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The discussion took place at the VCU Health Hub, located in Richmond’s East End. The panelists included local change-makers, Allan-Charles Chipman from Initiatives of Change, Katie St. Germain from Crossover Ministries, and Sherrell Thompson from the Richmond City Health District.
Among the topics discussed were the meaning of health equity and what it looks like in Richmond, as well as what resources were helpful to communities of color when trying to navigate through the pandemic. The panelists also discussed the role of “safety net providers” during the pandemic and how they are still needed, and why underserved communities sometimes distrust those in the medical field and the information they hear from them.
The discussion was part of an undergraduate course at Virginia Commonwealth University called “History and Health: Concepts in Health” under the professors Dr. Kimberly Battle, Logan Vetrovec, and Anne Massey.
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Director emeritus of the VCU Center on Society and Health, Dr. Steven Woolf, published a viewpoint in the Journal of the American Medical Association that examined how an individual’s life expectancy in the United States depends on the state in which they live.
Disparities in health across the states are growing, a trend that began in the 1990s. For example, in 1990, life expectancy in New York was lower than in Oklahoma. But the trajectories separated in the 1990s and, by 2016, New York ranked 3rd in life expectancy and Oklahoma ranked 45th. Although these changes in life expectancy may reflect other population shifts, it is likely the explanation is the growing polarization of public policies across the states. To read more, access the full JAMA article here.
You can also read more about the editorial on VCU News website.
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Years of research have documented the harmful effects of restricting a woman’s* ability to plan the number and spacing of children and of creating a legal environment in which abortions are unsafe and lethal.
Those who seek but are denied abortions are more likely to:
- Experience economic hardships and insecurity, which in turn can harm the financial wellbeing and development of their children and family members.
- Remain with, and be harmed by, a violent partner.
- Experience severe pregnancy complications, ranging from eclampsia to death following delivery. Maternal and infant mortality rates are higher in states with more abortion restrictions.
- Lose access to other health care services. Clinics that offer abortion services are often primary care providers for a range of women’s health needs, including cancer screening.
Women who are denied legal options for abortions are more likely to perform the procedure themselves or to rely on someone who is incompetent or lacks access to modern instruments and sterile techniques. History documents that women who resorted to these options in the era of illegal abortions were more likely to experience hemorrhage or sepsis, retain foreign bodies, and die from complications. A 1975 analysis estimated that the risk of dying from an illegal abortion was eight times that of dying from a legal abortion. That ratio is likely to be higher today, given modern advances that have made legal abortions much safer. Were abortion to be banned nationwide, it is estimated that pregnancy-related deaths would increase by 21% after the first year (33% for pregnant women who are Black).
State laws are ineffective in reducing the frequency of abortions. Those with the means to travel and pay for the procedure can seek safe abortions in states where they are legal, while others will obtain them under riskier and sometimes life-threatening conditions. Restrictions and bans will do little to prevent abortions but will increase the risk of pregnancy-related deaths. The best way to reduce the number of abortions is to prevent unwanted pregnancies and support individuals and families through comprehensive sex education, contraceptive services, and public policies that promote economic and social wellbeing.
At the Center on Society and Health we recognize that Americans hold different views about the propriety of abortion. We respect that diversity, and believe that those who learn they are pregnant have a right to make choices that are in accordance with their beliefs, but recent efforts to ban abortions completely are unconscionable. They demean women by removing their autonomy over their lives and bodies, and they threaten public health. The Center on Society and Health has remained silent on this topic for many years, but to be silent now in the face of current events is to be complicit, and that violates our commitment to public health, justice, and equity. We invite everyone, whether we agree on this issue or not, to join us in pursuing improvements to community conditions—such as education, housing, and childcare—in order to create a society that is more conducive to starting or growing a family for all who choose to.
*Although women are the primary targets of these restrictions, the Center acknowledge that these laws not only effect women but those who identify as non-binary or transgender.
