Health disparities are defined by the Centers for Disease Control and Prevention (CDC) as “preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” In the context of maternal mortality, it has been proven that Black women are three times more likely to die from complications during pregnancy than non-Hispanic white women.
Both structural racism and social determinants of health in combination give rise to this saddening statistic. Structural racism refers to the implicit modern-day racism embedded in the lives of people of color. It is referred to as the “invisible evil” because its existence is neither widely talked about nor acknowledged.
For example, laws, regulations or policies that are implicitly designed to reduce access to opportunities and services based on race can be characterized as structural racism. A practice called redlining is often implemented, where areas are ranked on a 4 point scale, with predominantly white and affluent areas receiving an “A” grade and predominantly Hispanic and Black areas receiving a “D” grade.
These “scores” disincentivize public and private investment in certain communities and promote racial housing discrimination, which in turn worsens living conditions and causes a disproportionate distribution of resources, including access to healthcare. This example demonstrates one of the countless problems that engender discrepancies in healthcare that begin long before seeing a physician. In addition, social determinants such as discrimination, long-standing racism and implicit bias are all factors that influence the quality and level of care delivered.
Although some would argue that pre-existing conditions, education, knowledge level or patient’s “negligence” may be skewing this statistic, this is not the case. Studies have shown that even correcting for pre-existing conditions, education and socioeconomic status, a disparity still exists. One explanation is implicit bias, the lingering effects of a history of long-standing discrimination and stereotyping.
The story of Dr. Shalon exemplifies the tragic odds stacked against Black mothers in America. Dr. Shalon was a high achiever from the beginning. She obtained a dual PhD in sociology and gerontology and a master’s degree at the Johns Hopkins Bloomberg School of Public Health. She then went on to work for the CDC, where her role was to understand public health problems and reduce public health disparities as they relate to race, class and gender.
She had everything necessary: an impressive educational background, a solid support network and high quality insurance. Shortly after giving birth to her daughter Soleil, she experienced postpartum complications, which the physicians dismissed stating that her symptoms would get better with time. However three weeks after giving birth, she died from complications of high blood pressure. This is just one example of the phenomenon; physician dismissal or failure to take the patient seriously cannot be the cause for the death of mothers.
However, successful and prominent Black women such as Serena Williams and Beyoncé have spoken out about their own complications during or after pregnancy. Citing these examples, if even Black mothers with an abundance of resources, education and high socioeconomic statuses are succumbing to the odds, how does the average Black woman stand a chance?
These stories enlighten the need for change in the healthcare system and beyond, starting with a foundational identification of solutions that can mitigate this disparity. An interdisciplinary approach is necessary to solve such a deeply rooted issue, and the solution must derive from multiple sources to maximize favorable results.
Such solutions include reducing the financial barriers for entry into medical school so that physician diversity increases in the United States or incorporating implicit bias training in medical schools’ curriculum.
In addition, the extension of Medicaid pregnancy coverage to 12 months after the end of pregnancy instead of 60 days will allow for postpartum monitoring that is necessary to ensure the child and mother’s health. There is also a need to improve access to reproductive health services, such as paid leave and
child care affordability.
Lastly, the importance of social determinants of health should not be neglected, such as lack of access to healthy foods, lack of safety and proper housing, air pollution and limited educational opportunities. Although seemingly unrelated, these factors exacerbate the systemic oppression and inequality that enables such
catastrophic outcomes.