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In recent years, concerns about equity in health have been top of mind here in the United States and around the world. The American Heart Association (AHA) has begun working to address the significant disparities in maternal and perinatal health outcomes among certain demographic groups.
This year, an innovative project was initiated to address these disparities. The Ohio State University Wexner Medical Center and College of Medicine joined four other strategically selected sites in the United States to form the Health Equity Research Network (HERN) on Disparities in Maternal-Infant Health Outcomes. A $20 million, four-year AHA grant funds the effort.
The network of centers is striving to understand why people of color, as well as rural people, are at drastically higher risk for maternal mortality and morbidity. Because roughly half of maternal and perinatal deaths relate to heart and vascular health, it’s logical that the AHA would commit to studying the topic and seeking solutions.
“This effort is devoted to developing a single network focused on improving and optimizing health outcomes by addressing the significant disparity that exists especially among people of color, with the ultimate goal being to eliminate disparities,” says William Grobman, MD, MBA, a specialist in the Division of Maternal Fetal Medicine at the Ohio State Wexner Medical Center.
Creating BETTER health outcomes
Ohio State’s project is called Better Birth Outcomes and Experiences Through Technology, Education and Reporting (BETTER). The research team is using innovative approaches to overcome barriers related to social determinants of health, factors that impact various health risks and outcomes. More specifically, the team will create and test strategies for improving health outcomes by addressing social and economic challenges.
Those challenges, which include housing instability, food insecurity and exposure to violence, are associated with an increased risk of adverse health and pregnancy outcomes.
The Ohio State team will identify the challenges pregnant people face and how people in need can be best linked to helpful resources.
Ann Scheck McAlearney, ScD, MS, distinguished professor of Family and Community Medicine in the Ohio State College of Medicine, associate dean for Health Sciences Research, and executive director of CATALYST, the Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, is co-principal investigator with Dr. Grobman in leading the project at Ohio State.
A multitude of leading-edge strategies to reduce health disparities
The project involves a combination of leading-edge strategies and tools, including innovative use of education and digital tools.
“We want to use this project — and all the projects in the AHA network — to find ways we can mitigate adverse outcomes related to social determinants of health,” Dr. Grobman says.
Each university in the HERN has its own related project. The sites are the University of Alabama – Birmingham, Northwestern University, the University of Pennsylvania and the University of North Carolina – Chapel Hill. The HERN has also partnered with North Carolina A&T State University, a historically Black university, and with a community partner, Connection Health.
“The centers come together, each with its own project, but with a singular focus devoted to enhancing equity in maternal and perinatal health outcomes,” Dr. Grobman says. “They function as a coordinated and synergistic network”.
Alarming and “shameful” inequity
The challenge could not be clearer or the issue more alarming. Cardiovascular conditions are associated with more than one-half of pregnancy-related deaths in the United States. Pregnant people of color are two to three times more likely to die from pregnancy-related causes than are white people, according to the Centers for Disease Control and Prevention (CDC). Also, according to the CDC, pregnancy-related mortality per 100,000 live births in people of color who are older than 30 is four to five times higher than in white people. Those statistics are one indication of the pervasive health disparities that exist.
“There are rising and disproportionate rates of preterm births among people of color,” Dr. Grobman says, “as well as of gestational diabetes, hypertensive risks and maternal and perinatal morbidity and mortality. This is shameful and a public health crisis. We are spending an enormous amount to take care of people,” he says, “but resources are not shared equally.”
Sustained and continuing efforts
Because there are so many complex and ongoing challenges, the expectation is that there will be continued collaboration across HERN.
“The goal is for the work to continue far beyond the four years of the grant,” Dr. Grobman says, “so it’s a springboard to an ongoing effort.” The initiative also involves developing and training the next generation of researchers who are exposed to and supported in conducting research and designing interventions to improve maternal and child health and health equity, ensuring these concepts stay in the spotlight.
“Much more needs to be done,” Dr. Grobman says, “and we need to do whatever we can. Our hope is that these projects help to point the way forward.”
