Structural Bias in SUID Investigations: A Deep Dive into Equity and Public Health

by Jon Scaccia January 10, 2024

When the unimaginable tragedy of an infant’s sudden and unexpected death occurs, it prompts a myriad of questions, chief among them being “why?”

For public health professionals, understanding the “why” through meticulous death investigations is pivotal in preventing future losses. However, a revealing study titled “Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs)” sheds light on significant disparities in the investigation process based on race, geography, and investigative agency​​.

Understanding the Landscape of SUID

Sudden Unexpected Infant Death (SUID) is a term that encompasses sudden and unexpected deaths of infants less than one-year-old in which the cause was not obvious before investigation. These typically occur during sleep and can be attributed to various factors, including sleep environment hazards or undiagnosed medical conditions.

The Structural Bias in Death Investigations

The study’s findings are a wake-up call to the critical issue of structural biases within our systems.

It highlights that 24% of SUID cases had incomplete investigations, with significant disparities noted for American Indian/Alaska Native infants and those in rural areas. Incompleteness is defined as missing crucial elements such as autopsy reports, scene investigation details, or vital information on the infant’s discovery. Notably, it was found that doll reenactments and SUID investigation forms, if performed, could significantly reduce the number of incomplete investigations​​.

Implications for Public Health

The implications of these findings are profound. For one, incomplete investigations hinder our understanding of SUIDs and thus the ability to prevent them. The study makes it clear that equitably improving the thoroughness and quality of these investigations is not just a matter of protocol—it’s a matter of justice and public health imperative.

For Public Health Practitioners:

1. Ensuring Completeness: Advocate for and implement practices that ensure thorough investigations, particularly in areas and communities identified as having higher rates of incomplete investigations.
2. Training and Resources: Promote specialized training for investigators handling infant death scenes, especially in rural areas where medical examiner resources may be scarce.
3. Community Involvement: Engage with Tribal Nations and organizations representing marginalized communities to understand barriers and collaborate on tailored solutions.

Moving Forward: A Call to Action

As a community of health practitioners, policymakers, and stakeholders, it’s incumbent upon us to heed the findings of this study. By recognizing and addressing the structural biases in our systems, we can move towards more equitable health practices and, ultimately, save lives. The study is not just a collection of data; it’s a call to action to uphold the inherent value of every life and the inherent right to a thorough and fair investigation into every untimely loss.

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