健康差距——即使是在社会经济成功的情况下——让专家们感到困惑

Boston pediatrician Dr. April Inniss has read the studies. She has reviewed the reports. She's spoken with colleagues. She has even done her own research.

Yet the information remains shocking to her, flying in the face of her medical training and even, seemingly, 常识:“拥有大学或更高学历的黑人女性比拥有高中文凭的白人女性婴儿死亡率更高," said Inniss, who is black. "The numbers are really startling."

杜克大学(Duke University)去年发布的一份研究婴儿死亡率问题的报告显示，拥有博士或专业学位的黑人女性所生婴儿的死亡率是只有高中文凭或普通教育文凭的白人女性所生婴儿的三倍左右.

“黑人和白人在婴儿死亡率上的差异不仅存在于所有教育水平, it is greatest for those with a master's degree or higher," the report concluded. "Further, 拥有博士或专业学位的黑人妇女(婴儿死亡率)最高."

这些差异是更广泛的令人不安的健康异常现象的一部分:研究表明，即使非裔美国人获得了更高的学位或提高了收入水平, 他们的健康状况——各种疾病和小病——通常比白人更糟糕.

A report published last year in the journal Healthcare 尽管“随着收入的增加，白人和非裔美国人都获得了身体健康, 收入对(慢性疾病)的保护作用对白人比对非裔美国人更大."

Another study published last April was even more sobering. A look at employment and health trends over a 25-year period, from 1986 to 2011, 显示白人成年人通过就业获得的预期寿命比黑人同龄人更长.

The evidence of disparities is clear. But the reasons are not, said Dr. Keith Churchwell, 康涅狄格州耶鲁大学纽黑文医院心脏和血管服务高级副总裁兼执行董事.

“我不确定我们有一个明确的答案，为什么非洲裔美国人和他们的白人同龄人之间仍然存在持续的差异”, he said.

"The question would be, do you have the same access to health care? Do you have the same access to follow-up? 你正在服用的降低心血管风险的药物是否和白人一样有效?" said Churchwell, 谁去年主持了美国心脏协会关于健康公平和健康的社会决定因素的特别工作组.

新的研究表明，种族主义可能在这些差异中扮演重要角色.

"A lot of us think that chronic worry about being exposed to racism, either that you will be or a loved one will be exposed, that is a very likely contributor to high-education, 高收入黑人的健康状况比白人差," said Dr. Paula Braveman, 加州大学家庭和社区医学教授, San Francisco.

She noted that her own study investigating the role of worry and racial discrimination in preterm birth rates revealed some surprising information.

“我们在最近的研究中发现，那些经常或非常担心(因种族而受到不公平对待)的黑人女性，, they were twice as likely to have a premature baby," Braveman said. 该研究包括1万多名女性，并于2017年发表.

Inniss, founder of eekMD, a health education program for children, is not surprised by Braveman's findings. 她的父亲在57岁时死于糖尿病和高血压并发症.

"I still think the toxic milieu that we live in ... has made it tough," Inniss said. "We're fish in a toxic ocean. 我不认为在我有生之年海洋会被清理干净."

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