Health Equity Digest – August 2023: Heart Health, Gun Violence, Maternal Health and Equitable Innovation

Welcome to Real Chemistry’s Health Equity Digest, a monthly summary of relevant highlights and emerging trends in today’s complex, ever-evolving health equity space.

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A study by researchers at the Smidt Heart Institute found:

• Black Americans experience sudden cardiac arrest at twice the rate of white people.  

• About 350,000 Black Americans die every year from sudden cardiac arrest.

• Black Americans were an average of six years younger than white people when they experienced sudden cardiac arrest.

• The incidences of sudden cardiac arrest numbered 175 per 100,000 Black men, compared to 84 per 100,000 white men.

• For Black women, the incidences numbered 90 per 100,000, compared to 40 per 100,000 for white women.

• 52% of Black women patients had diabetes, compared to 33 percent of white patients.

A study in the New England Journal of Medicine also found disparities in the rates at which Black people and Hispanic people receive bystander CPR. The studies show how the lack of CPR training — and the disparities in how much CPR training is conducted in Black and Hispanic communities’ — results in poorer health outcomes and Black people having a lower likelihood of surviving an out-of-hospital cardiac arrest.

When compared to white people, the likelihood of getting bystander CPR:

• Was 26% lower for Black and Hispanic people in their homes

• Was 37% lower for Black and Hispanic people in public environments

Black and Hispanic people were less likely than white people to receive bystander CPR in every public location category, including in:

• Workplace settings, at 53.2% vs. 61.8%.

• Recreational facilities, at 55.8% vs. 74.4%.

• Public transportation centers, at 48.3% vs. 69.6%.

READ:

• A new Forefront series, “Private Sector Solutions for Health Equity,” features analysis, recommendations, and commentary that will inform efforts to advance health equity. The series includes articles exploring private sector efforts to challenge injustices in healthcare, including public-private partnerships and community initiatives. Topics covered include cardiovascular health, mental health, and maternal health.

• Structural racism may contribute to mass shootings, study says: Mass shootings in major metropolitan areas in the United States disproportionately affect Black people and structural racism could be a factor, according to the Journal of the American Medical Association. The study found that in areas with higher Black populations, mass shootings are more likely to occur compared to communities with higher white populations. Black people are more likely to be injured and killed when mass shootings take place. One Georgia-based study found that economically disadvantaged neighborhoods with limited financial support for schools were more likely to have children victimized by gun violence. Within their sample, Black children had the highest exposure to this violence. The researchers aimed to find whether mass shootings result from structural racism, defined as “the normalized and legitimized range of policies, practices, and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color.”  In conclusion, the study found that “racial and ethnic minority populations are significantly more likely to be victims of (mass shootings)” and that systemic inequities lead to a variety of outbreaks of gun violence in the US.

According to Everytown research, persistent gun violence contributes to individual, family, and community-level trauma in Black communities. They define community trauma as “not only the sum of the hurt and suffering of individuals who have had traumatizing experiences. It is also a collective trauma experienced in communities with elevated levels of violence.” Community trauma can include many forms of violence, from gun violence to structural violence, like underinvestment in healthcare, schools, and housing.  

• Today, firearms are a leading cause of death among children and teens in the United States.

• Black Americans are 10 times more likely than white Americans to die by gun homicide.

• Every 11 minutes, a Black American is shot and wounded.

• Black children and teens are five times more likely than their white peers to die by a firearm.

• Black youth who have experienced trauma are five times more likely to attempt suicide than those with no personal history marked by trauma.

• Young Black men are 21 times more likely to be shot and killed by police than their white counterparts.

• Black Americans exposed to gun violence are more likely to experience physical, emotional, mental, and social symptoms of trauma due to gun violence.

• One study found that exposure to homicide among young children impaired their impulse control and impeded their cognitive functioning.

LEARN (U.S.):

• As breastmilk is a vital source of nutrition for babies — providing essential nutrients and disease protection – there is an urgency to make breastfeeding a public health priority. August is National Breastfeeding Month. This year’s theme “This is Our Why,” highlights the importance of supporting families in need. However, many families have expressed that breastfeeding is overwhelming and that there is a lack of postpartum support. Northwestern University researchers have found that mothers need the support and direct engagement from partners as a critical factor for success in breastfeeding. With many return-to-office mandates starting to pick up, working mothers are now facing logistical hurdles (pumping, packing, and transporting milk), posing steep and unfair challenges. Experts have underscored that healthcare systems and companies must change policies to support breastfeeding families with prenatal education, postpartum care, and workplace laws to help families feel confident and at ease throughout their postpartum and breastfeeding journeys. 

