OpEd – GRAAHI

Raising Awareness: Addressing the crisis of Black Maternal and Infant health Disparities

April 18, 2024April 18, 2024 by Vanessa Greene

By Vanessa Greene, CEO, GRAAHI

In the landscape of maternal and infant health in the United States, there exists a profound and persistent disparity that demands our attention: the disproportionate rates of mortality and morbidity among Black mothers and infants. Despite advances in medical technology and healthcare access, Black women are still two to three times more likely to die from pregnancy-related causes and experience higher rates of pregnancy-related complications such as pre-eclampsia, eclampsia, and gestational diabetes than white women, and Black infants are more than twice as likely to be born prematurely and with low birth weights, factors that significantly increase their risk of mortality and long-term health challenges. Additionally, Black babies are twice as likely to die before their first birthday compared to White babies. These statistics paint a stark picture of the obstacles Black mothers and infants face in achieving optimal health outcomes.

The roots of this crisis run deep, intertwining historical injustices, socioeconomic factors, and systemic racism. From the legacy of slavery and Jim Crow laws to ongoing discrimination in healthcare settings, Black individuals have faced barriers to accessing quality care and have been subject to unequal treatment within the medical system.

Policy initiatives at the federal, state, and local levels are essential for driving systemic change. In the pursuit of equitable maternal healthcare, the roles of Black Birth Workers and Midwives are increasingly recognized as pivotal in improving birth outcomes. Through education, emotional support, and empowerment, doulas and midwives help Black mothers reclaim agency over their bodies and births, navigate the complexities of pregnancy and childbirth, and develop a sense of empowerment and self-efficacy. Thus, Black women who receive care from Doulas and Midwives experience lower rates of preterm birth and low birth weight infants, due to the personalized care and support they provide.

In recent years, there has been growing recognition of the urgency to address Black maternal and infant health disparities. Advocacy groups, healthcare organizations, and policymakers are increasingly mobilizing to develop solutions and advocate for equity in healthcare delivery. However, meaningful progress will require sustained commitment, resources, and collaboration across sectors. Continuous investment in and expanding access to doulas and midwifery care is essential for advancing equity in maternal healthcare and ensuring that all Black mothers receive the support and respect they deserve.

Mindful of the data and the growing disparities GRAAHI has committed itself to take seriously our responsibility to black birth givers in Grand Rapids in particular. We have been collaborating with community partners to introduce the concept of a birth plan to expectant parents as the first step to exercising agency over one’s birthing process. We continue to send our staff and provide resources for others in our community to become birth and breastfeeding doulas to elevate the voice of the birth giver and provide evidence-based information. We have incorporated a doula and midwife track to our Pathways Workforce Development Initiative to increase diverse leaders in the healthcare sector and another level of support to Black birth givers. We have also implemented a multidisciplinary Maternal Infant Health Task Force to develop specific, actionable, and measurable targets to significantly reduce mortality rates among Black mothers and babies.

Ultimately, achieving equity in maternal and infant health is not just a matter of improving healthcare access; it is a moral imperative and a reflection of our society’s values for life. By dismantling systemic barriers, confronting institutional racism, and prioritizing the well-being of Black mothers and infants, we can work towards a future where race and socioeconomic status is not a predictor of health outcomes.

Research shows health care disparities still prevalent for Black residents

February 21, 2023 by Vanessa Greene

By Vanessa Greene for the Grand Rapids Business Journal – Published February 17, 2023

It’s no secret that historically, health care outcomes for Black people and other non-white Americans have been an area of concern.

These numbers, from longstanding systemic inequities in the health care system, social determinants such as a lack of accessible health care facilities in some communities, to outright discrimination, can leave Black residents less likely to trust doctors and seek proper care. This last point was most evident during the height of the COVID-19 pandemic, when more Black residents were dying in part due to this distrust of the medical establishment.

At the Grand Rapids African American Health Institute, we recently undertook a much more local approach to this issue and have analyzed state data to showcase the severity of the disparities right here in our backyard of Kent County.

County-level disparities

Led by our research coordinator Andrae Ivy, MPH, we dove into state health care data from 2014 through 2020, examining 17 key health trends — from diabetes and obesity, to cancer, infant mortality and teenage births — and how they impacted Black, white and Hispanic residents in Kent County.

