Historic Violence and Contemporary Racial Disparities in Birth Outcomes

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Abstract Racism and racist structures shape the social environment for all Americans, although the durable imprint of place on health and health disparities remains underexamined. Racial disparities and spatial variation in health outcomes are only partially explained by contemporary socioeconomic, political, and demographic factors, and a growing chorus of scholarship suggests that historical antecedents may play an important role. Extant research documents relationships between historical mob violence and indicators of the contemporary racial climate, and between experiences of racism and local racial attitudes and pregnancy outcomes. This project will interrogate how county-level variation in historic violence may be directly and systematically linked to local prevalence of and racial disparities in a variety of pregnancy outcomes (infant mortality, fetal death, pre-term birth, and low birth weight). We will also examine how historic patterns of mob violence may shape spatial variation in the pace of improvement in these metrics. We expect to find that women living in counties with a greater incidence and intensity of historical mob violence will experience worse pregnancy outcomes overall, and larger race-based disparities. We also anticipate finding slower improvement of these critical health metrics in places with more violent histories. We will utilize data on the incidence of different forms of mob violence (Beck and Tolnay 2015, Beck 2018) in counties across eleven southern states between 1882 and 1950 to identify the number of threatened, averted, and completed lynchings that took place there. We will merge these data with contemporary information from the restricted access CDC National Center for Health Statistics’ Natality, Fetal Death, and linked Birth-Infant Mortality files (Natality Files). We will attempt to isolate the effects of mob violence by incorporating aggregated county-level data from historic census records for factors known to have predicted lynchings, and contemporary community characteristics, as identified in the American Community Survey and population census, that are associated with poor pregnancy outcomes. We hypothesize that the historical experience of violent community conflict will have a durable effect on the health outcomes for women living in those places today, and black women living in those communities with bear a disproportionate health burden. If persistent social inequality and structural racial violence are also associated with historic local experiences of mob violence, we may also witness a slower improvement in rates of IM, FD, PTB and LBW, either among all women or concentrated among black women. With this project, we seek evidence from analyses of secondary data as a first step towards identifying biological mechanisms that would support these hypotheses.