  • On the topic: 

    • Motherly: Study shows fathers are key in supporting breastfeeding and safe sleep

    • Urbana Daily Citizen: Breastfeeding is a public health priority

    • KevinMD: Revolutionizing postpartum care: Transforming breastfeeding support for families

    • MarketWatch: Breastfeeding moms feel stressed by return-to-office mandates, according to this study of over 15,000 women

LEARN (GLOBAL):

• Sri Lanka’s department of labor unveiled a new policy which indicates that mothers working the private sector can have two hours for breastfeeding until the child is one year old, whereas a mother working in the public sector is entitled to one hour for breastfeeding. World Breastfeeding Week is celebrated annually across the globe from August 1-7. This year’s theme, “Enabling Breastfeeding: Making a difference for working parents,” aims to tackle workplace challenges when it comes to nursing and promote supportive parenting norms like paid leave.

• In Ireland, a provision of the Work Life Balance Act now allows mothers to take one-hour breaks to breastfeed or express to two years, making this a significant improvement in workplace policies. Ireland’s paid maternity leave was previously 12 weeks and has since been extended to six months, so the new policy for breastfeeding gives nursing mothers the chance to implement themselves back into the workforce without having to give up breastfeeding sooner or take unpaid maternity leave. Removing barriers in the workplace, it is vital to take the time to build the supportive environment needed as well as garner support from families and society.

RESEARCH:

• A new report from the United Nations (UN) reveals a systemic pattern of racially-motivated abuse against Black women in the healthcare system. Research shows a threefold higher risk of maternal mortality for Black women compared to white women. The UN report directly debunks several common myths that blame women of color for suffering worse maternal outcomes, and instead sheds light on the disproportionate levels of mistreatment that stem from unscientific and slavery-era beliefs still present in the medical system. New research from the Journal of the American Medical Association (JAMA) further underscores these discrepancies and emphasizes the importance of patient advocacy with findings that showed that the maternal mortality ratios were disproportionately higher among Black and Native American populations, particularly in states where these inequities are not being highlighted or explored. 

  • On the topic:

    • ABC News: Cedars-Sinai Medical Center facing federal probe over treatment of Black mothers

    • HealthDay: Higher Maternal Death Rates Among Black Women Tied to Racism, Sexism, UN Says

    • AP News: Maternal deaths in the US more than doubled over two decades. Black mothers died at the highest rate

    • Los Angeles Times: Cedars-Sinai faces civil rights lawsuit over Black mother’s 2016 death

    • KFF Health News: Black, Rural Southern Women at Gravest Risk From Pregnancy Miss Out on Maternal Health Aid

• The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2024 Medicare Physician Fee Schedule (PFS) proposed rule, outlining changes to advance equity in quality reporting and value-based payment programs. Example proposals include coding and payment for social determinants of health (SDOH) risk assessments; requiring health equity initiatives in the Medicare Shared Savings Program (e.g., SDOH screening tools, partnerships with community organizations); and expanding the health equity adjustment to Medicare Clinical Quality Measures (CQMs) for Accountable Care Organizations.

• A study published in JAMA Network found that Latinx and non-Latinx Black patients have lower participation in oncology trials compared to non-Latinx white patients. Additionally, there were greater inequities in participation between Black and white patients during the COVID-19 pandemic (2020-2022) than before the pandemic (2017-2019). These results indicate the need for regulatory guidance to enhance enrollment of individuals from historically excluded racial and ethnic populations in clinical trials.

• Opportunities and Challenges to Advance Health Equity Using Digital Health Tools in Underserved Communities in Southeast US: A Mixed Methods Study: The U.S. health system has seen a rapid increase in adoption of health information technology and digital health tools (DHTs) over the last 30 years. DHTs have the potential to ameliorate health disparities, but only if they are accessible and used by clinicians serving patient populations experiencing health inequities. Despite the rapid uptake of DHTs and accompanying investments, inequitable access to and use of DHTs by primary care clinicians and patients has remained a problem. This study describes the impact adopting DHTs by primary care clinicians has on expanded access to healthcare and reducing health disparities in regions with longstanding health and social inequities. The findings identify opportunities to leverage DHTs to advance health equity and highlight opportunities for policy improvement.

• Black people in redlined neighborhoods face higher risks for heart failure: A study published in the American Heart Association's scientific journal Circulation says that Black adults living in zip codes historically impacted by redlining have an 8% higher risk of developing heart failure than Black adults in non-redlined areas.

  • On the topic: According to the Cleveland Clinic:

    • Black men have a 70% higher risk of heart failure than white men.

    • Black women have a 50% higher risk of heart failure than white women.

    • Black adults are more than twice as likely as white adults to be hospitalized for heart failure. They also spend longer in the hospital and are more likely to be admitted again within 90 days.