What quickly emerged was a troubling pattern. Among the biggest Kent County trends were:

15.1% of Black residents have diabetes vs. 10% of white residents
Obesity rates were 41.6% for Black residents, compared to 28.5% for white residents and 30.1% for Hispanic residents.
Heart disease mortality rates continue to climb for Black residents, reaching a new high of 541.3 per 100,000 residents. Stroke mortality also grew significantly from 2017 to 2020.
10.2% of Black residents could not see a doctor due to health care costs vs. 8.8% for white residents.
Asthma rate for Black residents was 19% vs. 14.1% for white residents.
Both the prostate cancer rate (135 per 100,000 men) and lung cancer rate (75.9 per 100,000 residents) for Black residents were significantly higher than rates for white residents.
Infant mortality rate was 13.8 per 1,000 births for Black residents, nearly triple the 4.8 per 1,000 births rate for white residents.
Teenage birth rates were much higher for Black residents (32.3 per 1,000 females ages 15-19) and Hispanic residents (27.3), compared to the 7.7 rate for white residents.
Medical debt due to out-of-pocket costs is another major obstacle. According to a 2022 survey of Michigan residents by Epic-MRA and the advocacy group Consumers for Quality Care, among Black voters that have had their household finances seriously affected by medical debt, 80% say they’ve had medical bills go into collections.

Also, 65% of Black voters expressed concern that health care costs will be negatively impacted by long-term effects of COVID-19 in Michigan, compared to 58% of the state’s population overall. And 69% of Black Michiganders are concerned about expected impending loss of health care coverage expanded during the pandemic through the Affordable Care Act, compared to 51% of the state’s population overall.

Addressing inequities

While there is not one easy answer that will close these gaps in health care for Kent County’s Black residents, one thing is clear. Without major improvements to the systems surrounding access to health care in communities of color, these disparities in West Michigan and beyond will continue to persist.

Between changes at insurance companies to improve affordability of health care, increased state and federal support, and significant local community efforts, policymakers must prioritize implementing policies that improve health outcomes in the Black community.

Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. They also have worse health outcomes for most conditions. To combat these disparities, legislators and health care professionals must explicitly acknowledge that race is a factor in health care.

Although the majority of individuals have at least one full-time worker in the family across racial and ethnic groups, people of color are more likely to live in low-income families that do not have coverage offered by an employer and have difficulty affording private coverage. According to a recent study by the Kaiser Family Foundation, the ongoing gaps in coverage for people of color could further widen the coverage gaps they already face and, in turn, exacerbate broader disparities in health and health care. With this in mind, efforts to increase insurance coverage and make health care affordable are crucial.

My organization works every day to educate the public on their health care rights and how to navigate the system, while also teaching preventive health care measures, as we work to help change these statistics. But officials at the city, state and federal levels, as well as health care systems and insurance companies, must recognize the serious inequities this research has exposed and work to address them. Improving disparities requires a collective effort across many systems and organizations.

Some examples include working to address key social determinants that can lead to poor health, offering more accessible and affordable health care options in communities of color that lack them, diversifying the health care workforce, proactively connecting patients with supportive social services and eliminating inequities in the quality of care. Additionally, it is important to monitor and document efforts toward reducing health disparities to determine what’s working.

If we’re ever going to deliver a realistic chance at equal access to quality health care for all residents of Kent County, we must work together vigorously as if our own lives depend upon it.

To read the article on GRBJ, click here>>.

To learn more about GRAAHI and the Health Equity Index, visit https://hei.graahi.org/.

The Brutal Death of Tyre Nichols and the cumulative effects of police brutality and trauma on the Black community

February 27, 2023February 2, 2023 by GRAAHI Editorial

Andrae Ivy, MPH | GRAAHI’s Director of Research | February 2023

On January 27th of 2023, the world watched yet again as a Black man named Tyre Nichols was viciously beaten and harassed by a group of police officers in Memphis, TN. The images, words and violence in this video were terrifying to watch, as the officers seemed determined to end this

young man’s life following a routine traffic stop. After being violently punched, kicked and tasered, Mr. Nichols would eventually slump to the ground, blood running down the side of his swollen and distorted face onto the cold pavement. The officers showed no signs of treating Mr. Nichols like a human being before, during or after the attack, as they casually shared excuses and lies to justify their violence. The grotesque injuries Mr. Nichols suffered from the beating can also be viewed, as he laid lifeless in a Memphis hospital room with a face reminiscent of Emmett Till’s. Unfortunately, Mr. Nichols would eventually succumb to his injuries and lose his life three days later. Upon release of the video, five of the officers involved in the incident were fired. That following Monday on January 30th, a sixth officer was fired in connection with the beating. This traumatic event is all too familiar for Blacks or African Americans who are often reminded of their fragile and devalued nature in the face of police officers. Blacks are tired of this state-sanctioned treatment and need tangible protections and anti-hate policies to prevent such attacks from reoccurring.

