HEALTH EQUITY AND STILLBIRTH - starlegacyfoundation.org

Equity and StillbirthStar Legacy Stillbirth Summit

6/20/2017

Roberta Hunt 1

HEALTH EQUITY AND STILLBIRTH

Stillbirth Summit June 21, 2017Star Legacy Foundation Roberta Hunt RN, MSPH, PhD

Objectives• Relate the concept of health equity to poor pregnancy

outcomes. • Investigate the impact that lack of health equity has on

stillbirth rates. • Discuss how the concept of health equity maybe

considered in future initiatives and programming to reduce stillbirths.• Recommend priorities to address health equity related to stillbirth.Propose two ways health equity could be incorporated into the work you are doing in your agency, practice or community. • Discuss action steps you might take in your community begin this

process. .

What determines health?

• 30% of health is determined by health care.• Health services

• “Access” vs access

• 70% of the factors that determine health can be attributed to social determinants of health

• Gilbert C Gee @ Discrinimation in Health care: What Can be done? University of Minnesota, April 8, 2016. • . http://www.cnn.com/2015/08/04/health/planned-parenthood-by-the-numbers/index.html


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Health in America

Social Determinates of Health

Source: Healthy People 2020

Determinants of Health

Healthy People 2020


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Disparity

• Health disparities are preventable differences

in the burden of disease, injury, violence, or opportunities to

achieve optimal health that are experienced by socially

disadvantaged populations.

CDC September 1, 2015 online at: http://www.cdc.gov/healthyyouth/disparities/

What is health equity?Health equity refers to the study and causes of differences in the quality of health and healthcare across different populations. Health equity is different from health equality, as it refers only to the absence of disparities in controllable or remediable aspects of health.

• American Public Health Association.https://www.apha.org/ topics-and-issues/health-equity

How do we achieve health equity?• We value all people equally.

• We optimize the conditions in which people are born, grow, live, work, learn and age.

• We work with other sectors to address the factors that influence health, including employment, housing, education, health care, public safety and food access.

• We name racism as a force in determining how these social determinants are distributed.

• American Public Health Association. Health Equity. https://www.apha.org/topics-and-issues/health-equity


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Why do we want to achieve health equity?

•

Ted talk by Richard Wilkinson

• http://www.ted.com/talks/richard_wilkinson.html


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http://inequality.org/inequality-health/#sthash.yzGZuSaW.dpuf


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Inequality in Birth Outcomes

http://inequality.org/inequality-health/#sthash.yzGZuSaW.dpuf


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State of the Union

Inequity and IMR/IMR by Race• http://datacenter.kidscount.org/data/Bar/21-infant-

mortality-by-race?loc=1&loct=2#1/any/false/36/10,11,9,12,1,13/284

The Cost of Stillbirth


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Cost of Racial Disparities in Health• Excess death and human life lost

• Days away from work

• Excess health care expenses

• ASSESSING THE COSTS OF RACIAL AND ETHNIC HEALTH DISPARITIES @https://www.hcup-us.ahrq.gov/reports/race/CostsofDisparitiesIB.pdf

• Harvard Business Reviewhttps://hbr.org/2015/10/the-costs-of-racial-disparities-in-health-care

The Cost of Racial Disparities in Health

Harvard Business Review @https://hbr.org/2015/10/the-costs-of-racial-disparities-in-health-care

Costs of Lack of Health Equity


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Five Principles for Eliminating Racial Disparities • Provide insurance coverage and access to high-quality

care for all Americans.• Promote a diverse health care workforce.• Deliver patient-centered care.• Maintain accurate, complete race and ethnicity data to

monitor disparities in care.• Set measurable goals for improving quality of care, and

ensure that goals are achieved equitably for all racial and ethnic groups

Harvard Business Review https://hbr.org/2015/10/the-costs-of-racial-disparities-in-health-care

Make a mole hill out of a mountain…


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Ending Preventable Stillbirths: A Call to Action in High-income Countries

• Stillbirth rates vary across high-income countries (HICs) from 1·3 to 8·8 per 1000 total birth

• Reduction in stillbirths is possible in HIC

Flenady, V., Wojcieszek, A. M., Middleton, P., Ellwood, D., Erwich, J. J., Coory, M., & ... Joseph, K. S. (2016). Stillbirths: call to action in high-income countries. Lancet, 387 North American Edition(10019), 691-702. doi:10.1016/S0140-6736(15)01020-X

A Call to Action in High-income Countries• Improvements in data collection, investigation,

classification and understanding of causal pathways

• Setting and monitoring targets in all HICs to reduce preventable stillbirths.

• Substandard care contributes to 20-30% of all stillbirths; even more to late gestational intrapartum stillbirths

• Reduce stigma and improve bereavement care

Infant Mortality Rate by State• http://kff.org/other/state-indicator/infant-death-rate/#map


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Call to Action

Call to Action•Social determinants of maternal and fetal wellbeing should be: • monitored in all high income countries (by home visiting nurses)

• addressed through education and alleviation of poverty

• improved access to health care, especially timely, culturally appropriate antenatal care.

Call to Action: Star Legacy Recommendations to Practitioners

Women from high risk populations benefit from being:• Monitored as high-risk pregnancies

• Educated about their risk factors for poor pregnancy outcomes and how to reduce those risks

• Carefully listened to and counseled as high-risk pregnancies

• Provided quality prenatal care

• Wimmer, LJ & Hunt, RJ. (2017) Diversity and perinatal loss: risks, impact, and opportunities for growth. Poster session presented at the Association of Maternal and Child Heath Programs. March 4-7, Kansas City, MO.


