THE FIRST INJUSTICE - SOCIOECONOMIC DISPARITIES, HEALTH-SERVICES TECHNOLOGY, AND INFANT-MORTALITY

Infant mortality has long been viewed as a synoptic indicator of the h ealth and social condition of a population. In this article we examine critically the structure of this reflective capacity with a particula r emphasis on how new hearth care technologies may have altered tradit ional pathways of social influence. The infant mortality rate is a com posite of a series of component rates, each with its own relationship to social factors. Advances in health care have reduced dramatically t he risk of mortality for the critically ill newborn, thereby elevating the importance of access to this care in shaping absolute and dispara te infant mortality rates. These advances in health services technolog y have also had the effect of concentrating infant mortality among ext remely premature and low birth-weight infants, a group tied directly t o social factors operating through maternal influences and the general well-being of women. In this manner, current patterns of infant morta lity in the United States provide a useful illustration of the dynamic interaction of underlying social forces and technological innovation in determining trends in health outcomes. We review the implications o f this perspective for sociological research into disparate infant mor tality, including the social and economic structure of societies, acce ss to health services, the potential for prenatal intervention, women' s health status, and racial and ethnic disparities.