The USA has infant mortality rates 76 percent higher than other wealthy countries. A large part of the reason is that newborn Black children die at 2-3 times the rate of their white counterparts. To address this inequity requires understanding whether it reflects differences in healthcare in the hospital where the children are born or the influence of external forces. To test this, researchers investigated whether having a black doctor changes a baby's chances of living long enough to go home, and found it definitely does.
Dr Brad Greenwood of George Mason University collected data on 1.8 million births in Florida hospitals between 1992 and 2015. Greenwood used records of the race of the child. He assessed the likely race of their doctors using photographs, excluding those more difficult to categorize from his sample.
In Proceedings of the National Academy of Sciences, Greenwood reports that the overall death rate for white babies in the sample was 289 per 100,000 births, whereas it was 784 for Black children. With 460,000 Black babies born in Florida during the period, this means more than 2,000 deaths that would not have occurred if the Black mortality rate was the same as for whites.
However, when the primary physician was Black, the difference in death rates between Black and white children was 39-58 percent lower, depending on whether possible confounding factors were controlled for. For Black children, the race of their physician makes almost as much difference to their survival chances as whether their mother has health insurance. The results are similar whether or not the doctor was a certified pediatrician.
Some may leap to the conclusion this means everyone is best off having a doctor of their own race, but Greenwood found this is not true – white babies had the same risk of dying whether their doctor was Black or white.
The fact that even with a Black doctor a Black child has a higher risk of dying than a white one suggests the problem is not entirely hospital related. The list of possible contributing factors in the wider world is a long one. Pollution is a known risk factor for premature birth, for example, which in turn raises the chances of a child dying. Predominantly Black neighborhoods in America are much more likely to be located downwind of polluters or lack clean water.
Nevertheless, the size of the doctor's contribution is shocking. It's possible many white doctors lack knowledge about risk factors and symptoms for Black children, which their Black counterparts can recognize. Other explanations are so unpleasant to contemplate the paper doesn't mention them. Yet the possibility has to be considered that, for a subsection of white doctors, the lives of their Black patients just don't matter as much, even in the hours after birth.