Closing General Session: ‘Tackling health equity will require real social and political change’

Coming off a midterm election that sent a record number of women to the halls of Congress, it was uniquely apropos that the APHA 2018 Annual Meeting and Expo would end with a critical call to listen to and learn from women’s lived experiences.

“Applying the social and equity lens is the work — not separate work,” said Debra Joy Pérez, senior vice president of organizational culture, inclusion and equity at Simmons University in Boston and a panelist at today’s Closing General Session on “Dying Too Soon: A Look at Women’s Health.”

Pérez kicked off the closing by encouraging the audience of hundreds to recognize and celebrate so-called “nasty women” — women who stand up for the vulnerable, who say what they mean, who believe in equality for everyone. And while women are certainly making great gains and rising to positions of power, they still face social conditions and stressors that can put their health and lives in grave danger.

For example, said panelist Linda Blount, president and CEO of the Black Women’s Health Imperative, black women typically have more of the hormone cortisol in their blood than white women. It’s an inflammatory response to toxic stressors such as racism and discrimination that raises their risk for all kinds of serious health problems. Black women also experience high rates of post-traumatic stress disorder, she told the audience, with much of that due to being constantly exposed to visuals of violence — including police violence — taking the lives of black children.

Blount noted that there’s often a considerable disconnect between black women and the epidemiologists who study their health. Most black women, she said, self-rate their health as excellent — “they don’t see themselves as broke and broke down at all.” That disconnect is another reminder that to narrow disparities, public health workers need to start by listening to black women’s voices.

“We have to consider the lived experiences of black women in our work,” she said. “We have a choice: we can look at people through the lens of the problem or look at the problem through the lens of people. …If we value black women, if we consider they are worth listening to, then we can think about achieving health equity. If not, 30 years from now, we’ll be back here having the same conversation and that would be a shame.”

Cynthia Lamberth, co-executive director of the Kentucky Population Health Institute, works in Appalachia, where “deaths of despair” — or deaths from drugs, alcohol and suicide — among women have skyrocketed in recent years. Women’s health in the region “is definitely moving in the wrong direction,” Lamberth told attendees at the closing session in San Diego.

Lamberth noted that some people object to the terminology “deaths of despair,” but she doesn’t. Why? Because it pushes researchers and public health workers to go out into communities and ask women about their experiences — to ask women what they need to move from a place of despair to one of hope.

“A lot of the time, if the problem is in the community, then the solution is also in the community,” Lamberth said. “We just need to listen, particularly to women’s voices.”

Panelist Michael Lu, a professor at George Washington University Milken Institute School of Public Health, reminded the audience that black women are more than three times likely to die from pregnancy and childbirth than white women. Eliminating that disparity will take changes across sectors, he said, but we won’t be able to really turn the tide on premature death and advance health equity if “we don’t do something about the chronic stress that is becoming a way of life for so many women in this country.”

“There’s so much stress on women today, especially poor women and women of color, that it is really making women sick,” said Lu, who previously served as the director of the federal Maternal and Child Health Bureau under President Obama.

Healthy bodies have an easier time adapting to changes, including pregnancy, Lu noted. But a body worn out by chronic stress and racism can make pregnancy and childbirth a much riskier endeavor for some women more than others. Such circumstances require a hard focus on shifting the social conditions that serve as major sources of chronic stress.

“For such a long time, public health has looked downstream to try to impact the harms caused by decisions made upstream,” Lu said. “But as much as we’d like to think we can fix all public health problems with public health programs and services, tackling health equity will require real social and political change in this country.”

Lu just recently published a commentary in the Journal of the American Medical Association on reducing maternal mortality in the U.S. by half by 2025 and eliminating it by 2050. It’s a big goal, but Lu said it is possible through a variety of interventions, including efforts to improve the quality and safety of hospital maternity care. (For example, clinical efforts of the California Maternal Quality Care Collaborative have resulted in California’s maternal mortality rate declining by 55 percent between 2006 and 2013, even while the national maternal death rate continued to go up.) Still, Lu said clinical efforts will only get us so far — to really eliminate preventable maternal mortality, we must improve women’s health and the social conditions they face throughout their lives.

“We have to do everything we can to stop the assault on women’s health and reproductive rights in this country,” he told attendees.

At the end of the closing session, Pérez brought the conversation back to a common thread that wove its way throughout this year’s APHA Annual Meeting — building a narrative of belonging for all people and communities.

“It’s not just about changing the narrative,” she said, “it’s about changing the narrator.”

See everyone next year in Philadelphia for APHA’s 2019 Annual Meeting and Expo, which will have a theme of “Creating the Healthiest Nation: For science. For action. For health.”

At top, Closing General Session panelists from left to right: new APHA President Pamela Aaltonen, Michael Lu, Cynthia Lamberth, Linda Blount and Debra Joy Pérez. Photo by Jim Ezell, courtesy EZ Event Photography