Neonatal Mortality: The Quiet Crisis of the African-American Community

In my years working in healthcare, I have been blessed to see patients celebrate happy moments, but I have also witnessed times of profound grief. The loss of a baby is one such example that deals a devastating blow to our families, healthcare providers, communities and nation as a whole.

Most newborns grow and thrive, but in the United States, almost six out of every 1,000 babies die during their first year, according to the Centers for Disease Control and Prevention. Many of these deaths occur in the neonatal phase of development — the critical period

from birth to 28 days of life in which babies are more vulnerable to disease, infection and other complications. No mother, family or community in our country should have to endure the pain of losing a child. It’s all the more shocking to learn that African-American mothers lose a child before their firstmonth of life at more than twice the rate of white women— the highest rate of any racial group, according to the CDC.In some states, the equity gaps are even wider.

These figures should sound the alarm for all Americans, especially African-Americans, policy makers, healthcare providers and community leaders. This cannot be our quiet crisis any longer.

There are real lives at stake. It will take all of us, working together, to ensure African-American babies born in America have every opportunity to thrive. Here are five steps we can take to

get there:

Access— Increasing access to quality, timely and affordable healthcare is critical to our mission. African-American mothers who lost an infant were 2.3 times more likely than White mothers to not begin prenatal care until the third trimester, or not receive prenatal care at all, according to the Department of Health and Human Services.

Culturally Competent Care— The factors that influence neonatal health are myriad and complex, but we must continue our efforts to build a culture of health in the Black community— one that competently serves the unique needs of mothers on their pregnancy journey and ensures they are at her healthiest even before they conceive. This work requires healthcare providers enhance our outreach to communities of color to forge bridges of understanding among medical professionals and the patients they serve— relationships we know

lead to better health outcomes across the board.

Early Intervention— Caring for healthy Black babies begins before conception and continues throughout a mother’s prenatal and postpartum experience. Early care interventions are critical if we are to address and prevent neonatal and infant mortality, because they allow us to address conditions that could lead to poor birth outcomes.

Hypertension— a disease that disproportionately affects African-Americans and can cause serious birth complications —is one such disease that can be managed through a mother’s ongoing relationship with her healthcare provider.

Self-Empowerment— Importantly, African-American mothers must take full ownership of their healthcare experience. That means taking advantages of every opportunity to access proactive preconception, prenatal and postpartum care, and feeling empowered to ask questions. Understanding what’s normal, when to be concerned and when to call a doctor is the No. 1 thing African-American women can do to ensure their babies are born and stay healthy.

Healthy Communities— More cities and neighborhoods are waking up to the notion that where you live has a significant impact on your health. Addressing environmental and social factors of health— such as nutrition, stress, substance abuse and domestic safety— will do more than improve the lives of mothers and babies. Its impacts will be felt throughout the community. Healthy Neighborhoods Detroit, an Ascension Michigan program, provides a powerful example of a community building its capacity to address holistic health needs. By integrating healthcare, education, grocery access and affordable housing in some of the city’s most blighted areas, the effort is creating nerve centers where all residents can access the services they need.

The health of our youngest citizens is the yardstick by which we measure the prosperity of our country and communities. Fortunately, we have made great gains in reducing high rates of neonatal mortality. But there is still more work to do to address equity gaps for African-Americans. It will take a comprehensive,coordinated effort to eliminate this quiet crisis. By working together, we have reasons to hope for a future in which African-American babies survive, thrive and lead our communities into the future.

Patricia A. Maryland, Dr.PH, is the

President of Healthcare Operations

and Chief Operating Officer for Ascension

Health, the healthcare delivery subsidiary

of Ascension, the nation’s largest

non-profit and largest Catholic health

system.

Easing America’s Pain Epidemic: Managing opioid addiction in the black community

As America grapples with prescription opioid addiction, an epidemic shattering communities across our nation, healthcare providers face a challenging question: How can we help patients treat and manage their pain while reducing the risk of addiction?

Pain management is a serious health issue, as chronic cases of pain now affect more Americans than diabetes, heart disease and cancer combined. Not only does persistent pain afflict the emotional and financial well-being of people and their families, it also exacts a significant strain on our country— in the form of healthcare costs, long-term disability and lost worker productivity.

Pain does not discriminate based on background or health status, yet research points to substantial disparities in the prevalence, treatment and outcomes of pain. For many African-Americans and other minorities, understanding why these disparities exist is paramount to achieving pain care equity and improving quality of life.

Minorities are not at a higher risk for pain-related conditions than their white counterparts, but African-Americans consistently receive less-adequate treatment for acute and chronic pain— even after controlling for age, gender and pain intensity. What’s more, research also shows that minorities are more likely to be prescribed less-effective, non-opioid medications or opioids at a lower prescription dosage— than whites even when pain severity levels are comparable.

