There is an editorial in the NYT this weekend that's worth a thought. It centers upon the high rate of mortality among black pregnant women in the U.S. and more specifically in New York. Not surprisingly, it is someone's fault.
They report, "Black women here are 12 times as likely to die from childbirth-related causes as white women. They experience severe, life-threatening complications from pregnancy and childbirth in about 387 out of every 10,000 births, according to city data. That is triple the rate of white New Yorkers, and roughly comparable to complication rates in Sierra Leone." There are "shameful details of how we have failed to protect the lives of black women in pregnancy and childbirth."
The three leading causes of childbirth-related death in New York City, however, are not shameful; they are hemorrhage, hypertension and blood clots. The Times theorizes that care for these problems vary and one filter of medical decision-making is race. And, like the old question of prematurity in unmarried black women which was found later to be typical of married wealthy black women as well, nothing is easy. ("Wealthier, more educated black women in New York City are also dying or almost dying in childbirth at a far higher rate than their white neighbors. One city study found that black college-educated women were more than twice as likely to experience severe complications from childbirth as white women without a high school diploma.") Soooo.... "some researchers and city officials believe that the higher rates of death and complications among black women are caused only partly by longstanding disparities in poverty, obesity and lack of access to top-rate health care. The dangers black women face in pregnancy and childbirth, they say, are compounded by racism, unconscious biases in health care and the long-term anxieties, regardless of economic status, that come with being an African-American woman."
While all of these elements may be true--and assumed correlation here does not guarantee causation--these are pretty soft generalities to damn a group--i.e. medical personnel--on and harder to come to some therapeutic conclusions. Nonetheless, the NYT does. First is the old information shibboleth: People will be better served if they have a good idea of the opinions of people on the subject, like the NYT. So mistrust really helps. Second, hospitals should be rated, like "restaurants" says the Times. "..'if the city’s Department of Health can rate restaurants, it can find a way to grade hospitals." Of course, this is always being tried. Historically the grading of hospitals and doctors has had one consistent result: The institutions and practitioners begin to avoid cases and problems where the risks are high and where inevitable bad results might reflect badly upon them. Third, they suggest doula programs. I had to look it up. A doula, also known as a birth companion, birth coach or post-birth supporter, is a non-medical person who stays with and assists a woman before, during, or after childbirth, to provide emotional support and physical help if needed. Who could argue with that.
Disparities in health results are alarming--but they are opportunities, as well. Investigating the causes might help in our overall understanding of the very processes of our health. Of course, they may also reveal pathologies in the very health care system we rely on to provide that homogeneous care. But the assumption that bigotry is at work--which it may--is no better founded than the assumption that we all have the same health and wellness potential. This is science, not social action. And the process of science is long, hard and unassociated with banners.
There is a small town in Pennsylvania named Rosetto that has the longest life expectancy in the nation. The people who live there are of Italian descent, drink wine, smoke and are relatively lower middle income. People have tried to figure out their longevity for years. Diet? The water? The local grandmother's pasta formula? Should everyone who is old and/or sick move there? Generally people think these people are all from a specific long-lived gene pool.
But it is probably not an unspoken conspiracy.
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