COLUMN ONE : Why Does the Racial Gap Exist? : The high death rate of black infants can’t be fully explained by income and social class. One researcher suspects reproductive problems are passed between generations.

Objectivity is paramount, the scientist was saying. At least, that’s what she had been taught. Speak to the moral implications of your work and you risk leaving the impression that you are no longer neutral.

But then there is the notion of a Good German, she went on. They knew what was happening but kept silent--either out of fear of the consequences of speaking out, or out of misguided patriotism.

“I just didn’t want to be a Good German,” the scientist concluded simply. “So either you turn your back on the research and you work in something else, or you have to at some point say, ‘This is wrong.’ ”

Christiane Hale is in many ways an outsider--a Northerner repotted in the soil of the Deep South, an erstwhile expatriate, part epidemiologist, part historian, part social psychologist, an academic researcher with an undisguised point of view.

That geography, physical and psychic, defines her professional perspective. She has observed the U.S. public health system from abroad, and tracked patterns of disease and death among blacks and whites through the prism of American social history.

All of which has brought Hale to a chilling and controversial hypothesis in the attempt to unravel one of the more troubling puzzles in public health--why it is that black babies born in the United States are twice as likely as whites to die by age 1.

The racial gap, Hale and some others believe, cannot entirely be traced to racial differences in income and social class. Even middle-class black women, it seems, are twice as likely as whites to give birth to dangerously underweight babies.

Instead, they have begun to suspect that long-term poverty may have exacted a deep, physical toll--subtle but significant damage to the reproductive health of black women, which they believe can be passed from one generation to the next.

Precisely how that might occur is unclear. But Hale and others suspect that women whose growth was stunted in childhood or in the womb as a result of poverty may suffer internal organ damage that years later can place their own babies at risk.

That theory, still unproven, is one of several that have surfaced recently as researchers have explored the racial difference in infant death, a key reason why the overall U.S. infant death rate is among the worst in the industrialized world.

If proven, Hale believes the idea of an intergenerational health effect of poverty could serve as a powerful indictment of the treatment of blacks in the United States--evidence that the effects of racism extend beyond psychological scars to long-term physiological damage.

Other scientists are cautious about the theory.

Some believe the racial gap in infant death can be traced entirely to social and economic factors. If some of the difference appears unaccounted for, they say it is because they have not yet identified certain subtle, social variables.

Just because a white woman and a black woman have college degrees does not mean they have the same socioeconomic status, researchers note. A middle-class black woman may have grown up poor and may get worse health care than her white counterparts.

“The racial disparity seems to imply biological variation,” said Dr. Woodie Kessel of the National Institutes of Health. “But it’s not clear to me that it really isn’t a reflection of other things that are more difficult to measure.”

Other researchers fear the notion of biological factors in infant death could be taken as a racist one. Even if those biological differences came from social rather than genetic roots, they fear the idea might seem to imply inferiority.

Similarly, some worry that the concept could be willfully misconstrued to justify neglecting health and social welfare programs. If the racial gap in infant death is biological, people might argue, why invest tax revenue in trying to remedy social causes?

Finally, biological factors may be relatively insignificant.

“It’s quite possible (that such factors exist),” said Dr. Paul Wise, an assistant professor of pediatrics at Harvard Medical School. “The question to me is not so much do they exist but their relevance. How important are they?”

Hale, for one, intends to find out.

On a recent morning on the campus of the University of Alabama at Birmingham, a chill wind sent bundled-up students scudding along the sidewalks. Inside the overheated building that houses the School of Public Health, secretaries battled static cling.

Hale bustled into her office in a bomber jacket and long skirt. She wore running shoes to cushion her heel bones, broken two months earlier when the 48-year-old, tenured professor of epidemiology fell off her garage roof while trying to break into her locked house.

A small, bumblebee of a woman with reddish-brown hair and a laugh that bubbles upward in arpeggios, Hale speaks in the kind of mellifluous, modulated voice that might be heard doing commentary on National Public Radio.

To understand black infant death, she was saying that one must understand two aspects of the black experience: First, the peculiar intensity of poverty among black Americans; second, the region where blacks traditionally lived.

No group of poor whites, except perhaps in Appalachia, experienced comparable poverty and social isolation, Hale contended. And until the middle of this century, most blacks lived in a handful of Southern states with little or no commitment to the poor.

“One of the reasons we haven’t done much about (infant mortality), I believe, is that it is seen as a problem of the poor,” she said. “As a society, we have never been able to decide whether the poor are also deserving. . . .

“I see it as very consistent in a country that includes among its founding fathers the Puritans. One of their fundamental beliefs was that if God loves you, you aren’t poor; and if you’re poor, you have done something wrong in the eyes of God.”

The theory that Hale and others are exploring is just one of several being offered to help explain the racial disparity in infant death.

Much of the racial gap is clearly traceable to income and class. Black mothers have less money and less schooling than whites. Income and education influence diet, behavior and access to health care--which, in turn, can determine one’s risk of having a baby die.

But some researchers like Hale believe something else may be at work. For even when they take income and class into account, they still find differences in the average birth weights of black and white infants, and in the rates at which they die.

