On May 15, during National Women’s Health Week, distinguished speakers gathered to discuss the many milestones and achievements in pursuing a healthy world for women and girls. In a tribute to CDC’s Office of Women’s Health (OWH), past and present leaders helped to commemorate its 25th anniversary. Since 1994, OWH has led efforts at CDC to promote and improve the health and quality of life for women and girls. OWH has worked to identify gaps in public health programs that affect women and has actively promoted research to raise awareness of women’s health issues.
After introductory remarks by Leandris Liburd, PhD, MPH, MA, associate director for minority health and health equity and Stephen Redd, MD (RADM, USPHS), deputy director for public health service and implementation science, the audience watched video greetings from HHS Deputy Assistant Secretary for Women’s Health and director of Office on Women’s Health Dorothy Fink, MD. Liburd then presented the first speaker who needed no introduction to the audience.
As CDC director from 1993-1998, David Satcher, MD, PhD established the CDC Office of Women’s Health. Dr. Satcher provided a historical view from a director’s perspective about the events leading up to the establishment of OWH. His remarks included the rise of many women to leadership positions at CDC and how “the leadership role that women have played here at the CDC, [goes] beyond the Office of Women’s Health.”
Dr. Satcher continued his talk with a focus on access to healthcare and maternal mortality as major challenges for women’s health today. Satcher went on to discuss several women’s health issues, including the high rates of maternal mortality in the U.S. “The United States leads in the wrong areas where we don’t want to be leading. Like maternal mortality. Also, our health system really does not adequately serve the needs of women especially.” He reminded the audience that “these are areas where we need to make some real progress.”
After a standing ovation for Dr. Satcher, the crowd welcomed the first director of OWH (1994- 1998), Wanda Jones, DrPH. Dr. Jones recounted her path to the position that started with recognizing that AIDS was also a women’s disease that would ultimately infect children. Her tenacity led to successfully pulling together a proposal leading to a women and AIDS movement at CDC.
Establishing OWH “was about building for women who were not being well-served by the systems we were hoping to reach them with,” recounted Jones. “We walked into an arena in which research excluded women, excluded minorities and it wasn’t asking the right kinds of questions. And so it meant that many illnesses that affected women were not very well understood.” OWH pursued data disaggregation to see and better understand where those gaps were.
Her talk continued with exploring early efforts of the Community Task Force and their approach to addressing neighborhood environments as a determinant to health. These efforts led to what we consider the social determinants of health today. In her concluding remarks Dr. Jones noted, “I’m hopeful that the Office of Women’s Health, 25 or 125 years from now, in this mode where you are more integrated with minority health and health equity, really helps you [OWH] break through into some of those new opportunity areas.”
Succeeding Dr. Jones, CAPT (Retired) Yvonne Green, MSN, RN, CNM joined the celebration by video. Green served as OWH director (1999-2015) during the burgeoning age of the internet. “The internet was new and interesting,” said Green. “So we spent a lot of time in the office thinking about how to use the internet to reach people who we wanted to reach.” While Green was director, OWH developed Health Matters for Women, a monthly newsletter which remains among the most highly subscribed CDC newsletters today.
During her tenure, she transformed the office’s communication efforts with the goal of meeting women where they are in their everyday lives. As Green noted, “We should look at how we can better connect to women and help them better figure out ways to live safer and healthier lives because this is what women want to do.”
Pattie Tucker, BSN, MPH, DrPH, the current OWH director (2016- present) was next to take the stage. Tucker began by sharing the strategic shift toward exploring the conditions of social and other determinants of health to the disease burden and health related quality of life disparities among women. Tucker also emphasized the necessity of data disaggregation. Looking forward at the future of women’s health, “there is a need for more analysis and more reporting of data that are stratified by sex and various interacting social factors that affect health status and quality of life.”
Tucker closed her remarks by encouraging the audience “in your personal as well as your professional roles, to think about what you can do in your work, in your community, and the nation, and even the world, to make it a healthy place for women and girls.”
At the conclusion of the program, Liburd presented Drs. Satcher, Jones, and Tucker with plaques to honor them for their leadership in promoting the health of women and girls.
CDC’s 2019 Public Health Ethics Forum (PHEF): Ethical Dilemmas in Child and Adolescent Health focused on factors that affect healthy development, particularly among youth of color. This year’s PHEF aimed to identify and address ethical implications for future public health interventions. Hosted by the National Center for Bioethics in Research and Health Care at Tuskegee University and CDC’s Office of Minority Health and Health Equity (OMHHE), the forum was held on Friday, April 16. More than 900 people participated in the forum both in-person and online.
After greetings from OMHHE Director Leandris Liburd, PhD, MPH, MA, CDC Principal Deputy Director, Anne Schuchat, MD (RADM, USPHS, RET) provided opening remarks. Schuchat spoke about the history of the measles outbreak and the impact of the Vaccine for Children Program on low income and inner city children. She also mentioned the recent challenges in the rise and return of measles in the U.S. Following Schuchat, Associate Director of Education at the National Center of Bioethics in Research and Health Care at Tuskegee University, David Hodge, PhD, DMin, M.Ed., M.T.S., gave the opening plenary speech titled, “Theme Parks, Rap and Moral Dilemmas – Ethics and the Least of These”. Hodge outlined six major areas of philosophy, the different theories that make up the study of ethics, and we can apply those to our own decision making. CDC defines public health ethics as “a systematic process to clarify, prioritize, and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information”. The annual PHEF sheds light on ethical issues impacting various population groups with this year focusing on children and adolescents.