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“When the pandemic hit we were worried about how we will engage with our families,” said Miles, an Engaging Richmond team member at the VCU Center on Society and Health who works with Peter Paul in Richmond.
Early on, Peter Paul made the decision to go fully virtual. With the Peter Paul families in mind, Miles created a special, virtual hang-out for parents and caregivers, available no matter the individual’s zip code.
“I didn’t want it to be structured because the whole day is structured,” said Miles. “So for an hour, if I could give parents a space where they can be like ‘I’m stressed out, I don’t know what to do, but I don’t want to share that with my kids’ and have other parents say ‘I feel the same way’ to help you validate those feelings and help you work through them.”
“The parent hangout groups that Chimere started during the pandemic are vital for community members and parents,” said Phoenecia Hill, Community Engagement Coordinator at the Center. “It gives them a space to relax, vent, and bond with one another. Staying connected is key especially during this time when many can face feelings of depression from being socially isolated and not having in-person human connections.”
Miles said they had residents from all over the city of Richmond sign up, a barrier broken from their previous, in-person meetings which could only serve the East End community because of limited resources.
“It helped build connections to other community members throughout the city,” said Miles. “No one felt judged by coming, it was a no-judgment zone. Every parent or caregiver is an expert on the child they care for. Everyone that came had something to offer and share with the group.”
“I have experienced the parent hangouts firsthand and have gotten so much out of connecting with other residents and making meaningful connections with those in my community,” said Hill “I hope that Chimere continues these hangouts even after the pandemic subsides because it has helped so many.”
Chimere is also involved with other events at Peter Paul that are helping bring the community together during this tough time, such as a Dinner and Discussion with Chef Keonne Lomax, in which families walk through fun and easy recipes on Zoom. You can learn more about their programs at www.peterpaulrva.org/programs.
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The California Department of Public Health announced that it will be using the California Healthy Places Index (HPI), a tool created by the Center on Society and Health, as part of their new health equity metric that will be used as part of the state’s COVID-19 reopening plan, Blueprint for a Safer Economy.
The HPI is a tool that lets users explore local factors that predict life expectancy and compare community conditions across the state. It provides overall scores as well as detailed data on policy areas that affect health such as housing, transportation, and education so that policymakers and stakeholders can diagnose community conditions that affect the health and well-being of residents at a neighborhood level.
The HPI tool will be used to ensure that in addition to meeting overall case and positivity rates, each county must also meet the state’s threshold rate for positivity in neighborhoods with the least opportunities for health before progressing through the state’s blueprint tiers.
It’s important to consider health equity when making major policy decisions. In California as well as much of the U.S., minorities and low-income individuals have been hit the hardest by the COVID-19 pandemic, many of whom are essential workers or lack access to healthcare. According to the California Department of Public Health, Black residents make up about 6% of California’s total population, but about 8% of all COVID-19 related deaths, and while Latinx people represent about 39% of California’s population, they make up 61% of its cases and over 48% of deaths.
The California HPI was developed in 2018 in partnership with the Public Health Alliance of Southern California (the Alliance). Since its development, it has already been utilized by more than 100 government agencies, health care institutions, community groups, and other sectors. It has also been used to allocate almost half-a-billion dollars from state agencies and philanthropy, helping to direct resources to communities most in need. You can also use and explore the tool on the HPI website.
Learn more about the California Healthy Places Index on our website.
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In a follow-up study, the Center on Society and Health found that a shocking trend has continued beyond spring and through the summer–for every two deaths attributed to COVID-19 in the U.S. since March, a third person dies as a result of the pandemic.
According to the study, published in the Journal of the American Medical Association, “between March 1 and August 1, 2020, 136,561 deaths occurred in the U.S, a 20% increase over expected deaths,” the study continues, “of the 225,530 excess deaths, 150,541 (67%) were attribute to COVID-19.” During this time, mortality rates for heart disease and Alzheimer’s disease increased simultaneously with surges in COVID-19 deaths.