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Propose two ways the concept of health equity could be incorporated into the work you are currently doing or want to do in the future.

Discuss action steps you might take in your community to begin this process.

In summary…


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Questions/Comments

Bibliography• Ayanian, JZ. (2015). The cost of disparity in health.

(2015). Harvard Business Review. https://hbr.org/2015/10/the-costs-of-racial-disparities-in-health-care

• Ananth, C. V., Shiliang, L., Kinzler, W. L., & Kramer, M. S. (2005). Stillbirths in the United States, 1981-2000: An Age, Period, and Cohort Analysis. American Journal Of Public Health, 95(12), 2213-2217. doi:10.2105/AJPH.2004.043885

• Ayanian, J A. Costs of Racial Disparities in Health Care. Harvard Business Review @ https://hbr.org/2015/10/the-costs-of-racial-disparities-in-health-care

• Nybo Andersen, A., Gundlund, A., & Villadsen, S. F. (2016). Stillbirth and congenital anomalies in migrants in Europe. Best Practice & Research: Clinical Obstetrics & Gynaecology, 3250-59. doi:10.1016/j.bpobgyn.2015.09.004

• Flenady, V., Wojcieszek, A. M., Middleton, P., Ellwood, D., Erwich, J. J., Coory, M., & ... Joseph, K. S. (2016). Stillbirths: call to action in high-income countries. Lancet, 387 North American Edition(10019), 691-702. doi:10.1016/S0140-6736(15)01020-X

• Health-risk behaviours: examining social disparities in the occurrence of stillbirth. (2008). Child: Care, Health & Development, 34(6), 838.

• Unnatural Causes: http://www.unnaturalcauses.org/media_and_documents_video.php


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• Hogue, C. R., Parker, C. B., Willinger, M., Temple, J. R., Bann, C. M., Silver, R. M., & ... Goldenberg, R. L. (2013). A Population-based Case-Control Study of Stillbirth: The Relationship of Significant Life Events to the Racial Disparity for African Americans. American Journal Of Epidemiology, 177(8), 755-767. doi:aje/kws381

• Ibiebele, I., Coory, M., Boyle, F., Humphrey, M., Vlack, S., Flenady, V., & Boyle, F. M. (2015). Stillbirth rates among Indigenous and non-Indigenous women in Queensland, Australia: is the gap closing?. BJOG: An International Journal Of Obstetrics & Gynaecology, 122(11), 1476-1483. doi:10.1111/1471-0528.13047

• Lawn, J. E., Blencowe, H., Waiswa, P., Amouzou, A., Mathers, C., Hogan, D., & ... You, D. (2016). Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet, 387 North American Edition(10018), 587-603. doi:10.1016/S0140-6736(15)00837-5

•

• Murphy, M. (2016). Preventing stillbirth and providing support. British Journal Of Midwifery, 24(2), 81. doi:10.12968/bjom.2016.24.2.81

• Nybo Andersen, A., Gundlund, A., & Villadsen, S. F. (2016). Stillbirth and congenital anomalies in migrants in Europe. Best Practice & Research: Clinical Obstetrics & Gynaecology, 3250-59. doi:10.1016/j.bpobgyn.2015.09.004

• Rosenberg, J. (2010). Racial Disparities in Stillbirth Risk Are Greatest at Preterm Gestational Ages. Perspectives On Sexual & Reproductive Health, 42(1), 68. doi:10.1363/4206810

• Rowland Hogue, C. J., & Silver, R. M. (2011). Racial and Ethnic Disparities in United States: Stillbirth Rates: Trends, Risk Factors, and Research Needs. Seminars In Perinatology, 35(4), 221-233. doi:10.1053/j.semperi.2011.02.019

• Villadsen, S., Mortensen, L., & Andersen, A. (2009). Ethnic disparity in stillbirth and infant mortality in Denmark 1981-2003. Journal Of Epidemiology & Community Health, 63(2), 106-112. doi:10.1136/jech.2008.078741

• Willinger, M., Ko, C., Reddy, U., Willinger, M., Ko, C., & Reddy, U. M. (2009). Racial disparities in stillbirth risk across gestation in the United States. American Journal Of Obstetrics & Gynecology, 201(5), 469.e1-8. doi:10.1016/j.ajog.2009.06.057


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• Zhang, S., Cardarelli, K., Shim, R., Ye, J., Booker, K., & Rust, G. (2013). Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients. Maternal & Child Health Journal, 17(8), 1518-1525. doi:10.1007/s10995-012-1162-0

• Wimmer, LJ & Hunt, RJ. (2017) Diversity and perinatal loss: risks, impact, and opportunities for growth. Poster session presented at the Association of Maternal and Child Heath Programs. March 4-7, Kansas City, MO.

• Additional Resources•• TED how inequality harms societies

http://www.ted.com/talks/richard_wilkinson.html

• http://ideas.ted.com/what-does-inequality-do-to-our-bodies-and-minds-a-social-psychologist-and-an-epidemiologist-discuss/

• Investing in the Healthiest Nationhttps://www.apha.org/topics-and-issues/generation-public-health/invest-in-health• Sick Around the World.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

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HEALTH EQUITY AND STILLBIRTH - starlegacyfoundation.org