One of the highlights of this year’s PHEF was a student panel on the social and physical determinants of adolescent health. Students ages 16 to 18 from Atlanta and Tuskegee, Alabama discussed a range of topics such as access to sexual health education and resources, mental health challenges, and immunization rights and restrictions. The student panelists included: Adolfo Berduo Chamblee Charter High School; Kendarius Ivey, Booker T. Washington High School; Emma MacDonald, Rockdale Magnet School; Maya Martin, Agnes Scott College; and JaMyia McNeil, Booker T. Washington High School. Rueben Warren, D.D.S., M.P.H., Dr.P.H., M.Div., Director, National Center for Bioethics in Research and Health Care at Tuskegee University, served as moderator for the panel.
PHEF participants attended a range of breakout sessions that covered substance abuse, suicide, food and nutrition, and mental health. Experts from across the country led the sessions where participants shared personal experiences and solutions. The outcome of the PHEF sessions will be a part of a special edition of the Journal of Healthcare, Science, and the Humanities in coming months. The PHEF also includes poster presentations from public health graduate students from across the country. Rebecca Jung from Columbia University and Ashanti Ali Davis from Tuskegee University shared their research with participants.
The PHEF concluded with a riveting closing plenary from Dr. Stan Sonu, associate program director of Preventive Medicine Residency Program and assistant professor of the Department of Family and Preventive Medicine at Emory School of Medicine. His presentation, “Adverse Childhood Experiences, Toxic Stress, and Health Disparities – The Long-Term Effects of Childhood Adversity and How We Can Respond,” outlined the importance of understanding adverse childhood experiences (ACEs) and the impact these have on child development. Sonu gave moving experiences and stories from his career, and reminded us that we cannot intellectualize the struggle and hurt of communities facing adversity and inequity. Sonu addressed three main questions in his presentation:
- What are adverse childhood experiences (ACEs)?
- What do ACEs do that promotes disease?
- What can be done about it?
Sonu wrapped up his talk by inspiring participants to seek positive change.
“My hope is that one day, 30, 40 years from now, that we’ll look, and we’ll find it ironic and a little sad that we were a health system that did very little to address the structural conditions that permit adversity and context of trauma,” said Sonu.
“This topic is not new and we would do well to heed the words of great thinkers before us, and this is one of my favorite quotes from Frederick Douglas, ‘It’s easier to build strong children than it is to repair broken men.’”
Continuing education for 2019 Public Health Ethics Forum is also available on CDC’s website.
CDC released a Vital Signs report showing that nearly a third (31%) of pregnancy-related deaths happen during pregnancy, just over a third (36%) happen during delivery or the week after, and exactly a third (33%) happen one week to one year after delivery. However, 3 in 5 pregnancy-related deaths could be prevented, no matter when they occur.
The findings come from a CDC analysis of 2011-2015 national data on pregnancy mortality and of 2013-2017 detailed data from 13 state maternal-mortality review committees. Pregnancy-related death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.
The data confirm persistent racial disparities: Black and American Indian/Alaska Native women were about three times as likely as white women to die from a pregnancy-related cause. But the new analysis found that most deaths were preventable, regardless of race/ethnicity.
The analysis also found that leading causes of death differed throughout pregnancy and after delivery.
- Heart disease and stroke caused more than 1 in 3 deaths overall.
- Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), caused most deaths at delivery.
- In the week after delivery, severe bleeding, high blood pressure, and infection were most common.
- Cardiomyopathy (weakened heart muscle) caused most deaths 1 week to 1 year after delivery.
The report also summarizes potential prevention strategies from 13 state maternal mortality review committees (MMRCs). MMRCs are multidisciplinary groups of experts that review maternal deaths to better understand how to prevent future deaths.
The committees determined that pregnancy-related deaths are associated with several contributing factors, including access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs. MMRC data suggest that the majority of deaths – regardless of when they occurred – may have been prevented by addressing these factors at multiple levels to prevent deaths during pregnancy, at labor and delivery and in the postpartum period:
- Providers and patients can work together to manage chronic conditions and have ongoing conversations about the warning signs of complications.
- Hospitals and health systems can play an important coordination role, encouraging cross-communication and collaboration among healthcare providers. They can also work to improve delivery of quality care before, during, and after pregnancy and standardize approaches for responding to obstetric emergencies.
- States and communities can address social determinants of health, including providing access to housing and transportation. They can develop policies to ensure high-risk women deliver at hospitals with specialized health care providers and equipment — a concept called “risk-appropriate care.” And they can support MMRCs to review the causes behind every maternal death and identify actions to prevent future deaths.
- Women and their families can know and communicate about the warning symptoms of complications and note pregnancy history any time medical care is received in the year after delivery.
CDC is prioritizing the lives of America’s mothers to prevent pregnancy-related death. CDC tracks pregnancy-related mortality and severe pregnancy complications. The agency provides technical assistance and resources to MMRCs to review maternal deaths and make prevention recommendations. CDC will provide support to as many as 25 MMRCs across the country through the Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees funding opportunity, beginning in fall 2019. CDC also funds 13 state perinatal quality collaboratives and the National Network of Perinatal Quality Collaboratives to improve the quality of care for mothers and their babies. To help states standardize their assessment of levels of maternal and newborn care for their delivery hospitals, CDC offers the CDC Levels of Care Assessment Tool and provides technical assistance to those who want to use it. CDC is working to educate the public about pregnancy-related death. Please share the CDC Vital Signs on Pregnancy-related Deaths with your colleagues and partners.