That is not to say opioids are always the preferred tool for treating pain. Indeed, when appropriately administered, opioids can help patients relieve or manage their pain. However, the prescription of less-effective medications or lower dosages does signal a troubling gap in instances when opioids can be an effective, pragmatic solution for African American patients.

Many factors are at play in understanding why African American patients are more likely to receive inadequate pain treatment, but physician bias is perhaps the biggest factor. While most physicians are strong advocates for health equity, negative preconceptions can creep into how pain is addressed in the clinical setting. Eliminating these biases is one key way we can achieve better outcomes for African-Americans experiencing pain, and that starts by understanding a patient’s heritage and belief system. With greater cultural competence, physicians can better manage pain in a manner that’s compatible with and respectful of patients’ backgrounds.

Access is another instrumental lever in erasing the pain care gap. The Affordable Care Act (ACA) widened helped to increase access to the doors to healthcare considerably for African-Americans, but too many individuals remain uninsured or unable to access basic medical services, including pain relief.

Encouraging loved ones to take advantage of the opportunities provided by the ACA can help them access the care and treatment they need to live comfortably.

But access alone is not enough. Equally important is building trust with the healthcare community so that pain-related conditions can be treated, managed and prevented. We know some African-Americans continue to be skeptical of the healthcare system, and that lack of trust can lead African American patients to underreport their pain levels, only furthering inadequate pain management. African American patients must take charge of their health and feel empowered to honestly communicate and set expectations with healthcare providers in order to receive the right care at the right time.

At Ascension, we’re working to achieve equitable pain management across all minority groups. We know our field is at a tipping point, and a failure to treat pain is not only poor medicine, it’s denying our brothers and sisters a basic human right. That’s why we are working in concert with our patients to develop national, comprehensive guidelines to pain management— standards that embed healthcare equity with our understanding of patient history and cultural sensitivity.

Guided by this understanding and deepened by our relationships with our patients, we are committed to the highest standard of pain management along the care continuum. This work also requires we actively engage African American patients and explore all pathways to care, including non-medicine, integrated forms of therapy.

There is still much more work to do to truly and fully eradicate disparities in pain management, and every member of our community has a role to play. Too many of our family members, friends and neighbors are hurting— often in silence— from pain in many different forms. Together, healthcare providers and the communities we serve can empower and support vulnerable patients along their pathway to relief.

Managing pain and opioid addiction in the black community

— As America grapples with prescription opioid addiction, an epidemic shattering communities across our nation, healthcare providers face a challenging question: How can we help patients treat and manage their pain while reducing the risk of addiction?

Pain management is a serious health issue, as chronic cases of pain now affect more Americans than diabetes, heart disease and cancer combined. Not only does persistent pain afflict the emotional and financial well-being of people and their families, it also exacts a significant strain on our country — in the form of healthcare costs, long-term disability and lost worker productivity.

Pain does not discriminate based on background or health status, yet research points to substantial disparities in the prevalence, treatment and outcomes of pain. For many African-Americans and other minorities, understanding why these disparities exist is paramount to achieving pain care equity and improving quality of life.

Minorities are not at a higher risk for pain-related conditions than their White counterparts, but African-Americans consistently receive less-adequate treatment for acute and chronic pain — even after controlling for age, gender and pain intensity. What’s more, research also shows that minorities are more likely to be prescribed less-effective, non-opioid medications — or opioids at a lower prescription dosage — than Whites, even when pain severity levels are comparable.

That is not to say opioids are always the preferred tool for treating pain. Indeed, when appropriately administered, opioids can help patients relieve or manage their pain. However, the prescription of less-effective medications or lower dosages does signal a troubling gap in instances when opioids can be an effective, pragmatic solution for African American patients.

Many factors are at play in understanding why African American patients are more likely to receive inadequate pain treatment, but physician bias is perhaps the biggest factor. While most physicians are strong advocates for health equity, negative preconceptions can creep into how pain is addressed in the clinical setting. Eliminating these biases is one key way we can achieve better outcomes for African-Americans experiencing pain, and that starts by understanding a patient’s heritage and belief system. With greater cultural competence, physicians can better manage pain in a manner that’s compatible with and respectful of patients’ backgrounds.

Access is another instrumental lever in erasing the pain care gap. The Affordable Care Act (ACA) helped to increase access to healthcare considerably for African-Americans, but too many individuals remain uninsured or unable to access basic medical services, including pain relief. Encouraging loved ones to take advantage of the opportunities provided by the ACA can help them access the care and treatment they need to live comfortably.

