The Health Divide: Health care workers call racism against patients a ‘major problem’ in new survey

Mental health a big contributor to pregnancy-related death rate

Efforts to cut the United States’ embarrassingly high maternal death rate must address mental health to be effective, according to a new analysis in JAMA Psychiatry. 

“We need to bring this to the attention of the public and policymakers to demand action to address the mental health crisis that is contributing to the demise of mothers in America,” said study author Dr. Katherine Wisner of Children’s National Hospital in Washington, D.C., in a news release.

The study’s review of 45 other studies found that more than 80% of maternal deaths are preventable. That holds particularly true for the nearly one in four maternal fatalities linked to mental health disorders, according to the paper.

The U.S. maternal mortality rate is double or triple that of nations with comparable income, and it’s going up. 

The ongoing rise in maternity health care deserts only exacerbates the situation. (See our recent webinar, "Dangerous Deliveries,” for a deeper look at the issue.)

The maternal death rate for Black women is higher than for white and Hispanic women, according to data from the Centers for Disease Control and Prevention. And maternal death rates are rising among Native American and Alaska Native women. 

Federal efforts to improve the situation include plans to ensure access to pre- and postnatal care, expand Medicaid access after giving birth, and boost the ranks of midwives and doulas. Since 2022, there is also a National Maternal Mental Health Hotline, 1-833-TLC-MAMA, which offers real-time mental health support. 

And the city of Flint, Michigan, has piloted cash payments to pregnant people and infants, with the aim of improving infant and maternal health, reports Frances Kai-Hwa Wang at PBS NewsHour. Studies suggest such programs can improve parent mental health as well as physical health for moms and babies. 

But the JAMA Psychiatry study authors said recent efforts don’t do enough to address the scope of the maternal health crisis. 

Mental health is the leading cause of maternal death, responsible for almost twice as many deaths as the next most common cause, hemorrhage after delivery, according to the new study.

Women are at high risk for depression around and after the time they give birth, but only one in five are screened for depression after the baby is born, Wisner said.

And Black mothers are more likely to experience mental health conditions, but less likely to receive treatment, reports Mira Cheng at CNN.

Restrictions and bans on abortion also “reliably worsen women’s mental health,” writes Dr. Karen Landman at Vox. One study that Wisner’s analysis highlighted noted that enforcement of laws that make it harder for abortion providers to operate are linked to higher suicide rates in people of reproductive age in that state. 

Nearly half of health care workers have observed racism, discrimination

A new survey reports that 47% of workers in hospitals, nursing homes and outpatient care centers have witnessed discrimination against patients, such as withholding of pain medication from Black patients with sickle cell anemia or making “ignorant comments” about Native American patients, writes Ken Alltucker at USA Today. 

The Commonwealth Fund surveyed 3,000 workers by phone in spring 2023, in what the researchers called a first-of-its-kind study on health worker perceptions of discrimination. (The Commonwealth Fund helps support the Center for Health Journalism’s webinars and fellowships.)

Of those workers — including physicians, nurses, dentists and others — 52% described racism against patients as a “major problem.”

Younger workers, and those who were themselves Black or Latino, were more likely than their older or white peers to report discrimination against patients.

Nearly 60% of survey participants also noted that non-English speaking patients sometimes received inequitable treatment, reports Anissa Durham at the outlet Word in Black. 

And workers noticed that patients who advocated for their own care were more successful if they were white, rather than Black. 

Workers in the survey also reported rampant racism against employees, reports Margo Snipe at Capital B News: Nearly 60% of Black workers said they’d faced discrimination at work.

“It is something that not only affects patients but also affects health care workers,” said Dr. Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund. “It creates stress.”

That means addressing discrimination could help retain medical staff, she added.

Many workers worry they’ll face retaliation if they speak up, Snipe noted.

The report recommended that clinics train staff to spot discrimination and encourage them to report what they see anonymously.

“Patients of color deserve fair and equitable treatment, and health care workers of color deserve the same,” writes Durham.

More Black cardiologists needed to create equitable care

Heart disease affects about 60% of Black adults and kills them at higher rates than any other racial or ethnic group. But when those patients see a cardiologist, it’s rarely someone who looks like them or shares an understanding of the Black experience, reports Claretta Bellamy at NBC News.

Just over 4% of physicians specializing in cardiovascular disease were Black in 2021, according to the American Association of Medical Colleges. 

“Increasing the number of Black cardiologists could mean better heart health for Black patients,” writes Bellamy.

Becoming a cardiologist while Black is difficult, and candidates must compete for scarce training spots. In addition to the usual challenges of 10 years of medical training and several exams, financial strains, discrimination and microaggressions can make it harder for Black physicians to succeed in residency and cardiology fellowships.

The problem is not unique to cardiology. Black residents leave or are fired from training programs at higher rates than white trainees, keeping them out of elite specialties including dermatology, neurosurgery and plastic surgery, according to a 2022 investigation by Usha Lee McFarling at STAT.

“Until there are programs that are mandating that there’s diversity in training programs, we’re never going to have a lot of inclusivity,” Dr. Marlon Everett, a Chicago cardiologist, told Bellamy.

And those demographics matter in the exam room. “For many Black patients, having a Black cardiologist creates feelings of trust and comfort,” writes Bellamy. “The layer of trust and comfort often seen between a Black patient and Black doctor can help motivate patients to stay on their heart medications and stick with healthy life style changes.”

Black patients are also underrepresented in trials for cardiovascular interventions, meaning physicians — regardless of ethnicity — may not have the best possible information to treat Black patients.

Institutions like the American Heart Association and American College of Cardiology have tried to recruit and support people of color, providing information and resources to students of color.

But it’s also important to collect and publicize data on the dearth of Black people in advanced specialties, and to support those students once they become residents with mentorship and due process when they suspect discrimination, as McFarling wrote in STAT in 2022.

From the Center for Health Journalism

• April 10 is the deadline to apply for the National Fellowship. This fellowship helps journalists report a major enterprise health or social well-being project with reporting grants of $2,000–$10,000, a week of intensive learning and discussions held June 24–28, and five months of additional mentorship and workshops. Learn more here!
• April 11 is the deadline to apply for the Domestic Violence Symposium and Impact Reporting Fund. These grants, starting in May 2024, supports journalists covering domestic violence in California with reporting grants of $2,000–$10,000 and five months of professional mentorship. Find out more here!

What we’re reading

• “An essential medical device fails people of color. A clinic is suing to fix that,” by Corinne Purtill, Los Angeles Times
• “It’s tougher for non-white Americans to get opioid addiction drug,” by Ernie Mundell, HealthDay
• “More teens are reporting that a partner has threatened their reproductive health,” by Jennifer Gerson, The 19th
• “Pregnancy care was always lacking in jails. It could get worse.” By Renuka Rayasam, KFF Health News
• “‘All of US’ reports half of the genomes it has sequenced are from non-Europeans,” by Megan Molteni, STAT
• “Mortality surged for renters facing eviction during the pandemic, study finds,” by Deidre McPhillips, CNN

“A quarter of smokers quit under menthol bans, study finds,” by Christine Jewett, The New York Times