Presenter:

Authors:

Ellen Meara, David M. Cutler, Seth Richards

Chair: David Meltzer; Discussant: Anna Aizer Mon June 5, 2006 17:15-18:45 Room 325

Racial disparities in the rate of infant mortality have been documented throughout the 20th century in the United States. Despite progress in reducing black white differentials in the late 1960s, the gap between black and white infant mortality has again increased in the past two decades. The ratio of black to white infant mortality is higher now than at any point in the past century. We consider explanations for this trend. We estimate that two thirds of this adverse shift in relative black infant mortality relates to greater improvement in survival for whites of any birth weight. We further argue that the faster improvement for white infants stems from biased technological innovation. Because research and investment tends to favor the leading causes of death overall, medical advances that improve infant mortality automatically favor infants from the majority group. In support of our hypothesis, we document that between 1983 and 1998 1) mortality declines are greatest for causes of infant mortality that were most prevalent in 1983 2) mortality declines increase with the level of research devoted to a given cause of death; and 3) both initial mortality rates and measures of technological innovation are positively related to the increase in relative black mortality during this period. Our theory also draws support from case studies of particular causes such as respiratory distress syndrome. Our findings suggest that even in the absence of disparities in access to medical care or discrimination in the medical system, racial disparities in infant mortality can increase as medical technology improves.