But access alone is not enough. Equally important is building trust with the healthcare community — so that pain-related conditions can be treated, managed and prevented. We know some African-Americans continue to be skeptical of the healthcare system, and that lack of trust can lead African American patients to underreport their pain levels, only furthering inadequate pain management. African American patients must take charge of their health and feel empowered to honestly communicate and set expectations with healthcare providers in order to receive the right care at the right time.

At Ascension, we’re working to achieve equitable pain management across all minority groups. We know our field is at a tipping point, and a failure to treat pain is not only poor medicine, it’s denying our brothers and sisters a basic human right. That’s why we are working in concert with our patients to develop national, comprehensive guidelines to pain management — standards that embed healthcare equity with our understanding of patient history and cultural sensitivity.

Guided by this understanding and deepened by our relationships with our patients, we are committed to the highest standard of pain management along the care continuum. This work also requires we actively engage African American patients and explore all pathways to care — including non-medicine, integrated forms of therapy.

There is still much more work to do to truly and fully eradicate disparities in pain management, and every member of our community has a role to play. Too many of our family members, friends and neighbors are hurting — often in silence — from pain in many different forms. Together, healthcare providers and the communities we serve can empower and support vulnerable patients along their pathway to relief.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer for Ascension Health, the healthcare delivery subsidiary of Ascension, the nation’s largest non-profit and largest Catholic health system.

Taking a closer look at black mental health

— Good physical and mental health help drive success and enjoyment in our lives. But when it comes to overcoming some of our society’s biggest health challenges – from HIV/AIDS to cancer to diabetes to behavioral health issues – the African-American community unfortunately shoulders a disproportionate share of the burden. As our nation increasingly deals with violence, suicide and depression, it’s important to take a close look at the state of Black mental health in America.

The National Institute of Mental Health estimates that one of every five adults in the U.S. — some 43 million people — will experience mental illness this year. African-Americans are far from immune. In fact, Blacks are more than 20 percent more likely than Whites to report having serious psychological distress. For people of color living in poverty-stricken neighborhoods, where rates of homelessness, incarceration, substance abuse and violent crime are higher, the risk of mental illness is compounded.

One of the challenges African-Americans with mental health issues continue to face is an imbalance in health insurance coverage. While the Affordable Care Act has caused the uninsured rate among Blacks to decline by close to 10 percentage points between 2013 and 2016, it remains almost twice as high as the uninsured rate for non-Hispanic Whites. There is also a lack of African-American mental health professionals who can deliver culturally competent care for illnesses that are often deeply personal and can be the subject of stigmatization. According to a 2014 survey, less than 2 percent of American Psychological Association members are African-American.

These disparities are unacceptable. It is clear that we must make mental health equity a guiding principle and an utmost priority. As Ascension’s President and CEO Anthony Tersigni recently stated: “Insurance coverage for the treatment of these disorders has long been discriminatory compared with coverage for physical diseases. In 2008, the federal government essentially legislated that there be parity between mental health coverage and physical health coverage, but the intended changes have been problematic and slow in coming.”

On the part of healthcare providers, addressing this challenge means promoting and expanding access to affordable mental and behavioral healthcare — care that recognizes the stressors that African-Americans experience and provides solutions that are culturally competent. For our part, we have established behavioral/mental health as a dedicated priority service line across our national healthcare system.

This work demands continued investment in community health centers, which are vital to serving high-need minority neighborhoods. And it requires that we go beyond the traditional scope of care by addressing the socioeconomic needs that contribute to mental health, including access to affordable housing, food security and more.

Going beyond the traditional scope also means that our nation must address the care of our military veterans. Current statistics reveal that 18 to 22 veterans die by suicide each day in America because of their unique mental and behavioral health needs. Some of these veterans are African-Americans; we must do more to help all vets. That’s one reason for Ascension’s participation in the federal Veterans Choice Program, which was formed to improve the quality and access of care to veterans nationwide.

All of these programs and investments are important, but real gains in this fight will not come without the support and participation of the African-American community overall. We must stop viewing mental illness in America as if it were a personal failing rather than a serious health concern. And we must help our loved ones and neighbors to stop neglecting the care they need because of stigmas that surround mental health. These stigmas must be addressed and overcome.

While communities of color are having important conversations about mental health, we can do more. Breaking down these barriers will compel us not only to recognize the necessity of mental health care, but also to marshal our support for family, friends and neighbors who are seeking the help and treatment they need. Together, we can build a healthier, stronger community, where getting support for mental health problems is not a sign of weakness, but one of strength.

Patricia A. Maryland, Dr.PH, is the President of Healthcare Operations and Chief Operating Officer for Ascension Health, the healthcare delivery subsidiary of Ascension, the nation’s largest non-profit and largest Catholic health system.

PHOTO CAPTION: Patricia Maryland says that we must make mental health equity a guiding principle and an utmost priority.