Democrat Beto O’Rourke brought his presidential campaign to the Richmond area on April 16, pledging to reform an economic system he said, "works too well for too few, and not at all for too many."

He said national policies have fostered racial inequalities in criminal justice, education and wages. Then, he called out what he sees as another unfairness.

"It’s our system of health care," he said, "where you see disparities in infant mortality between white Americans and black Americans greater today, in 2019, than in the year 1850 - 15 years before the abolition of slavery."

We fact-checked whether the racial gap in infant mortality has, indeed, widened over the last 169 years.

Let’s start with a definition: The infant mortality rate is the number deaths before age 1 per 1,000 live births.

Chris Evans, communications director for O’Rourke’s campaign, sent us an email saying the candidate got his information from an April 11, 2018, article in The New York Times Magazine headlined, "Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis."

The article cites estimates of child mortality in 1850 that were made by economists Michael Haines of Colgate University and Richard Steckel of The Ohio State University. Haines concluded that in 1850, the infant mortality rate for blacks was about 340 per 1,000; Steckel estimated the white rate was 217 per 1,000.

The Times compared those estimates to modern rates computed by the Centers for Disease Control and Prevention. In 2016, the latest year available, the infant mortality rate for blacks was 11.4 per 1,000. For whites, it was 4.9 per 1,000.

In other words, in 1850, blacks were 1.6 times more likely to die in infancy than whites. In 2016, blacks were 2.3 times more likely to die in infancy than whites. That shows "a racial disparity that is actually wider than in 1850, 15 years before the end of slavery," The Times article said.

Haines, who developed the 1850 black estimate, said O’Rourke’s statement is "right," but tells an incomplete story about infant mortality since the decade before the Civil War. "There has been remarkable improvement for both races; really quite dramatic," he said.

The estimates roughly show that in 1850, one in three black infants died in the first year compared to one in five white newborns. In 2016, CDC statistics show one in 88 black infants died before the first birthday compared to one in 204 whites.

"The mortality decline since the late 19th century seems to have been the result particularly of improvements in public health and sanitation, especially better water supplies and sewage disposal," Haines wrote in a 2008 paper. "The improving diet, clothing, and shelter of the American population over the period since about 1870 also played a role."

Haines said there have been "rapid reductions" in infectious and parasitic diseases such as tuberculosis, pneumonia, bronchitis, and gastrointestinal infections; and in "well-known lethal diseases" such as cholera, smallpox, diphtheria, and typhoid fever.

So, why has the racial gap increased? There's debate among researchers.

Infant mortality is often associated with premature births and low birth weights, and black infants in 2014 were 3.2 times more likely than whites to dies of those causes, according to the U.S. Department of Health and Human Services. But what leads to prematurity and low weight isn’t fully understood.

Black mothers are more likely than white mothers to be impoverished, very young and unmarried - factors associated with with higher infant deaths. They are twice as likely as whites to have received late or no prenatal care.

But research has shown a gap in low birth weights exists even when black and white mothers are matched for age, marital status, education, prenatal care and the father’s education.

A growing body of research points to racial discrimination as a cause of infant death disparity. It was pioneered by Arline Geronimus, a professor in the Department of Health Behavior and Health Education at the University of Michigan. The theory is that repeated exposure to discrimination and insult can have a stress-related "weathering" effect on a black mother’s body, producing poor pregnancy results and infant death.

Our ruling

O’Rourke said, "Disparities in infant mortality between white America and black America (are) greater today, in 2019, than in the year 1850...".

O’Rourke’s statement is deeply grounded. Academic studies lead to estimates that in 1850, live-born black babies were 1.6 times more likely to die in their first year than white ones. The latest racial infant mortality statistics are from 2016 - not 2019 as O’Rourke suggests. They show blacks were 2.3 times more likely to die in infancy than whites.

O’Rourke’s claim, however, lacks important context. He omits in his statement and entire speech that, even with gap growth, there’s been a monumental drop in infant death rates for blacks and whites since before the Civil War. In 1850, it’s estimated that roughly one in three blacks and one in five whites died in infancy. Statistics show in 2016, the ratios improved to one in 88 black babies, and one in 204 white ones.

So, overall, we rate O’Rourke’s statement Mostly True.