Racial inequality shows up in just about every possible measure of opportunity you can think of - in schools, neighborhoods, employment numbers, incarceration rates and even health.
Perhaps the most disturbing racial disparity, though, happens right at birth.
In the United States, African American babies are twice as likely to die in their first year as are white babies. In Michigan, it’s even worse - about two and a half times as likely.
For context, say you compare the infant mortality rate for African Americans in Michigan to the national rates for every other country in the world. Using a three-year moving average for Michigan's rate, we’d be behind every advanced nation, tucked between countries like Malaysia and Syria.
And, in certain Michigan cities, the numbers are even worse.
The African American infant mortality rate in Grand Rapids is just slightly better than the overall rate in the Gaza Strip.
And that is actually a huge improvement for the city.
"This town is really pretty segregated," says Jamisha Alexander, a social worker for a program in Grand Rapids called Strong Beginnings. The program started about eight years ago when Grand Rapids had the worst black infant mortality rate in the state. Now it’s sixth.
Alexander and her coworkers drive out to the homes of pregnant African American mothers, and follow them until the kids are two.
These visits aren’t just to talk about medical issues. Alexander covers work, housing and all kinds of general problems that can create stress.
Alexander tells me during the car ride that the Strong Beginnings program also doesn’t have income requirements, because poverty doesn’t explain all of the disparity in infant deaths.
"So like let’s say you have a mom who’s 30 years-old, she’s well-educated, she makes good money, she’s African American," Alexander says. "And then you have the same mom and she’s white, the African American mom will still have a higher chance of infant death."
It is true that moms with a low-income, or moms who live in troubled neighborhoods are more likely to lose a child. But those differences don’t explain all of the racial disparity.
In the past 20 years or so, when it really became clear that this racial difference in infant deaths was a problem, there have been lots of explanations put forward, and lots rejected.
Peggy Vander Meulen heads up the Strong Beginnings program. She was one of the first people to try to raise the issue of African American infant mortality in Grand Rapids. She says a lot of people thought the disparity came from a genetic difference.
So studies have looked at immigrants of African descent who came to America. When they first arrived, birth outcomes were about the same as whites.
"But over time their outcomes get worse and worse, you see that it’s not genetic.
So why do African American babies die at twice the rate of white babies in this country? There’s been a lot of scientific effort to try to answer that question, and there is no simple answer.
But a growing number of public health workers believe that racism itself is a major cause of the problem.
Vander Meulen says she has data, charts and 15 years worth of scientific studies that all point to racism as a cause for the higher numbers of infant deaths. But many people still don’t believe it.
"A lot of people even question that racism still exists," Vander Meulen says. "For many people, the attitude is, 'Oh, well we took care of that in the sixties. Civil rights happened. We have laws, we have legislation in place.'"
But for the mothers enrolled in Strong Beginnings, there’s no question about whether racism still exists. And there’s no question for Jamisha Alexander.
“Even though I have a job, and I have an education, I have to deal with racism," Alexander says. "I have to deal with people looking at me a certain way, or not, just not being treated, I guess, fairly. So I can relate to some of that."
There’s a lot of evidence that this kind of racism causes increased stress for African American mothers, and that the body’s response to chronic stress creates long-term biological change that can affect pregnancy.
Claudia Holzman is chair of the epidemiology department at Michigan State University, and she’s one of the nation’s top experts on premature birth. Early birth is the leading cause of the disparity in deaths between African American babies and white babies.
Holzman says scientists have struggled with quantifying and even defining the effects of racism on pregnancy. She says the causes of infant death can be as varied as they are for death later in life. It’s a complex story
“I really don’t think we’re able to parse out ... attributing a percent to this, and a percent to that," she says.
But Holzman says there is enough evidence to justify action.
"I don’t think there’s too much argument that racism is bad for health," she says. "So we don’t have to understand the pathway to know that we have to address that."
Holzman says addressing it means better care for pregnant moms. And it means better care long before they become pregnant.
Earlier this month, the Michigan Department of Community Health released a new plan for dealing with the disparity in infant death.
Olga Dazzo, the director of the MDCH, introduced the plan at a news conference in Flint.
"We have an important goal ahead of us," she said. "And we’re going to need everyone’s help to change the environment in Michigan so that our babies survive.”
The plan Dazzo presented took a year to put together, and the process involved groups from across the state. The plan has eight main strategies, including things like more progesterone treatments for high risk moms, better sleep positions for babies and eliminating unwanted pregnancies. The eighth strategy on the list is to look at the impact of community, and the experience of racial minorities (for the full version of the plan, click here).
The news conference to announce the plan was held at Hurley Medical Center in Flint. The location was picked because Hurley is one hospital that’s already made big progress on reducing infant deaths, and reducing the disparity in infant deaths.
Hurley doctor Larry Young said the efforts go beyond the hospital walls.
"I see infant mortality as a community disease, as well as a medical disorder," he said at the news conference. "Too often we focus on the medical aspect, and not the community aspect."
But focusing on the community, and really trying to save the lives of babies in Michigan – it’s not free.
The MDCH estimates its plan will cost about $11 million. The state has committed to pay only a part of that. Officials hope grants will help pay for the rest.
Whatever the funding, whatever the strategy, the one thing that is painfully clear is the stakes.
Too many babies die in Michigan.
Too many of the babies who die have dark skin.
