Kimberly Glazer, PhD, MPH
The COVID-19 pandemic is a watershed global health crisis. It is heartrending, uncharted territory. Here in New York City, we have weathered a health emergency nearly inconceivable just a few months ago. With incredible fortitude, compassion, and grace, health care professionals and other essential workers carried us past the crest of this wave of infection. We have been forced to learn a set of arduous lessons: about the price of foregone planning and prevention; about limitations in our capacity to control hazards in an interconnected world; and about the imperative of working together to develop and share solutions to existential global issues.
In reflecting on the challenges of the past weeks, I cannot help but connect this crisis with my own research area of perinatal health. I have spent my postdoctoral training learning from expert clinicians, epidemiologists, and health service researchers studying maternal and infant health disparities in New York City. The themes coming to the surface in this pandemic, in particular its disproportionate toll on communities of color, are regrettably familiar.
COVID-19 mortality data indicate a clear differential impact by race. In a previous post, we showed how Black, poor neighborhoods suffer the highest burden of COVID-19 in New York City. According to the COVID Racial Data Tracker, a collaboration between The Atlantic’s COVID Tracking Project and the Antiracist Research and Policy Center, Black people are dying at a rate nearly two times higher than their share of the population. Some data suggest that Black people may be less likely to receive coronavirus testing when symptomatic, and delays in diagnosis and treatment are particularly consequential for people of color, who are more likely to suffer from risk factors for severe illness such as diabetes and hypertension. In another report, “The color of coronavirus: COVID-19 deaths by race and ethnicity in the U.S”, researchers at APM Research Labs conclude: “if they had died of COVID-19 at the same rate as White Americans, about 13,000 Black Americans, 1,300 Latino Americans and 300 Asian Americans would still be alive.”
We confront similarly appalling disparities for perinatal outcomes. The U.S. maternal mortality rate increased while other nations halted or reversed their trends. Black mothers die at alarmingly high and disproportionate rates, their infants are less than half as likely as their non-Hispanic White counterparts to survive the first month of life, and both Black and Latina mothers face increased risk of life-threatening pregnancy-related complications. A large proportion of these disparities are due to preventable complications and systematic deficiencies in obstetric and neonatal care quality.
Our research team at the Blavatnik Family Women’s Health Research Institute has developed a body of research examining these inequities. Critically, there is a growing recognition of disparities that persist even beyond differences in underlying health conditions, insurance coverage, and the hospitals where women receive care. Entrenched racial and ethnic biases manifest in power imbalances and communication gaps in maternal and neonatal care, contributing to the unnecessary escalation of avoidable morbidity.
I read an article about the impact of COVID-19 on global hunger, in which a volunteer in Kibera, the largest Nairobi slum, called the coronavirus “the great revealer, pulling the curtain back on the class divide and exposing how deeply unequal this country is.” His quote referred to Kenya but could have easily described the trajectory of the pandemic, or any number of health issues, here in the United States. In this moment, as we confront the legacy of deep-seated, structural racism and bias in our country, it is past time to challenge the systems that create the conditions for disparities.
This emergency provides a trying but important lesson in empathy–of shifting our paradigms to consider, and prioritize, equity and the common good. Looking out my window over the past few weeks–at largely empty streets, peppered with socially-distanced dog walkers and stir crazy runners–I have been heartened to see people heeding the warnings of public health and medical officials. Extreme social isolation has been necessary to slow the pace of infection and conserve health resources for those who need them most. We are living out the tension between individual liberty and public safety: taking stock of the implications that our choices have, day in and day out, for those around us, and considering the experiences of those whose circumstances differ from our own.
This is public health. And (though of course I am biased), I also think it is the best of humanity. When we force ourselves to ask difficult questions about what we can live without, what we need to mobilize now to mitigate future harm, and how to redress inequitable risk. These questions are applicable to a viral pandemic, a maternal mortality crisis, and each of the seemingly mounting threats facing humanity. Now what do we do with this wake-up call?
We can learn from this crisis. We can change how we think about health, and the capacity of our infrastructure, systems, and workforce to protect it. Listen to the data, engage the experts, and proceed as if lives depend on our actions. They always do.
Kimberly Glazer, PhD, MPH, is a perinatal epidemiologist with research interests in obstetric management and peripartum morbidity, with specific attention to maternal obesity. She is a postdoctoral fellow with the Blavatnik Family Women’s Health Research Institute. Her research evaluates social and quality of care determinants of severe maternal morbidity, adverse neonatal outcomes, and racial/ethnic perinatal disparities.