For that reason, they are looking for other possible factors.

In Atlanta, researchers at the U.S. Centers for Disease Control and at several black colleges are investigating whether subtle differences in the experiences of middle-class blacks and whites might help account for differences in birth weight and infant death.

One factor being considered is psychological stress. Stress has been linked, directly or indirectly, to problems in childbearing. Some researchers suspect that black women experience more stress than whites--from financial and domestic pressures, perhaps from racism.

They are also looking at degrees of social support among the middle-class blacks and whites they are studying, and at differences in income and financial stability between black and white women ostensibly of the same social class.

Finally, they are examining how blacks and whites use the health care system. Some of the researchers suspect that middle-class blacks may turn to a doctor less readily than do whites, who have grown up with good access to affordable health care.

“It’s not just money,” said Bruce Wade, a Spelman College sociologist working on the study. “It’s the way social class impacts people’s attitudes--how likely you are to go to a doctor, how you treat a person once a pregnancy occurs.

“The effects of social class are sometimes very devastating, and it’s sometimes things that we’re not readily aware of. The idea that once a group is educated and brought into higher socioeconomic status, all the problems will be resolved--that may not be the case.”

In other words, black and white women of seemingly similar income and education may in fact experience life quite differently, since social class reflects not only money and schooling but family history, attitudes and expectations.

The new hypotheses are disturbing not only for what they suggest about long-term harm done by discrimination. They also call into question conventional wisdom about what it might take to eliminate the racial gap in infant death.

While most researchers stress unequivocally the importance of prenatal care, they say even universal access to care cannot alone close the gap. It will take much more--for example, a concerted attack on poverty--to erase the effects of decades of deprivation, they say.

“The gap between ethnic groups is going to be reduced or eliminated by addressing the issues of poverty and how poverty affects child health,” said Dr. Irvin Emanuel, a professor of epidemiology and pediatrics at the University of Washington.

“If we want healthy babies, we have to have healthy children who grow up to be healthy adults who will have healthy babies. . . . We have to take care of our people. And in my view, it will take more than just one generation.”

The racial gap in infant mortality in the United States is not new. It has existed as long as statistics have been kept. While the black and white rates declined steadily over much of this century, the gap between them persisted and even gradually widened.

As a result, a black baby born in 1987, the latest year for which national statistics exist, had less chance of surviving to age 1 than a white baby born in 1970--well before the spread of new technology made it possible to keep many premature babies alive.

Now some experts fear the black-white gap will grow even wider in the 1990s. They cite the spread of illegal drug use among inner-city black women and the disproportionately high rate at which black babies are born infected with the AIDS virus.

As Hale tells it, she became interested in infant death in the mid-1960s while working in the health care system of Labrador, Canada. It was there that she recognized the infant mortality rate for what it was--a telling measure of a society’s well-being.

Returning to the United States in 1967, she moved to Montgomery, Ala., and began accumulating degrees in history, epidemiology, social psychology and demography. During the next 10 years, she waded into statistics, an epidemiologist’s stock in trade.

Assigned to calculate so-called standard mortality ratios for an introductory epidemiology course, Hale chose to compare white and black rates of infant death. What she found, she recalls, were two radically different sets of numbers.

The white numbers were low, the black numbers were high. Yet Hale found it was common practice in epidemiology to blur the difference between the races by reporting one overall average rate of infant death.

“It’s two different rates and it’s bad science to pool them,” Hale said recently. “So let’s just own up to the fact that the infant mortality rate in this country among blacks is slightly better than that of Central and South American countries.”

In the early 1980s, some researchers began to suspect that income and class might not explain the entire racial gap, a discovery that Hale believes was made possible in part by the evolution of the epidemiologist’s tools.

For one thing, the federal government began linking birth and death certificates in cases of infant death. Infant death researchers could now estimate parents’ socioeconomic status using information, such as education level, recorded on birth certificates.

At the same time, statisticians developed a method of analyzing data that made it possible to control for socioeconomic factors. Controlling for education and income, researchers still found that black babies were still more likely than whites to die.

In the mid-1980s, federal researchers studying babies born in 1980 found that blacks at every education level were more likely to have underweight babies. Even among college-educated black women, the rate was twice as high as that of comparable whites.

When researchers then looked for factors that might explain that difference--the mother’s marital status, medical care, age, place of residence--they could not fully explain the difference in the size of black and white college women’s babies.

Finally, they compared the pregnancies of college-educated blacks to those of high-school educated whites. According to Carol J.R. Hogue, of the CDC’s division of reproductive health, the black women were 60% more likely than the whites to have an infant die.

In Seattle, meanwhile, Emanuel, who is considered an expert on birth defects, was approaching the issue from a different angle. He had been exploring the relationship between a woman’s stature and her ability to bear a healthy child.

Emanuel found that smaller women are more likely to have underweight babies. From studies throughout the world, it seemed women born underweight were more likely to give birth to an underweight child.

