Black Infant Death Rate 2 1/2 Times That of Whites : Health: State committee calls for increased spending and reallocation of resources to help close the gap.

The gap between the black and white infant death rates in California has widened to the point where black babies are about 2 1/2 times as likely as whites to die in the first year of life, a committee of health leaders and advocates reported Thursday.

The committee, appointed in 1989 by then-Gov. George Deukmejian to study black infant health, reported that the black infant death rate is now 19.2 deaths per 1,000 live births, while the rate among non-Latino whites is 7.8.

While the white rate has dropped steadily over the past 10 years, the black rate has remained practically unchanged. As a result, the ratio of black to white deaths has widened from 2 to 1 to about 2 1/2 to 1.

Furthermore, the state appears inadvertently to have underestimated black infant deaths in the past. It recently began classifying babies by the race of the mother, instead of that of both parents. That shift raised the black rate from about 16.5 per 1,000 live births to 19.2 per 1,000.

“Ultimately, the answer to this problem is going to require significant change in the political structure and distribution of resources,” said Dr. Xylina Bean, associate director of neonatology at Martin Luther King Jr./Drew Medical Center and a member of the committee. “But a great deal of the problem can be addressed immediately in terms of increased resources and reallocation of resources.”

Among other things, the committee called for increased participation by health care providers in the Medi-Cal program, new programs for teen-age fathers as well as mothers and training for health professionals in issues involving substance abuse during pregnancy.

The committee also suggested redirecting funding to hospitals delivering a high percentage of black babies for follow-up of high-risk infants, requiring counties to draw up plans for reducing black infant death, developing ethnically sensitive educational materials for diabetic black mothers and expanding substance-abuse prevention and treatment programs.

Dr. Nathan Hale Allen, a Sacramento obstetrician and gynecologist and a member of the committee, said the effectiveness of the report will depend on the state’s willingness to spend money on the problem in the midst of a much-publicized budget crunch.

“This report really isn’t anything that’s surprising to the people that collect data or to health care providers,” said Allen. “This is just the first state-sponsored project.”

The 26-member committee traced the gap in infant death rates in part to “long-term, deplorable conditions in the African-American community,” including poverty, unemployment, substandard housing, single-parent households and lack of access to medical care.

In an interview, Allen suggested that the state recruit health care providers back into the Medi-Cal program. He said many remain alienated, unaware of recent increases in reimbursement rates and some streamlining of the required paperwork.

Bean called for a more decentralized system of clinics so that pregnant women without transportation have easier access to prenatal care. She also said many blacks have been driven away from the health care system by insulting treatment.

For example, she said black patients are automatically asked upon arrival at a physician’s office whether they have Medi-Cal coverage--not whether they have insurance in general, but whether they have insurance for the poor.

“For minorities . . . they no longer necessarily believe that medical care is going to help them or is designed to help them,” said Bean. “. . . If you treat them as second-class citizens when they try to get care, they begin to believe that the care is second class.”

Dr. Molly Joel Coye, the state health director, called the statistics “extremely troubling” but pointed out that the Wilson Administration recently initiated a prenatal education program to let pregnant women know that eligibility guidelines for Medi-Cal coverage have been expanded and to encourage them to seek prenatal care.

Coye also noted that the state is funding four community-based demonstration projects aimed at improving black women’s access to prenatal and postnatal care. In addition, the state appropriated $5 million for 16 hard-hit counties to target black infant death.

Donzella Lee, director for women, adolescent and children’s services at the Watts Health Center, which operates one of the four demonstration projects, has accused the state in the past of neglecting the problems of blacks and focusing on other ethnic groups. “They’ve ignored the needs of African-American women and children,” she said.