Health Divide: New rules protect pregnant workers from discrimination, weight- loss drugs drive disparities

Native Americans die 14 years younger than white Americans on average, but many families bury children, teens and young adults, reports Arielle Zionts at KFF Health News.

And according to new report on nationwide health disparities from the Commonwealth Fund (which also supports programs at the Center for Health Journalism), there’s a “stark rate of premature death for Indigenous people,” as Usha Lee McFarling wrote at STAT.

Indigenous people had the highest rates of premature death in several states, and the causes were often treatable conditions, according to the report.

“Most Native American kids and young people lose their friends at a young age,” 20-year-old Katherine Goodlow of the Lower Brule Sioux Tribe in South Dakota, who has personally experienced loss due to suicide, accidents and illness, told KFF. “We’re basically used to it, but it hurts worse every time we lose someone.”

Young Native Americans die prematurely from causes including chronic disease, drug overdose and homicide, but experts told Zionts that the problems are rooted in social and economic factors. 

For example, an employee at the Sioux Funeral Home told Zionts many families live in crowded homes or in neighborhoods littered with garbage, and may not be able to afford healthy food or heat their homes.

Generational trauma fueled by past government policies that attacked Native culture and families, as well as trauma from modern racism, abuse, drugs or violence can also contribute to shorter life expectancy.

Addressing the problem will require collaboration between tribal, state and federal leaders, Dr. Donald Warne, an Oglala Sioux member and co-director of the Johns Hopkins Center for Indigenous Health, told KFF.

Several initiatives already exist, such as suicide prevention talks in high schools and the Hopkins Family Spirit program that connects pregnant women with community health workers. 

But not everyone can benefit from the help that’s available. Insurance doesn’t always cover programs that help people access healthy food and community health workers, and not everyone has insurance in the first place.

If families don’t have good internet connections or personal transportation, it can be difficult to reach health professionals, either virtually or in person.

“They just need the resources, the training, even the moral support,” Katrina Fuller, a Rosebud Sioux and health director of the nonprofit Sicangu Co, told Zionts. “I had one person in our health coaching class tell me they just really needed someone to believe in them, that they could do it.”

Weight-loss drugs widen health disparities

Diabetes and obesity medications such as Wegovy could have been a “powerful tool” to help people in marginalized groups control their weight and improve their health — but uneven access is exacerbating health disparities, reports Karen Kaplan at the Los Angeles Times.

Obesity rates are highest among Black and Hispanic Americans, according to CDC data. Obesity is also linked to lower income. 

“These patients have a higher burden of disease, and they’re less likely to get the medicine that can save their lives,” said University of Pennsylvania cardiologist Dr. Lauren Eberly. “I feel like if a group of patients has a disproportionate burden, they should have increased access to those medicines.”

The problem, Kaplan reports, is the cost of the medicines, which can be upwards of $1,000 per month. Even if insurance covers the medications, people may be unable to afford a copay of $30 to $50, or more.

In one study, people whose copays were at least $50 per month were less likely to fill their prescriptions than those who paid less. 

There are also geographic patterns, Kaplan reports, with Black people with diabetes only half as likely as their white counterparts to get these medications in certain areas. And the gap between Black and white use rates is highest in places where these medications are most popular.

“The drug is actually widening the gap,” said Dr. Serena Jingchuan Guo of the University of Florida, who discovered this pattern. 

New guidelines require time off for pregnant, recovering workers

The Biden administration has released new regulations that give workers access to leave for pregnancy-related treatment and recovery from birth, miscarriage or abortion.

The regulations, devised by the Equal Employment Opportunity Commission (EEOC) to enforce the Pregnant Workers Fairness Act, “could be a groundbreaking shift in American workplaces,” writes Chabeli Carrazana at The 19th. 

The legislation seeks to address “rampant” discrimination against pregnant people at work, Carrazana writes. Pregnant people, especially women of color in low-paying jobs, have reported a lack of basic accommodations, such as a bottle of water or a chair.

And Walgreens recently settled a lawsuit brought by a worker who wasn’t allowed to leave work as she experienced early signs of miscarriage. 

The Family and Medical Leave Act, which was passed in 1993 and allows for 12 weeks of unpaid time off, only applies to employers with 50 or more workers and employees who had a significant history with that employer. That leaves almost half of American workers ineligible.

The Pregnant Workers Fairness Act, in contrast, applies to employers with at least 15 employees. It was passed in 2022, but the new rules, which clarify how the law will be put into practice, go into effect June 18. 

Under the new guidelines, if a workers request time off to recover from childbirth or access abortion, the employers must work to accommodate the person with leave, though it doesn’t have to be paid leave. 

The rules broadly cover pregnancy issues such as prenatal visits, morning sickness, miscarriage, and postpartum depression.

The EEOC clarified that the regulations cover workers seeking abortions in states where that procedure wouldn’t be legal, who must travel elsewhere for their health care.

Republicans in Congress argued against including pregnancy termination in the law, reports Ariel Cohen at Roll Call. And Texas attorney general Ken Paxton said that state will not enforce the law for state employees, because the initial bill passed via proxy voting during the pandemic.

“The rule also will help avoid workers being forced into harrowing situations, jeopardizing their health, their pregnancies and their economic security,” said EEOC chair Charlotte Burrows.

From the Center for Health Journalism

Apr. 26, 10 a.m. PT: Join us for a webinar, “Can the Child Welfare System be Saved?” We’ll explore the ongoing crisis in how America’s child welfare system investigates families and removes children, the latest attempts at reform, and how journalists can tell urgent stories of young lives and families at risk. Sign-up here!

May 23 is the deadline to apply for the Domestic Violence Symposium and Impact Reporting Fund. Grantees receive reporting funds of $2,000–$10,000 and five months of professional mentorship. Learn more here. 

What we’re reading

• “Overdose deaths swell among SF’s Maya residents, highlighting urgent need for culturally competent drug health services,” by Sylvie Sturm, San Francisco Public Press
• “Mental health and substance use disorders often go untreated for parents on Medicaid,” by Emily Baumgaertner, The New York Times
• “Only two percent of psychiatrists are Black, leading some to creative solutions to fill the void,” by Kymani Hughes and Oyewumi Oyeniyi, MindSite News
• “We can make birth safer for Black mothers. Here’s how.” By Anna North, Vox
• “How ‘medical gaslighting’ ignores Black women with long COVID,” by Jennifer Porter Gore, Word in Black
• “Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom” by Amanda Seitz, AP News
• “First Opinion: Autism doesn’t discriminate. Autism research shouldn’t either,” by Wendy K. Chung, STAT