Emanuel came to suspect that women whose own growth was stunted in the womb or in childhood--perhaps by poor nutrition, bad maternal health or inadequate care--suffered long-term damage to their reproductive health that could echo into the next generation.

” . . . If the overall size of a baby is compromised,” Emanuel said, “then it’s not hard to imagine that growth and development of internal organs become compromised.”

Hale and Emanuel began running into each other at scientific meetings in the early 1980s. Emanuel explained his findings to Hale, she recalls. She describes the discovery as “just like a big light coming on. . . . It just made so much sense to me.”

In 1989, they published a paper on the subject, fusing Hale’s historical and Emanuel’s biological perspectives. The question they posed was: What in the lives of American black women “is apparently so hazardous to fetal and infant health?”

The answer lies in the mother’s childhood and in the environment in which her pregnancies occur, they suggested. They cited numerous studies linking an infant’s birth weight to its mother’s birth weight and stature, and to her parents’ social class.

“A reasonable interpretation . . . is that a mother’s own childhood family conditions affect her reproductive outcomes and the effect is greatest among families in which few economic resources have to be shared by many people,” they wrote.

That theory and others like it have been received with interest and caution.

Dr. Arthur Kohrman, professor of pediatrics at the University of Chicago and director of La Rabida Children’s Hospital, believes there is clearly a biological factor in the racial differences in birth weight and infant death.

Perhaps in some women the uterus is unusually sensitive to the early onset of labor, he speculated. Perhaps for some biological reason, hormonal or neurological, they advance to full-blown labor more easily than other women.

But scientists have been cautious about discussing biological factors, Kohrman contended.

“I don’t want some guy saying, ‘Well, if it’s all biological, why are we putting all this money into these (social and health) programs?’ ” he said. “And in the current political climate, that’s not such a far-fetched thing.”

More important, said Wise of Harvard, is the question of significance.

While biological factors are possible, their role would probably pale by comparison to social and economic factors, he said. It seems more likely that certain social factors--like poverty, education and family dislocation--are echoing from one generation into the next.

“I can’t tell you what proportion (of the racial gap) is due to poverty, what proportion is due to medical care, what proportion to smoking, or to generational effects,” said Dr. Woodie Kessel of the National Institute of Child Health and Human Development.

“They’re sort of mixed in together,” he said. “The issue is not to explain the difference but to do something about the difference.”

In May, 1989, Hale and Emanuel were married. She took a sabbatical and moved to Seattle to be with him. There, she worked as a visiting professor and as a consultant to the county health department.

Back in Birmingham this fall, Hale mused about what comes next.

To test the intergenerational hypothesis, Hale would like to help set up a study tracking the birth weights of black families over generations, to see whether those families that have been in the middle class the longest indeed have the better birth weights.

It would also be useful to study births and infant death among Appalachian whites, she said. There, too, one might find additional evidence for an intergenerational effect of poverty on reproductive health, if it exists.

At the same time, Hale and Emanuel have called for research into the biological mechanisms by which poverty translates into poor health--specifically, how experiences in the womb and in childhood in one generation “are linked to health hazards in the next.”

“If you are as conscious as we are of the statistics on childhood poverty, one has the impression of a time bomb waiting to go off,” she said. “Poverty has become a female experience, a child experience. One in four kids live in poverty.

“What are we going to do? This is the labor force,” she wondered, half sad, half angry. Then she continued--unconstrained by academic etiquette: “We have screwed up our future labor supply. It’s the dumbest thing a country could do.”

INFANT MORTALITY RATES

A look at infant mortality rates per 1,000 live births among blacks and white in the United States, California and Los Angeles County. The numbers in each category are the latest statistics available. UNITED STATES Whites: 1980: 11.0 1981: 10.5 1982: 10.1 1983: 9.7 1984: 9.4 1985: 9.3 1986: 8.9 1987: 8.6 Blacks: 1980: 21.4 1981: 20.0 1982: 19.6 1983: 19.2 1984: 18.4 1985: 18.2 1986: 18.0 1987: 17.9 Source: National Center for Health Statistics CALIFORNIA Whites: 1980: 10.5 1981: 9.8 1982: 9.8 1983: 9.3 1984: 9.0 1985: 9.1 1986: 8.5 1987: 8.6 1988: 8.1 Blacks: 1980: 19.1 1981: 16.7 1982: 16.7 1983: 17.3 1984: 16.4 1985: 16.2 1986: 16.2 1987: 16.1 1988: 15.8 Source: California Dept. of Health Services LOS ANGELES COUNTY Whites: 1980: 12.8 1981: 13.8 1982: 12.2 1983: 10.0 1984: 11.0 1985: 11.8 1986: 11.3 1987: 11.2 1988: 8.8 1989: 7.4 Blacks: 1980: 21.0 1981: 17.7 1982: 18.7 1983: 19.0 1984: 17.3 1985: 18.2 1986: 17.7 1987: 18.4 1988: 21.1 1989: 20.8 Note: In Los Angeles County, infant mortality figures for whites do not include Latinos. The Latino in the county is generally slightly lower than the rate for non-Latino whites.

* Figures for 1988 and 1989 are preliminary