Health Equity & Social Justice

The Health Divide: Black maternal health gets election boost; high marks for gender-affirming care; pain med disparities persist

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(Photo by Kent Nishimura / Los Angeles Times via Getty Images)

October 28, 2024

Advocates are seeking to use the presidential election as an opportunity to shine a light on Black women’s reproductive health, reports Reuters.  

“Such concerns go beyond abortion rights, an issue that has galvanized women since the U.S. Supreme Court overturned the constitutional right to an abortion in 2022,” write reporters Bianca Flowers and Disha Raychaudhuri.  

Harris has made abortion rights a key part of her campaign, and she was a sponsor of the 2020 Momnibus Act, focused on maternal health disparities, as a senator. Several recent campaign stops have also highlighted Black maternal mortality.  

As the election approaches, numerous activist groups are mobilizing women of color around systemic health inequities, such as higher rates of maternal and infant mortality. 

Study: Birth weight, not physician race affecting Black infant mortality 

New research is challenging an earlier finding that Black infants fare better when they receive care from Black physicians.  

In 2020, researchers found that Black infants were less likely to die in their first year of life if they received care from a Black doctor, according to the influential study published in Proceedings of the National Academy of Sciences (PNAS) journal. 

But a study published last month took another look at the same data, this time controlling for very low birth weights, as STAT science correspondent Usha Lee McFarling reports. Researchers this time found the survival differences were tied to infant birth weight — not the race of the attending physician.  

The new findings, also published in PNAS, “suggest that the key to narrowing the Black–White gap may continue to lie in reducing the incidence of such low birth weights among Black newborns,” the authors wrote.  

Youth who receive gender-affirming care ‘highly satisfied’ 

Transgender youth ages 12 and older who used puberty blockers or hormones reported high levels of satisfaction and low regret, according to a survey of 220 youth in the U.S. and Canada published in JAMA Pediatrics this month.  

Researchers checked in with the participants several years after they had received the gender-affirming medical care, part of a longitudinal study called the TransYouth Project. “The findings suggest that youth accessing puberty blockers and hormones as part of gender-affirming care tend to be satisfied with and not regretful of that care several years later,” the authors write.  

Access to that care depends on where you live in the United States, with more than two dozen states banning the treatment, reports The Washington Post. In an interview with The Post, the study’s lead author, Kristina Olson, said these inequities in access to treatment means that the youth receiving gender-affirming care — and included in such surveys — are disproportionately White.  

“There are huge disparities in who accesses that care,” said Olson, a professor in the department of psychology at Princeton University.  

Racial disparities in post-surgery pain meds 

Black patients were more likely than their white peers to be prescribed oral opioids and less likely to receive multimodal analgesia, an approach that uses a combination of non-opioid medications to avoid the harmful side effects of those drugs.  

CNN reported the findings, which were recently shared at the American Society of Anesthesiologists’ annual meeting in Philadelphia.  

“Multimodal analgesia” is increasingly considered better than opioids for pain management.  

This latest study did not address patient pain levels, which would have been helpful, Dr. Eli Carrillo, an emergency physician and director of prehospital education at Stanford Medicine, told CNN. 

Study: High-deductible plans could exacerbate wealth gaps 

High deductible health plans can compound racial and ethnic health disparities. That’s the finding of a recent study published in Health Affairs that examines the equity implications of high-deductible plans, or health plans that require patients to spend a certain amount out-of-pocket before benefits kick in.  

Researchers found that White households with these plans had significantly more wealth than Black and Hispanic households. Low-income Black and Hispanic families had median financial assets that were well below their average health insurance deductible — findings that demonstrate why a family might forego or delay care if they have these plans.  

Numerous previous studies have reported that consumers with these high-deductible plans are more likely to skip health care, even if it would improve or preserve their health.  

Indigenous tobacco interventions overlook key factors 

There’s a need for more “culturally grounded” tobacco interventions among American Indian and Alaska Native (AI/AN) populations that address the social factors driving health, according to findings published in the American Journal of Health Promotion this month. 

In reviewing more than 1,100 articles, researchers identified a dozen that included steps such as using community health workers, creating community engagement, and providing culturally-tailored interventions. Of those, six were considered effective.  

While the number of adults using tobacco in the United States has declined, disparities persist. American Indian and Alaska Native Communities have some of the highest smoking rates among all racial and ethnic groups, according to the Centers for Disease Control and Prevention.   

Using sewage to advance public health equity  

Wastewater monitoring is a powerful public health tool that can track key community health markers, such as the prevalence of COVID-19.  

It also has the potential to overcome disparities in public health surveillance, identifying trends in a community’s disease burden that might not otherwise be detected. Little prior research, though, has investigated whether wastewater monitoring programs accurately reflect an area’s population.  

In a new paper published in PLoS One, researchers compared populations within North Carolina counties and found that households with septic systems were more economically advantaged than ones connected to sewer lines.  

That’s good news for health equity research, the authors indicated, explaining that “wastewater monitoring may fill in the data gaps needed to improve health equity.”  

Dollar stores: Good or bad for food access?  

As dollar stores have spread throughout the United States, more Americans are getting their food from such outlets. 

That raises important public health questions, and there’s an urgent need for more research into what the growth of these stores mean for health and food access among low-income populations, according to an article published this month in Advances in Nutrition.  

Future research could help public health stakeholders with “understanding the public health, equity and economic impact of this important change in how many consumers are accessing food.”  

Dollar stores are growing especially fast in rural areas, which already facing food access challenges, explain the authors of a study published last year in the American Journal of Public Health. Earlier this year, the Financial Times explored firsthand accounts of the role of these stores for low-income Americans nationwide. 

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Women's and Maternal Health
Race and Equity