    • Hispanic adults are more likely than white adults to have heart failure.

    • Unlike Black adults, the study found that White adults living in communities with a high proportion of redlining did not have a higher risk of heart failure.

    • People living with hypertension and Type 2 diabetes are at an increased risk for heart failure and complications. These chronic conditions disproportionately affect historically marginalized communities more than white communities.

    • Increased risk for hypertension and Type 2 diabetes are among the other ailments that disproportionately affect Black residents in these neighborhoods.

    • American Indian people/Alaska Native people, and non-Hispanic Black people are diagnosed with diabetes at double the rate compared to non-Hispanic white people.

    • Racial and ethnic groups also have a higher burden of diabetes-related complications. However, they have less access to treatments to prevent and manage those complications, the Centers for Disease Control and Prevention reports.

MEET:

• Warren Whyte received his Ph.D. in bioinformatics from MIT and has dedicated his career to advancing health equity through novel technologies for almost two decades. Whyte is currently a Vice President at ConcertAI, a company dedicated to improving outcomes for patients through real-world data, AI technologies, and scientific knowledge in partnership with leaders in the medical community. As the founder of the company’s health equity program ERACE (Engaging Research to Achieve Cancer Care Equity), he spends his days partnering with life science companies to embrace new models to achieve more equitable health outcomes. His work has led to the creation of a Health Equity Guide for leaders titled “Using Data and AI to Achieve Health Equity” and coverage in publications such as the Boston Business Journal. Most recently, he contributed to a Syneos Health Weekly Newsletter titled “Promoting Health Equity through AI Integration: Navigating Challenges and Embracing Regulation.” Follow him on LinkedIn where he frequently shares informative posts about the intersection between health equity and data science.

• Jen Horonjeff has a Ph.D. in environmental medicine and is a researcher and the founder and CEO of Savvy Cooperative, the “first and only patient-owned public benefit co-op” which “gives patients direct ways to share their experience with health innovators” and helps them earn money for their contributions. As a lifelong autoimmune disease patient and brain tumor survivor, she witnessed a lack of diversity in the patient perspectives being shared with the medical community firsthand which inspired her passion for patient engagement. Her thought leadership has been recognized by the likes of TechCrunch and The Boston Globe, and she regularly speaks on industry panels and LinkedIn about social determinants and inclusivity in healthcare.

WATCH:

• Health Equity Distinguished Lecturer – NINR: The lecture hosted by National Institute of Nursing Research (NINR) features Daniel E. Dawes, Senior Vice President of Global Health Equity, and the Executive Director of the Institute of Global Health Equity at Meharry Medical College. The conversation explores the Dawes’ research on health equity and social and political determinants of health.

• Health Equity with a Latino Lens: The conversation was a part of Aspen Ideas: Health 2023. The panelist explores the opportunities to advance equitable health outcomes that include increasing access to affordable healthcare, expanding insurance coverage, providing culturally competent services, and addressing social determinants of health for Latinos.

• DRIVing Diabetes Equity in the Heart of Oakland – Building a Sustainable Community Approach: The webinar highlights the Center for Sustainable Healthcare Quality & Equity’s DRIVE diabetes program, a community-based approach and multi-tiered collaboration in Oakland, CA with West Oakland Health, and the Hope Center Church.

• Policy Implementation for Increasing Diversity in Clinical Trials – Can FDORA Get Us There: This blackdoctor.org discussion explores the Food & Drug Omnibus Reform Act (FDORA) of 2022, the complexities of increasing diversity in clinical trials, and what it means for the development of safe and effective drugs and devices for diverse populations.

• Conversations on Food Justice – Race and Water Equity: Panelists discuss how the construction of U.S. urban water systems and the development of water policy have been rooted in racial discrimination, depriving communities of color access to essential water services and contributing to a water affordability crisis that threatens the health and safety of millions.

LISTEN:

• To Improve Cardiac Outcomes for Women, Increase Their Representation: This conversation features cardiologist Martha Gulati, M.D., and explores women’s historical exclusion from clinical trials for heart disease, why sex and gender matter in the search for better treatments, and the persistent gaps in women’s cardiology care and research.

• Empowering Crisis Response and Treatment—featuring Nishi Rawat: This episode explores the OpenBeds initiative to improve access to mental health and substance disorder treatments led by Nishi Rawat, Chief Clinical Innovation Officer at Bamboo Health.

• Black Women Share Pregnancy and Post-birth Experiences in Community Circles: This conversation explores the Community Circles led by Dr. Diane Banigo, a certified nurse midwife, and Ciana Cullens, a community relations liaison. Community Circles are virtual, consultant-led and supported classes that bring Black women together through every stage of pregnancy and post-birth to share their experiences, joys, questions, thoughts, and fears.

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