2y ago

Ethnicity affects pregnancy healthcare, research suggests

www.bbc.com

Parents whose baby died before or shortly after birth believed their ethnicity led to worse care.

18 comments

Any black person could have told you this.
- Well, yeah. The problem is folks don’t listen to us. They might listen to data.
  
  Doubtful. They always know better than those stupid scientists.
  
  Most of the healthcare establishment is very aware of this already. Unfortunately, it does not penetrate the skulls of certain docs.
  
  Nah, people will just twist the data like they always have. Like accusing black people of higher rates of crime and using arrest and conviction data when that are the outcome of a racist system.
  
  They might listen to data.
  lol
- It's criminal that so much of the medical profession has this ridiculous idea in their heads that black people are more impervious to pain than white people.
- I am by training a theoretical scientist, but I spent a good chunk of my career working on problems in public health and healthcare.
  Yes, every black person knows this, as do most health professionals, both in public health and medicine - the latter a lot less so, in my opinion and experience.
  Here’s why this study matters:
  This is the British NHS, not US medicine (I know from other studies that we do much worse). Because the NHS is a cohesive healthcare system (despite what they’ve been voting to do lately over there), they have the duty and the ability as an organization to address it. The article mentions programs they’re undertaking and spending hundreds of millions of pounds on. Hopefully this is going to include things like mandatory training and following the data throughout the year with consequences for facilities that do not bring those numbers in line.
  If I was still in active research, I would for sure make use of this report in my own work. One of my major interests is how neurodevelopment and neuroanatomy affect and determine behavior. Those things are directly affected by things like prenatal and postnatal care, physical and emotional stress of the mother, nutrition, and so on. These things in turn affect everything in childhood and adulthood from likelihood to commit violent crimes to likelihood to complete higher education. These problems don’t begin and end at the hospital door, and by using this as one of several pieces of demonstrable and quantitative evidence, we can build off of it to further show the impact and importance of medical disparity. A significant part of my post history is me going into depth on this kind of issue and the implications for things like “criminal justice.”
  The same goes for what would be a followup paper on the neurological and then sociological impacts of systemic racism. Unfortunately, those papers are less likely to be used directly to affect policy but can themselves provide the basis for other studies.
  We have so fucking far to go it’s daunting, but we wouldn’t have gotten to where we are if we do not keep pushing.
- And Indigenous people. :/
Ethnicity affects all healthcare.
As a white person who had been taken very seriously in an ER about a panic attack (with a history of anxiety no one asked about) I've first hand seen the effects of race in hospitals. I recognize my privilege which shouldn't exist, and the life threatening situations that occur from nurses and doctors who simply don't care enough about their patients terrifies me. If they can simply turn off their care for some, they shouldn't be practicing medicine.
While there very likely are a host of social factors going into racial differences in outcomes, that this relates to stillbirth outcomes means there's another factor that needs to be considered in the mix too.
There was a pretty neat study this year looking at how national Vitamin D fortification programs in the food supply of Finland and Sweden and how those programs correlated with stillbirth before and after: Is there a relation between stillbirth and low levels of vitamin D in the population? A bi-national follow-up study of vitamin D fortification (2023).
Key point:
Our observational data of > 4 million pregnancies show that in two Northern countries with widespread low plasma vitamin D levels (< 50 nmol/l), each increment of national vitamin D food fortification was associated with an approximately 15% reduction in stillbirths.
This is relevant to the above study given the findings in Distribution of vitamin D status in the UK: a cross-sectional analysis of UK Biobank (2021):
Asian (n=4297/8000, 53.7%) and black (n=2459/7046, 34.9%) participants had a higher proportion of vitamin D deficiency than white participants (n=50 920/422 907, 12%).
It's worth noting that the picture is a bit more complicated, as there's studies that indicate that specifically for bone health and cardiovascular health that low Vitamin D serum levels don't necessarily mean deficiency for all populations, so a uniform watermark for deficiency for all people may not be the best approach.
But it's certainly possible that things like viral clearance rates or neonatal health are more dependent on Vitamin D than has been studied up until the past few years and that some of the racial differences between those outcomes (i.e. COVID response or stillbirths) is actually related to the levels of a vitamin that's fairly trivially supplemented.
It's a bit frustrating, as while it's understandable why scientists tend to avoid research focused on racial differences with a 10' pole, the key biological difference between white people and black or Indian people is going to be skin melanin and thus Vitamin D absorption. And in a society that's increasingly indoors and sun avoidant, that may be having serious health consequences on everyone but disproportionately negatively impacting minority communities.
We kind of need to grow the fuck up and be able to maintain both a commitment to decreasing differences in social treatment in medicine while simultaneously being willing to seriously look at biological differences to (a) identify ideal Vitamin D levels for different people with different biological factors and different circumstances (i.e. maternity health may need a different level than other periods of time), and (b) further look at how these differences may be responsible in part for racial disparities in standards of care.
If we only assume social differences and are unwilling to seriously look at other factors, it will lead to years of aimlessly pursuing measures to change outcomes that will continually fail while leaving people vulnerable to factors that can be fixed with something incredibly easy and cheap to improve.
So while the OP study difference in stillbirth outcomes is likely due to multiple factors, a 4x higher rate of potential deficiency in the UK for something linked to double digit decreases in stillbirth rates at each supplementation interval during national supplementation campaigns elsewhere seems like it shouldn't be ignored in thinking about possible ways to help improve outcomes here.
Study took place in the UK, which I found interesting. My own bias would've assumed the NHS would've lessened impacts like these, by nature of its own beuraucracy.
As a white person in a mostly white country, i would like to move to one of those countries you say I'd be getting preferential treatment according to my skin and not my wallet.
I can assure you, the only ism that fuels lack of medical care is assholeism.
Patients suck. Some doctors suck. Some nurses suck. And it's the good ones that have to deal with the blame. And they'd rather not.
If you feel discriminated against, it's because the other side needed an excuse to be an asshole.

18 comments