Your ZIP code is more important to your health than your genetic code

September 22, 2017

Baby Zoie died before she was born. Baby Bauer was stillborn too, 45 years ago. Isaac died during his first year. He would have been 14 by now.

Adin. “Baby Boy.” Violet. John. James. “Baby Girl.” Lady’s Daughter. Lady’s Son. Lady’s Son.

Family and friends wrote out each name and added them to a colorful paper tree hanging in the Northeast Health Center.

Therese Lugano, a community health worker at Mid County Health Center, added the name of another baby, who survived for just three days. “Her mother still cries,” she said. “She doesn’t understand why the baby didn’t survive.”

Community members and health care professionals gathered Wednesday at the Healthy Birth Initiatives monthly Community Action Network meeting to recognize National Infant Mortality Month and focus on the disproportionate mortality rate of infants of color. In Multnomah County, a 2014 report showed, Black infants were 2.6 times more likely than White infants to die before they reach their first birthday; that’s higher than the national rate of 2.2.

Too often society blames the mother, when research shows the real culprit is society itself, explained Dr. Larry Wallack, a professor in the School of Public Health at the Oregon Health and Science University.

“The main determinants of health are not with individuals; it’s about the distribution of resources in that community,” he said. “Public health is really an issue of social justice.”

Compared to other industrialized countries, the United States spends more than any other on physical health care, but its infant mortality rate is higher than most. That is in large part due to the nation’s lack of investment in social services such as affordable housing and education, and to the disparities in who has access to what.

Genetics only accounts for about 10 percent of a person’s health outcomes. Disease, he said, is largely tied to economic and social status.

“We have a values problem, not a money problem,” Wallack said. “Medicine and economics should not be kept apart. If people tell you that it’s all about providing someone with medical care, it’s about a lot more than that. It’s about politics.”

Wallack said that changing public policy can actually effect changes in a person’s biology. Take stress, for example.

Some stress is good — the moderate and brief uptick in heart rate and hormones. For an adult that might be starting a new job or going on a first date. For a child it might be starting the school year or making a new friend.

Some stress is tolerable — triggering a longer and more severe hormone reaction. For an adult it might be losing a job or being unfairly arrested. For a child it might be a serious illness or her parents filing for divorce. But that stress becomes tolerable by a strong social or family support.

Dr. Larry Wallack, a professor in the School of Public Health at the Oregon Health and Science University.

Some stress is toxic — a prolonged powerful hormone reaction that often doesn't allow the body time to re-stabilize between bouts. For an adult it might be raising kids alone or living in an abusive home, while working a low-paying job and constantly fighting to keep up with rising rent, in neighborhoods made unsafe by crime rates and inaccessible by few sidewalks and poor lighting. For a child, it might be exposure to those same stressors.

Add to that the stress of being a person of color who experiencing the daily barrage of microaggressions and outright racist acts. “This has been directly linked to low birth outcomes for African American women,” said Ronnie Meyers, program coordinator for the county’s Healthy Birth Initiatives.

That stress has as much power to affect a person’s physical health as nutrition, Wallack said. Even before a child is born, the stress hormone cortisol can pass through the placenta and impact the child, who will be born already in a heightened state of alert.

“Is it a dangerous world or a friendly world? People born into a dangerous world are hypersensitive to threats,” he said. It made good sense 10,000 years ago. “You needed to know, if you saw a mastodon, you need to get the heck out of there,” he said.

People who live in a state of toxic, or chronic, stress, he said, are focused on survival.

Dyvisha Gordon, a community specialist at the Portland Housing Bureau who is black, said she wants more than that.

“I don’t want to just survive, but that’s the way a lot of people feel,” she said. “I want to think about stocks and bonds, not whether my landlord is going to raise the rent.”

Healthy Birth Initiatives coordinator Meyers said there are things individuals — lawmakers, policymakers, advocates and voters — can do to move everyone from surviving to thriving. It means investing in social services that support early and quality education, living-wage jobs, safe homes and healthy relationships. Harvard’s Center on the Developing Child has published a series of articles on tackling toxic stress. It has also policy recommendations on ways to improve health outcomes for children vulnerable to toxic stress.

Reports on Race the Social Determinants of Health in Multnomah County