The study also notes that states that experienced surges in April and reopened later, had shorter epidemics that returned to baseline in May, whereas states that reopened earlier experienced a prolonged increase in excess deaths that extended into the summer.
Total death counts in the U.S. are fairly consistent from year to year. These deaths attributed to causes other than COVID-19 – such as diabetes, heart disease, or other conditions – could reflect undocumented infection or deaths among uninfected patients resulting from disruptions produced by the pandemic, such as delay in care.
The study is building upon a similar study by the Center published in July that focused on reported deaths from March and April. The studies pull data from the Centers for Disease Control and Prevention (CDC) for 2014 and 2020, using regression models to predict expected deaths from 2020.
Read more about the study on the VCU News website. You can also read the study on the JAMA website.
You can also find coverage of the study on NPR, NBC News, or in USA TODAY, and Forbes.
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Last year, the VCU Center on Society and Health published a study that showed the mortality rates among working-age Americans continue to rise, causing a decrease in life expectancy in the United States. A new study, co-authored by the center’s director emeritus, Steven Woolf, seeks to explain this change.
“US State Policies, Politics, and Life Expectancy”, published Milbank Quarterly, shows that state policies since the 1970s, particularly after 2010, on issues such as tobacco, labor, immigration, civil rights, and the environment appear to be driving these trends in life expectancy. After examining policy changes in all 50 states, the researchers found that states with more left-leaning policies had better life expectancy outcomes compared to states which policies were more right-leaning.
For example, In 1959, life expectancy was 71.1 years in both the states of Connecticut and Oklahoma. But by 2017, Connecticut had gained 9.6 years while Oklahoma gained only 4.7 years.
According to the study, Connecticut made the greatest movement towards liberal policies between 1970 and 2014, which may have helped it claim its place as one of the states with the longest life expectancy. At the same time, Oklahoma has made the greatest movement towards more conservative policies and is currently one of the states with the shortest life expectancy.
The researchers also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states shared the same health advantages of states with more liberal policies.
The study points out that while individual behaviors and medical care are important, Americans’ opportunities and constraints for living a healthy life, and in this case a long life, are strongly shaped by structural conditions.
The study was lead by Dr. Jennifer Karas Montez and an interdisciplinary team at Syracuse University. The report is open-access and you can read it online at the Wiley Online Library.
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Emily Zimmerman, Director of Community Engaged Research at the VCU Center on Society and Health, invited project teams from the U.S., Canada, and the U.K. to describe the methods they use in participatory health research projects. The introduction covers types and history of stakeholder engagement in research, as well as issues of representation, the roles of different types of research partners, and ongoing challenges in the field.
The text is organized into 5 parts, highlighted below with a sample chapter description for each part. With an emphasis on learning how to implement participatory health research, each chapter has a set of discussion questions that challenge readers to think of potential applications for the research methods.
Part 1: Stakeholder engagement in research topic identification and modeling
Sample chapter: Williams, Hovmand, and Stange describe a community-based approach to group model building with stakeholders. They provide two case examples including the Paradox of Primary Care Study and the Racial Disparities in Breast Cancer Mortality and Treatment Study. Group model building with stakeholders allows for new ways to understand complex systems and identify opportunities to intervene.
Part 2: Stakeholder engagement in research design
Sample chapter: Dean, Friedman, Sutphen, Bourquardez-Clark, Duquette, and Rezende describe the ABOUT (American BRCA Outcomes Utilization and Testing) Network. ABOUT is a Patient-Powered Research Network (PPRN) that engages patients throughout the research process. Their approach to engagement includes a health registry, research collaboration, research advocate training, and research question development and prioritization. Their GAP360 tool is a stepwise patient-centered research process.
Part 3: Implementing stakeholder-engaged research
Sample chapter: Vargas, Palmer, Rouse Iniquez, Fleisher, Goette, Chicuata, Campbell Fine, Mar and Schmidt recount how community-engaged research helped spur successful policy on a soda tax in San Francisco. A multi-stakeholder coalition brought together research, education, and advocacy. They identified local priorities, mapped social indicators, and gathered qualitative data on the needs and perceptions of residents.
