risk conditions improve; that is, a larger gap exists between black and white mothers of higher socioeconomic status than between overall black and white rates, which do not adjust for socioeconomic status. Although “discriminations and black disadvantage are so pervasive and multilayered in American society,” why should improvement in risk factors lead to an increasing gap?

A third alternative to the risk factor and genetic explanations sheds light on the above paradox. Individual socioeconomic status adjustments may not be sufficient to control for social and ecological factors that differentiate between the races since discrimination is all-pervasive in our American society. While race may be defined a biological concept, race is more aptly viewed as a social, historical, and political entity. Although, stressful life events are more frequent among lower social classes, psychophysiologic stress may help explain the well-off black women paradox. Affluent and well-educated black women may experience racial discriminatory related stress than their white peers. A saturation level of stress may explain the reduced disparity among poor black and white women.

A new orientation that shifts the focus of research from race to racism is required to fully comprehend the phenomenon of racism and its affect on various health outcomes. The shift rejects the biological theory for racial disparities. Previous lack of recognition of racism has limited meaningful research. Areas for future research to address the racial disparity should include psychophysiologic reactions to racism, stress coping mechanisms among the ethnic groups, social support systems and the effects of social conditions on the integrity of the black or minority family. Also, environmental factors with established racial biases should be explored since regardless of income level, ethnic minorities are more likely to reside in areas exposed to environmental toxins and pollutants.

The authors state that over the 37 years studied, the United States fell in relative infant mortality standing while the racial disparity in infant mortality increased. Nevertheless, the U.S. infant mortality rate was not significantly pulled down by the U.S. nonwhite infant mortality rate. However, as the infant mortality racial disparity widened, the U.S. white and overall U.S. infant mortality rates further deteriorated. The authors then conclude that improvements in U.S. white and overall U.S. infant mortality can not be expected until the racial disparity is eliminated. However, the authors appear to link racial disparity in infant mortality with U.S. relative standing in infant mortality rates, without fully examining the U.S. nonwhite to white ratio over the 37 years. While the U.S. nonwhite to white infant mortality increased 20% during this time, the U.S. white infant to world lowest infant mortality ratio increased by over 50%. Thus, other variables, possibly changes in socioeconomic status and access to health care should be examined. While improvements in the overall U.S. infant mortality may occur with narrowing of the racial gap, it may be an indirect effect. Nevertheless, acknowledgement of race as “social, historical, and cultural group whose position in the even social order” must be considered in order to understand and eliminate the differences in disease patterns in racial groups.