The "inverse care law" and infant mortality among Whites and Blacks in the United States
Purpose ‐ In the context of a much higher infant mortality rate (IMR) among Blacks than among Whites in the USA, the purpose of this paper is to compare changes in IMR in the two groups to judge whether the rates of decline are indicative of the so-called Matthew-effect or the inverse-care principle, which, in contrast with the usual expectation of "diminishing marginal product," suggests that higher level of IMR would be associated with a slower rate of IMR decline. Design/methodology/approach ‐ Changes in the IMR for each group over the period 1980-2007 are studied. Levels and rates of decline in the two groups are compared for 1980-1990, 1990-2000, and 1980-2007 for the USA. In addition, the levels and rates of decline in the two groups over these periods are also compared for each state. Findings ‐ Despite the much higher level of IMR among Blacks, the rates of decline in IMR over 1980-1990, 1990-2000, and 1980-2007 are considerably lower for Blacks than for Whites when data for the entire USA are considered. Moreover, the same pattern is observed for a vast majority of the states in each period. Originality/value ‐ This is perhaps the only study that considers the possible operation of the inverse-care principle relative to Black and White IMR in the USA over a fairly long period. The findings suggest several useful points. First, the pattern is consistent with the Matthew-effect or the inverse-care principle, and is not supportive of the usual expectation of "diminishing marginal product" in healthcare improvements. Second, the observed pattern seems to reflect poorer access of Blacks to prenatal, maternal, and infant healthcare. Third, it appears likely that, as suggested by Hart and indicated by recent research on increasing Black-White IMR disparity, the pattern reflects a high degree of reliance on the market forces in healthcare provision and innovation, particularly relative to infant mortality. Fourth, in that context, greater role of the public sector in healthcare, particularly relative to IMR, might be given serious consideration. Fifth, given the observed pattern, the goal of eliminating racial disparities in IMR is unlikely to be met for a long time. Sixth, the relatively low-international ranking of the USA in IMR, which has been declining, might not improve for quite some time.
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