African American and Black communities often experience the greatest disparities across health conditions. Black Iowans have the highest mortality rate in 10 of the 12 major causes of death (heart disease, stroke, cancer, etc.). These disparities in health outcomes are also significant for pregnant Black individuals.
As the former Division Director for Health Promotion and Chronic Disease Prevention at the Iowa Department of Public Health before joining Mid-Iowa Health Foundation, Dr. Nalo Johnson oversaw a number of programs including those addressing maternal and infant health. This blog summarizes what she shared in the Black Health Matters radio show hosted by Zakiya Jenkins on KJMC 89.3 about what conditions are impacting Black pregnant Iowans and how we can begin to address those issues.
Here are 5 things you should know:
About 8 percent of Iowa births are to Black birthing individuals each year, and three-quarters of those births are covered by public health insurance. In comparison, one-third of White individuals’ births are covered by Medicaid. Black individuals more likely to initiate prenatal care later and breastfeed at a rate that is consistently between 10-20 percent less than White individuals annually. Black babies are more likely to be born at a lower birth weight and have a higher likelihood of being born prematurely than White babies.
To understand why there are these health disparities, we must ask critical questions. For example, are Black Iowans able to access jobs that offer health insurance to cover preventative care as easily as White Iowans? Can they go to providers who offer culturally relevant care? Are they more likely to rent homes that make it harder to mitigate environmental dangers like mold and radon? The One Economy report shares disparities among the social determinants of health, including: 69.3% of Black people rent their homes in Polk County, compared with 32.9% of the general population. An average of 13.3% of adults living in predominately Black Des Moines tracts lack health insurance compared with 8.6% of adults in non-Black tracts.
Understanding disparities in the environmental and economic conditions that affect health allows the community to think differently about interventions that could address challenges. For example, focusing on solutions that increase access to stable housing would increase individuals’ ability to access regular preventive health care, as well as their ability to be present at work. Improving community conditions influence an individual’s ability to be healthy, while an individual’s ability to be healthy influences the well-being of the entire community.
Data showing disparities across most health issues means poor health outcomes are driven by factors outside of individuals’ personal choices. Iowa’s Black maternal mortality rate is six times higher than the rate for White birthing individuals. Complications like excessive bleeding, cardiac arrest, and extreme high blood pressure are experienced at higher rates by Black Iowans regardless of whether they have public or private health insurance or live in poverty. Beyond just statistics, Black Iowans are sharing negative experiences they have had with the health system and, because of that, are not always comfortable accessing health care. Combined, the data and personal experiences identify areas to target our attention, including how are providers and staff trained, how are policies created, where are clinics being established, and what times should they be open.
In 2021, the CDC declared racism as a serious public health threat to the nation—a critical step in addressing the root issue of what is impacting all communities’ ability to thrive. Naming it inspires greater action. While at the Iowa Department of Public Health, Johnson used data and experiences to drive the development of a doula program for African American and Black birthing individuals to integrate into the Title V clinic system. The project is working with a variety of partners and focused on clinics that serve a higher proportion of African American communities. The model is being implemented and evaluated now. This is the kind of specific, culturally relevant, community-based solutions that can be created by being in conversation with community members and thinking differently about how services are provided.
Developing new solutions that address racism and improve community and social conditions are critical for everyone to thrive. When we invest in opportunities that increase access to positive health and well-being outcomes, we invest in the economic vitality of the community and have impact over multiple generations. The work is not about just improving an individual’s health outcomes, but also our ability to create a thriving community.