Part 4: Stakeholder engagement in health and health systems interventions
Sample chapter: Zittleman, Espinoza, and Westfall show how Boot Camp Translation can help communities translate medical evidence and guidelines for faster community implementation. Developed by the High Plains Research Network, Boot Camp Translation has been used to promote uptake of guidelines for many conditions, including colorectal cancer screening, opioid use disorder, asthma, diabetes, and hypertension.
Part 5: Governance, evaluation, and ethics in stakeholder-engaged research
Sample chapter: Concannon describes the need for greater accounting of the impacts of stakeholder-engagement in research. He provides frameworks for identifying stakeholders and types of evidence and describes the evaluation questions that can be answered by different types of evaluations. An example stakeholder engagement plan is provided.
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The study, published in the Journal of the American Medical Association, shows that approximately 87,000 more Americans died between March 1, 2020, and April 25, 2020, than would have been expected based on historic averages. Of these, only 56,246 deaths, or 65%, were attributed to COVID-19.
“Put simply, for every two deaths from COVID-19 that Americans hear about on the nightly news there is another extra death that is being attributed to some other cause,” said Steven Woolf, director emeritus of the VCU center.
The pandemic is costing more lives than the COVID-19 death count would suggest, Woolf said. In 14 states, including the nation’s most populous states (California and Texas), COVID-19 explained less than half of the excess deaths.
The undercount could have multiple explanations, said Woolf. The number of publicly reported COVID-19 deaths is taken from provisional data that are often incomplete and may omit COVID-19 deaths that were misattributed to another cause.
Additionally, some extra deaths may have less to do with the virus than the restrictions imposed by the pandemic, such as stay-at-home orders, reduced access to health care, fears of calling 911 for acute emergencies like chest pain or stroke, or psychological stresses that lead to deaths from drug overdoses or suicide.
“States hard-hit in the first weeks of the pandemic, like New York and New Jersey, saw big spikes in deaths from other causes, such as heart disease, stroke, diabetes, and Alzheimer’s disease,” said Woolf.
“Deaths from these diseases could reflect undocumented complications of COVID-19, such as clotting disorders or inflammation caused by the virus, but they also may be unrelated to the virus and caused by disruptions and delays in care for those conditions. As the nation experiences more surges in COVID-19, doctors and public officials need to be prepared for a wave of deaths from these other causes.”
To read the full VCU study, visit: https://bit.ly/2ApvxYA
In an accompanying editorial, the editor and a deputy editor of JAMA discuss the implications of the study by Woolf and colleagues. The VCU study was released simultaneously with another study of excess deaths, published in JAMA Internal Medicine, by researchers at Yale University and the National Institutes of Health. Daniel Weinberger, who led that study, was also a co-author of the VCU study.
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Racism is a human rights and public health crisis and should be treated as such by anyone with a stake or influence in population health or public health practice, including public health practitioners, officials at all levels of government, community leaders of all backgrounds, educators, health care providers, and more.
Whether through excessive police force and criminal justice abuses, vigilantism, disproportionate exposure to deadly viruses and risk factors for chronic disease, reduced access to resources for good health, or other biases and discrimination, Black and brown people in the United States die sooner and live sicker lives than their white counterparts. The pain and suffering that have inspired recent activism around the country share the same history and root causes as the long-standing disparate health outcomes that have claimed so many lives. These health inequities are, unequivocally, by design. The United States government and its citizens are rightly being called upon to right the damage done by the racist ideas and institutional racism that pervade our society.
Everyone has a stake in the health and well-being of our Black and brown brothers and sisters. We hope that we can all take inspiration in the fact that, because this was done by design, it can be undone too.
To learn more about racial justice issues and how to get involved, visit: Racial Equity Tools, Race Forward, America & Moore, and the Virginia Center for Inclusive Communities.
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