Health equity includes addressing maternal mortality

The recent crisis of protests following George Floyd’s killing and the killings of scores of black men and women, as well as higher mortality in blacks from the COVID-19 pandemic, highlight the systems of health care that have historically and currently disadvantaged communities of color, particularly black women. Physician leaders are taking a stand on the vast inequality of health care in this country. 

“The profound grief and stress triggered by these events, as well as the consequences for black lives, contribute significantly to cardiovascular risk,” Albert writes.

Cardiovascular disease remains the No.1 killer of Americans, and black Americans have the highest risk of major cardiovascular events. The United States has the highest maternal mortality among developed countries. 

More than 40 percent of women dying during or after pregnancy are black American women. More than 40 percent of deaths are due to cardiovascular or cerebrovascular disease. Black women have greater than three times higher risk of deaths due to complications from pregnancy than white women.

Maternal mortality is one of the most tragic events in a family’s life. To lose a mother at birth may be the most tragic event in a child’s life. 

As a cardiologist for 30 years and a member of these groups, the pledge is to work to decrease the excess morbidity and mortality of vulnerable and historically oppressed people.

I am a brown Filipina immigrant, who came to the United States at 12 with my parents. I took advantage of many opportunities to become a successful cardiologist. 

As chairs of the Women in Cardiology of the American College of Cardiology and the American Heart Association, Dr. Toniya Singh and I are addressing the rising maternal mortality in the United States, with recent scientific statements and recommendations about how to decrease maternal mortality. The Association of Black Cardiologists is leading the effort and we will be there to support and help them.

Chants in protests around the country and the world and in eulogies spoken at his recent funeral service call to mind some of George Floyd’s final words, “I can’t breathe.”

These are the same words from many of my patients; especially black patients whom I take care of in the hospital and clinics, many of whom suffer from cardiovascular disease. 

When their hearts become too stiff from untreated high blood pressure or weakened by heart attacks, they say they have trouble breathing. Fortunately, for my patients, I can help ease their trouble breathing since many suffer from heart disease easily treated by medications to get rid of fluid from the lungs and help their hearts relax. Some patients need heart procedures and surgeries which can help them feel much better. 

An ambitious goal is to cut the rate of maternal mortality by 50 percent, which the state of California did between 2006 and 2013. They changed the way doctors and nurses responded when there is excessive bleeding during the delivery. 

What they found was despite this decline, racial disparities persisted and black women still had three to four times higher risk than white women. Cardiology organizations can advocate for congress to pass the Black Maternal Health Momnibus Act, which has nine bills. 

The risk of death for the mother can be highest after childbirth. As part of this act, one of the bills proposes to increase the Medicaid coverage for 12 months instead of three months after delivery. Another bill proposes using digital tools like telehealth to improve outcomes in underserved areas, something that the COVID-19 pandemic has enabled doctors and patients to use effectively. An important measure is to increase the diversity of health care workers and utilizing doulas to decrease maternal complications. 

Health equity is a human mission that needs to be granted the highest priority by the health care community and policymakers to enhance the lives of all men and women. 

Annabelle Santos Volgman, M.D., is the McMullan-Eybel Endowed Professor of Cardiology at Rush University and medical director of the Rush Heart Center for Women. She is the governor-elect of the Illinois American College of Cardiology and the Chair of the Women in Cardiology Committee of the American Heart Association.