New Report Links Black Maternal Mortality to Racial Bias
The Center for American Progress released a new report on the high death rates among black mothers and infants in the U.S. As previously reported here, black mothers die at at rate three to four times higher than white mothers, and infants born to black women die at twice the rate of those born to white women. The disparity is driving the country's overall maternal mortality rate, which is the worst in the developed world. This growing crisis can't be explained by socioeconomic factors. The report presents research showing that risk factors including income, education, and physical and mental health cannot account for the disparity in outcomes. Instead, the report points to systematic racial bias, including within the healthcare system.
From the report:
Although evidence suggests that maternal and infant mortality are greatly influenced by mothers’ life circumstances growing up, health care institutions often deepen racial disparities. For example, women of color are less likely to have access to vital reproductive health services including family planning; abortion; and screenings for sexually transmitted infections and cervical cancer, when compared with non-Hispanic white women. Studies also show that African American women receive lower-quality health care generally, which results in higher risk for mortality across the life span for this population. This contributes to racial disparities in pregnancy-related risk factors—such as hypertension, anemia, gestational diabetes, and obesity—and other conditions such as heart disease, HIV, AIDS, and cancer. Relatedly, African
American infants receive lower-quality care than non-Hispanic white infants within
the same neonatal intensive care units.
Another problem is inadequate bias training among the health care workforce. In their
investigation of U.S. maternal mortality, NPR and ProPublica collected more than
200 stories from African American mothers and discovered that feeling devalued and
disrespected by medical providers was a unifying theme. Mothers also frequently
reported that medical staff did not take their pain seriously, consistent with earlier
studies that found pain is often undertreated in African American patients. [Emphasis added.]
Exploring African Americans' High Maternal and Infant Death Rates, from the Center for American Progress
Death is Defined by Culture and Perceived Bias
A long profile in The New Yorker tells the story of Jahi McMath, a 13-year-old African American who was declared brain-dead following complications from a tonsillectomy. Jahi awoke after the surgery, but then she began to experience bleeding from her mouth and nose. Her father asked repeatedly for a doctor. Her grandmother, a nurse, pointed out to the nurse on duty that the amount Jahi was bleeding was not normal. According to Jahi's mother, “No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.” That night, Jahi's heart stopped. Two days later, she was declared brain-dead. Her family disagreed with the diagnosis. And thus began a years-long battle over Jahi's life—or death, depending on your definition.
For the past four years, Jahi's parents have fought to keep her on a ventilator. After a long period of hospital care, she now receives 24-hour nursing in her home. She is visited by a series of neurological specialists—some of whom agree that she maintains a level of consciousness. Some of Jahi's doctors have been ridiculed by colleagues for treating a "corpse." Her exorbitantly expensive treatment is paid for by Medicaid, even as she is classified as deceased by the federal government. Jahi's case begs the question, "What is death?" It turns out that the definition of death is cultural, and it may be connected to perceived bias. [Jahi's grandmother] said she sometimes wonders, “If the hospital had been more compassionate, would we have fought so much?”
From the article:
African-Americans are twice as likely as whites to ask that their lives be prolonged as much as possible, even in cases of irreversible coma—a preference that likely stems from fears of neglect. A large body of research has shown that black patients are less likely to get appropriate medications and surgeries than white ones are, regardless of their insurance or education level, and more likely to receive undesirable medical interventions, like amputations. [Robert Truog, the director of the Center for Bioethics at Harvard Medical School] said, “When a doctor is saying your loved one is dead, and your loved one doesn’t look dead, I understand that it might feel that, once again, you are not getting the right care because of the color of your skin.”
Native Americans Revive Cultural Practices to Address Health Disparities
Native Americans have a lower life expectancy and poorer health outcomes than white Americans. In some regions, like the state of Montana, Native Americans residents die an average of 20 years sooner than white residents. In response, Native American communities are taking on more health equity work. National agencies like the National Council of Urban Indian Health, the National Indian Health Board, and the National Congress of American Indians are finding success by engaging tribal leadership and using Native American cultural practices to teach best practices of disease prevention.
From the article:
At the local level, [Annie Belcourt, an associate professor in public health at the University of Montana] notes, “Many tribal communities have even taken over the health care provision structure.” Measures taken including bringing back traditional healing methods, languages, and foods, and launching Native health initiatives around issues like tobacco use. “This revitalization is showing promise to improve health the entire family and community,” Belcourt says.
American Indians Address Health Disparities by Restoring Cultural Practices, from Nonprofit Quarterly
Hospital Program Reduces ER Use by Housing Homeless People
The University of Illinois Hospital pays the rent for homeless people who frequent the emergency room (a.k.a. "super-users"), in an effort to reduce their visits to the ER. NPR interviewed the pilot program's director and a formerly-homeless beneficiary of the program. The program's goal is to reduce hospital costs and improve the health of chronically homeless patients—and it's working. It's just one example of a growing trend around the country of hospital systems investing in housing to reduce costs. By some measures, these initiatives result in a 50% drop in ER use.
From the interview:
STEPHEN BROWN: Housing is health, right? That's kind of what we say around here now.
[MILES BRYAN, WBEZ reporter]: Stephen Brown runs the housing project at the hospital. He says fully half of the hospital's ER super users are homeless. Just one night in the hospital can run three grand. Now the hospital pays a thousand bucks a month to house them. Brown says those in the hospital's pilot housing project have seen their health improve. And after crunching the numbers, monthly medical costs for their care are down significantly.