HEALTH EQUITY: ENRICHING A PRACTICE OF EMPATHY USING THE PERINATAL HEALTH STRATEGIC PLAN

February 26, 2020

Jasmine Getrouw-MoorePerinatal Health Strategic Plan ConsultantNC Division of Public Health/ Women’s Health Branch

Lynae Baker, MPH(c)Intern, Perinatal Health Strategic PlanNC Division of Public Health/ Women’s Health Branch

• This training was developed by the March of Dimes North Carolina

Preconception Health Campaign, under a contract and in collaboration

with the North Carolina Division of Public Health, Women’s Health

Branch.

• Special thanks to Jasmine Getrouw Moore and Lynae Baker for their

partnership and contributions to today’s webinar.

• Wake AHEC for their support in providing continuing education credit for

this webinar

ACKNOWLEDGEMENTS

None of the presenters today, have any relationship with commercial

companies that could be perceived as a conflict of interest (within the

past 12 months).

DISCLOSURES

• Obtaining continuing education credits:

▪ If attending as a group, everyone must sign-in

on Wake AHEC Roster and email to:

DYelverton@wakeahec.org

▪ Must be present for whole training

▪ Complete evaluation up on receipt

• Questions

HOUSEKEEPING

Nursing: 1.5 Contact Hours

Wake Area Health Education Center (AHEC) Nursing Education is an approved provider of

continuing nursing education by the North Carolina Nurses Association, an accredited approver

by the American Nurses Credentialing Center’s Commission on Accreditation.

Wake AHEC CEU: Wake AHEC will provide 0.2 CEU to participants upon completion of this

activity.

National Association of Social Workers (NASW)

NC AHEC is a 2019 NASW-NC approved provider of distance continuing education. This

program has been approved for 1.5 contact hours

A participant must attend 100% of the webinar to receive credit. Partial session credit will not be

awarded.

Contact Hours: Wake AHEC will provide up to 1.5 Contact Hours to participants.

Wake AHEC is part of the North Carolina AHEC Program.

CREDITS

Enriching a Practice of

Empathy Using the Perinatal

Health Strategic Plan

Jasmine Getrouw-Moore, MPA

February 26, 2020

Jasmine Getrouw-Moore, MPA

Perinatal Health Strategic Plan Consultant

NC Division of Public Health/ Women’s Health Branch

Lynae Baker, MPH(c)

Intern, Perinatal Health Strategic Plan

NC Division of Public Health/ Women’s Health Branch

Objectives• Describe inequities which have major

implications for perinatal health.

• Discuss how to use the Perinatal Health

Strategic Plan as a resource for your

practice.

• Understand the relationship between

marginalized women and the health field.

• Identify how to enrich patient-provider

relationships for improved health outcomes

for North Carolinians.

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The Perinatal Health Strategic Plan

• Framework is based on the “12-Point Plan to Close the Black-White Gap in Birth Outcomes: A Life-Course Approach” developed by Lu, Kotelchuck, Hogan, Jones, Wright, and Haflon

• Broader focus encompassing infant mortality, maternal morbidity and mortality; and the health of women and men of childbearing age

• Data driven and focused on the best evidence available

• Infused throughout with issues of health equity and social determinants of health

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The Stakeholder Team

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• Data and Evaluation

• Policy

• Communications

• Community and Consumer Engagement

• Village 2 Village (Consumer Work Group)

Work Groups

Data and Evaluations Work Group

Identifies data sources, develops monitoring and evaluation strategies, and supports research activities to support and inform the goals of the Perinatal Health Strategic Plan (PHSP).

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Policy Work Group

Works to advance policies found in the Perinatal Health Strategic Plan through education and information sharing.

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Communications Work Group

Shares the intent and goals of the Perinatal Health Strategic Plan to audiences and stakeholders across North Carolina by forging opportunities and identifying champions who are interested in promoting the plan locally. We do this by developing educational materials and promotional items using social media platforms (including our website) to promote the plan.

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Community and Consumer Engagement Work Group

Comprised of a diverse group of community members to be a part of a joint effort by providing feedback regarding the North Carolina Perinatal Health Strategic Plan (PHSP) strategies, publications and services. The Work Group designs and implements capacity building training for community and Village 2 Village participants (consumers) by engaging in interactive, empowering activities. We seek to strengthen relationships and share background knowledge on the Plan.

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The Perinatal Health Strategic Plan is a

complex roadmap to health equity.

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Defining Terms within the Perinatal Health Strategic Plan

• Health Equity

• Life Course Perspective

• Social Determinants of Health

Health Equity

Reference: NC Office of Minority Health and Health Disparities North Carolina Equity Report 2018

The opportunity for everyone to have good health.

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What is the difference between “equality” and

“equity”?

The Life Course Perspective

The Life Course Perspective offers a way of looking at health, not as disconnected stages unrelated to each other, but as an integrated continuum. This perspective suggests that the many facets of life contribute to health outcomes across the course of one’s life. It builds on public health and social science literature which highlight the influence of each stage of life on the next and shows how social, economic, and physical environments interact to have a profound impact on individual and community health.

Reference: City MatCH

Social Determinants of Health

Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.”