From Rodney King to Sandra Bland to George Floyd to Breonna Taylor to Tamir Rice to Atatiana Jefferson to Patrick Lyoya and so many others, the deaths of Blacks or African Americans in the presence of police officers are commonalities that plague the hearts and minds of not only the victims and their families, but also those who share a similar phenotype across the many cities and states in this country and across the world. According to Mapping Police Violence, Blacks in America are nearly three times more likely to be killed by police officers compared to whites, resulting in 254 Black deaths in 2022. In addition, this study found that 100 out of 100,000 Black men and boys will be killed by police officers during their lifetime compared to 39 white men and boys. Since Blacks as a whole collectively share the grief and trauma of these deaths, it’s important for Blacks and society to better understand the cumulative effects of these unethical actions on the mental, physical and emotional health of the entire Black population. Several studies have investigated the impact of traumatic events, such as police brutality and racism, on the overall wellbeing of Blacks. One study in 2018, led by Dr. David Williams, found that the killing of an unarmed Black person by a police officer resulted in many days of poor health for Blacks in that state for the next three months. Another study found that Blacks and other non-white groups were more likely to report police victimization, in which that victimization was significantly linked to psychological distress and depression. In a more robust study, researchers found that the constant threat of police violence, the actual acts of police brutality, and the aftermath of these events have a collective and “allostatic load” effect on the mental health of those victimized along with those who identify racially or culturally with said victims. In addition, this study also determined that the effects of police brutality mirror the effects of racism

occurring within many facets of society such as housing, education, employment and health care.

In this interesting study, Black drivers in America were nearly 20% more likely to be stopped by police officers and nearly twice as likely to be searched compared to their white counterparts. When being confronted by police officers, many Blacks run and flee, which is viewed by some as an indicator of guilt. Many Blacks know the history of this country and the unequal treatment with police officers and the justice system, even when no wrongdoing has occurred. In 2016, the Massachusetts (MA) Supreme Judicial Court showed support for this reality regarding a Black man in Boston who was wrongfully profiled during a police investigation. The MA Supreme Court stated, “The finding that Black males in Boston are disproportionately and repeatedly targeted for FIO [Field Interrogation and Observation] encounters suggests a reason for flight totally unrelated to consciousness of guilt. Such an individual, when approached by the police, might just as easily be motivated by the desire to avoid the recurring indignity of being racially profiled as by the desire to hide criminal activity.” This statement by the MA Supreme Court basically means that Black men running from police officers is understandable due to the fact that Black men are more likely to be racially profiled. Their statement also confers that some Black men simply run to escape the indignity of being racially profiled and a potential victim of police brutality, and that this shouldn’t indicate any form of guilt on their part. This is important to note when thinking about Tyre Nichols who decided to run in an attempt to reach his mother’s home, just sixty yards away. Unfortunately, he was unsuccessful.

Typically, police brutality against Blacks usually involves white officers. In Tyre Nichols’ case, the officers involved were mainly Black, indicating that Black officers can also possess and demonstrate hate, bias and prejudice towards Black life. Such behavior is repulsive no matter the person’s background, and justice should be served no matter the officer’s race. This fact reinforces calls to investigate police departments, unions and officers to determine their ability to serve and protect the community without bias, hate and prejudice. If not, more innocent lives will be lost. On another note, these acts of police brutality from some officers stain the image and reputation of all officers, even though this behavior isn’t indicative of all officers. Like many citizens, many police officers also expressed their dismay with the vile behavior displayed by the officers in Mr. Nichols’ case and many other cases of police brutality, showing that all officers can’t be blamed for the actions of some. The Grand Rapids African American Health Institute (GRAAHI) is dedicated to increasing health equity for Blacks or African Americans in the Grand Rapids community. These acts of violence against Black bodies impact our mental and physical health. We are deeply troubled by the death of Tyre Nichols and so many others. Even though these officers were swiftly charged, many systematic changes, such as anti-Black hate policies and protections, are needed to revamp and rebuild the justice system and the consciousness of Americans, so a person’s life isn’t deemed less valuable because of the color of their skin.

