Poverty, segregation and a lack of political empowerment are key factors leading to high U.S. infant mortality rates, according to a Johns Hopkins University sociologist.
"Tinkering with the current system and improving health insurance I don't think is going to solve the problem," said Thomas A. LaVeist, an assistant professor of health policy and management in the Hopkins School of Public Health.
"What is really driving high infant mortality rates . . . is not access to medical care but the quality of the lives that people lead," he said.
Dr. LaVeist commented yesterday in the wake of a report by a bipartisan national commission warning that the United States is falling further behind other developed nations in several key measures of child health, including infant mortality.
The U.S. infant mortality rate in 1989, the most recent year for which final figures were available, was 9.8 deaths for every 1,000 births. That was a slight reduction from the previous year, but other countries showed far greater improvement.
Black babies in the United States die at more than twice the rate of whites, the report said. The white rate was 8.2 per 1,000 births, compared with 17.7 for blacks.
Maryland's infant mortality rate in 1989 was 10.3.
The most recent figures available for cities, from 1988, showed Baltimore with an infant mortality rate of 18.
Dr. LaVeist's studies of infant mortality rates in Baltimore and 175 other U.S. cities from 1981 to 1985 concluded that segregation in housing and a lack of black political empowerment contribute significantly to higher black rates.
Poverty rates are a reliable predictor of high infant mortality for both blacks and whites, his study found.
If the nation is serious about addressing its high rates of infant mortality, Dr. LaVeist said, it must address "economic development, job creation, reductions in poverty, the quality of housing."
In studies published in 1989 and 1990 and in the current issue of the American Journal of Sociology, Dr. LaVeist looked at data on poverty, housing and political representation in U.S. cities.
"As you would expect," he said, "cities with the highest poverty rate also have the highest infant mortality rate, for blacks and whites."
Dr. LaVeist used U.S. census tract data to measure segregation.
"What I found was that the more segregated the cities are, the wider isthe infant mortality gap [between blacks and whites]."
Dr. LaVeist's research also found that cities with the highest black city council membership relative to black population had the lowest black infant mortality rates relative to whites. White rates were unaffected.
"Black communities that are able to reach their political potential in city council representation are the communities best able to organize in other areas, and that could improve the social environment and quality of life," he said.