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Prioritizing Preconception Health

Goal 1 - Improving Health Care for Women and Men

Point 2. Increase access to preconception health and health care to women and men

• 2A. Expand the college-based Preconception Peer Education (PPE) Program to reach additional women and men in colleges, universities, graduate schools, community colleges and adult learning programs

• 2B. Integrate preconception health (PCH) care and messages into primary care for women of reproductive age

• 2C. Integrate the use of evidence-based and evidence-informed curricula with adolescent and young adult populations in educational and community settings

• 2D. Implement the North Carolina Preconception Health Strategic Plan and Supplement

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Prioritizing Reproductive Health

Goal 2 - Strengthening Families and Communities

Point 7. Support coordination and cooperation to promote reproductive health within communities

• 7A. Promote reproductive life planning

• 7B. Expand community stakeholder involvement and community engagement in service design and implementation

• 7D. Promote utilization of evidence-based strategies to prevent all forms of violence and promote coordinated community response

Prioritizing Healthy Equity with information sharing and high quality

trainingGoal 3 – Addressing social and economic inequities

Point 9. Close the education gap

• Strategy 9D. Promote and increase access to early childhood education

• Strategy 9E. Disrupt the school to prison pipeline, beginning with pre-school

Point 12. Undo racism

• Strategy 12B. Promote high quality training about institutional and structural racism and its impact on poor communities and communities of color

U.S. Infant Mortality Rates by Race and Ethnicity, 2016

Non-Hispanic Black: 11.4

American Indian/Alaska Native: 9.4

Native Hawaiian or other Pacific Islander: 7.4

Hispanic 5.0

Non-Hispanic white: 4.9

Asian: 3.6

Data Source: CDC Reproductive Health

Infant Mortality in NC

African American babies 2.4 times more likely to die than white babies

American Indian babies 1.7 times more likely to die than white babies

Data Source: NC DHHS, 2018

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We have looked at the data, now let’s delve deeper into

some of the issues.

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Sexual Violence and Medical Experimentation

Illustration of Dr. J. Marion Sims with Anarcha by Robert Thom.

Anarcha was subjected to 30 experimental surgeries. Pearson

Museum, Southern Illinois University School of Medicine

_________________________________________________________

Image and Text Source: NPR

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Tuskegee Syphilis Project

Image Source: CDC

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Eugenics

Image Source: Indy Week “American Eugenics Movement After World War II”

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Eugenics cont.

• “Both the Civil Rights and post-Civil Rights eras have been characterized by overt and subtle forms of racism in the U.S. healthcare system. Legal segregation in healthcare continued through the mid-1960s until Congress passed the Civil Rights Act of 1964.51 Shortly thereafter, the Medicaid program forced many hospitals to adhere to the Civil Rights Act and to hire doctors who would treat patients of all races, although unequally.51 Federal funding supported coerced sterilization, and some African American women were threatened with denial of medical care or termination of welfare benefits if they did not undergo sterilization” (2018)

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Eugenics + North Carolina

• “Debra Blackmon (left) was sterilized by court order in 1972, at age 14. With help from her niece, Latoya Adams (right), she's fighting to be included in the state's compensation program.” (Image and caption source: NPR)

• A Reproductive Justice Issue

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Why is this relevant today?

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Implications for Health Outcomes

Kira’s StoryCharles Johnson Lost His Wife Suddenly in Child

Birth — Now He Wants Change | NowThis

https://youtu.be/iWM2Rm72uQc

Reference: CDC Reproductive Health

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Human Rights Centered Care: Equity Infused in System of Care

Ensure strategies focus on culturally and contextually appropriate, evidence based careEnsure

Ensure equitable access to effective careEnsure

Support quality education and training for providers and administrative staffSupport

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Human Rights Centered Care: A Reproductive Justice Framework

Non-traditional partnerships:

Tap into your resource persons, i.e., Women’s Health Branch, March of Dimes

Racial Equity Training

Implicit Bias Training

Learning continuum

Patient-centered care

Taking time to explain procedures and medical care

Encouraging Q&A with compassion and empathy

Listening to voices of patients

Cultural humility

Practicing non-judgmental and supportive care

Ask Questions to understand patients needs

Re-route from assumptions about patients needs

Human Rights Centered Care: Tune into Your Patient

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Listen to your patients’ stories

Commit to engage your patients

Build a relationship founded in authenticity, care and trust

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How will you implement today’s webinar in your

practice?

Do you want to learn more about the Perinatal Health Strategic Plan?

Website: https://whb.ncpublichealth.com/phsp/

Email: PHSPquestions@dhhs.nc.gov

Helpful Resources

References and Helpful Resources

• NC Perinatal Health Strategic Plan

• NC Early Childhood Action Plan

• NC Social Determinants of Health by Regions

• Payments Start For N.C. Eugenics Victims, But Many Won't Qualify

• NC Health Equity Report 2018

• Healthy People 2020

• CityMatCH

• Advancing Holistic Maternal Care for Black Women Through Policy

• To Prevent Women from Dying in Childbirth, First Stop Blaming Them

• Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity

• Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology

• The American eugenics movement after World War II (part 1 of 3)

North Carolina National

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WEBSITES & SOCIAL MEDIA

English and Spanish

OUR TEAM!

Brenda Stubbs, Triad Regional Coordinator

Danielle Little, Eastern Regional Coordinator

Fiorella Horna, Latina Sana Campaign Coordinator

Rocío Anderson, State Director

Kelli McNair,Communication Coordinator

Drea Mora,Western Regional Coordinator

QUESTIONS?

This Photo by Unknown author is licensed under CC BY-NC.

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