• race and health
• epidemiology
• ethics
• health economics
• health service

Burris et al 1 provide a succinct summary of the current state of knowledge regarding the glaring inequity in preterm birth by race in the USA. They then offer a logical approach to redressing the underlying environmental causes, both physical and social, of this inequity through an improved focus in research and policy. Unfortunately, translating an understanding of health inequities into political changes that could eliminate them is not easy. Moreover, the needed political changes are unlikely without addressing the other major inequity with which racial inequity is entwined—class.

Moving from a biological-genetic concept of race to our current understanding of race as a social construct has taken decades. From the publication in 1950 of The Race Question by Unesco, an effort led by social scientists like Ashley Montagu, which explicitly rejected Nazi race theories, to the popularisation of the rejection of the biological concept of race in medicine and epidemiology advanced in writings by Sherman James, Richard Cooper and others in the 1970s and 1980s, the progress has been neither rapid nor uncontested. Diane Rowley and Carol Hogue, both at the Centers for Disease Control and Prevention (CDC) at the time, organised a series of meetings bringing together clinicians, epidemiologists and social scientists to accelerate the paradigm shift from ‘race’ to ‘racism’ in the study of adverse birth outcomes for African-Americans in the 1990s, and many others have continued to advance this work in the years since. Still, in the new millennium, interest in—and funding for—a search for the ‘prematurity gene’ in blacks has continued.2

Despite progress in developing the theory explaining racial health inequities, the inequity in infant mortality has failed to improve over time, it has actually widened. In 1960, when the USA …