We at GRAAHI offer our sincerest thoughts and prayers to the family of Tyre Nichols.

My Take: COVID vaccination rates highlight African American distrust of health care system.

July 14, 2022April 28, 2022 by Vanessa Greene

Grand Rapids African American Health Institute

As COVID-19 restrictions are lifted, the future health of Michigan residents will rely in large part on the percentage who are vaccinated against the virus. Unfortunately, that number remains low among African Americans. In Michigan, only 44 percent of the African American population has received a COVID-19 vaccine dose, among the lowest rates in the country.

The answer to why is multi-factored, but a large part is general distrust of the health care system by many African Americans — distrust formed over time due to a long history of inequities and mistreatment. We must become more intentional about making changes, both immediately and over the long-term, so African Americans have better experiences in their health care journey and their level of trust in the system grows.

Although COVID vaccination may be the topic of the day, this distrust impacts African American health care in many ways beyond the virus. For example, African Americans have the highest death rate and shortest survival of any racial/ethnic group in the United States for most cancers. Diabetes, HIV/AIDS, asthma, obesity, and Alzheimer’s also appear at higher rates in people of color when compared to whites.

Longstanding systemic inequities and structural racism are disproportionately harming communities of color. Studies show that physicians spend less time with African American patients, and when they are seen, concerns are more often dismissed or ignored. Communities of color are more likely to live in poverty and in areas with high pollution, substandard education and housing, and fewer health care facilities.

Another area where disparities stand out for African Americans is maternal health care. In Michigan, African American women die of pregnancy-related causes in 41 out of 100,000 live births, compared to 15 in 100,000 live births of white mothers. African American babies also die at a rate 3 times higher than white babies. In Kent County, African American infants are 2.5 times more likely to die before age 1 than white infants, and 2.2 times more likely to have low birth weights. At the root of this issue, studies show that pregnant African American women are often ignored by their doctors when discussing possible complications of their pregnancy.

Unfortunately, the distrust in the health care system caused by these and other inequities will lead to further health disparities in the future, as African Americans will be less protected against COVID.

African Americans currently make up 18 percent of all COVID deaths in Michigan, a disproportionate number compared to population, and many more will suffer from long-term impacts, especially since COVID is more dangerous to people who have co-morbidities such as heart disease, diabetes and obesity, which appear in African Americans in higher rates due to past inequities.

The Grand Rapids African American Health Institute’s (GRAAHI) “United Against Covid” campaign is working directly with African American communities to promote vaccinations and other preventative health care measures. We have clinics set up throughout Kent County in Grand Rapids, Kentwood and Wyoming, and with vacations and travel increasing, it is all the more important for people to get vaccinated. Many people believe that those who want to get vaccinated have already done so, but we do not accept this to be true and will continue to provide every opportunity possible for people to get vaccinated. You can learn more about GRAAHI’s vaccination clinics at graahi.com/getvaccinated.

But we can only do so much as one organization. Our elected leaders must prioritize policies that recognize the impact of social determinants on diverse populations and seek to remedy key factors that help lead to inequities, solving the problem at its source. Advocacy, community education and research must all be key components of these efforts. Finally, the lack of diversity in the medical field is another issue that can be addressed. Only 6.2 percent of nurses and 5 percent of doctors identify as African American. The role of African American health care providers is critical, as more diversity on health care teams can play a key role in lowering the level of distrust. At GRAAHI, we work with Michigan universities to improve the pipeline of African American medical professionals in our state, and we need elected officials to make this a priority as well.

Although we have made progress, we are dealing with a system that has been broken for centuries. It is time to recognize the magnitude of this problem and come together at the community and governmental levels to break this vicious cycle. Through our combined efforts, the future can be much brighter. Vanessa Greene is CEO of the Grand Rapids African American Health Institute, an organization devoted to achieving healthcare parity for African Americans and ensuring all people have optimal health care and benefit from health systems without race being an impediment.

In the Media:

https://www.hollandsentinel.com/story/opinion/columns/2022/04/22/my-take-covid-vaccination-rates-highlight-african-american-distrust-health-care-system/7371611001/

and

https://www.cheboygannews.com/story/opinion/columns/2022/04/22/my-take-covid-vaccination-rates-highlight-african-american-distrust-health-care-system/7371611001/