Before I attended a recent event on NEOMED’s Embracing Diversity series, I believed that infant mortality and adverse childhood experiences (ACEs) were disparate topics. I knew that both were social determinants of health (SDOHs)—but I thought that was their only connection. A presentation by Marie Curry, J.D., M.P.H., on this topic opened my eyes.
A graduate of Harvard Law School with a Master of Public Health degree from the Johns Hopkins Bloomberg School of Public Health, Marie Curry is the managing attorney of Community Legal Aid’s Health Education Advocacy and Law (HEAL) Project as well as Legal Aid’s Immigration practice in Akron. At the Embracing Diversity lecture, she discussed the question, “How can we help families raise healthy children?”
While infant mortality rates and ACES concern people at different stages of life, I realized after the Embracing Diversity lecture that they both involve negative stressors within social determinants of health—the surroundings and daily activities that impact a person’s health for better or worse.
Curry described ACEs as high-stress events that change the physiological and mental well-being of the child. ACEs include separated or divorced parent; alcoholism in the family; childhood physical, sexual, and/or emotional abuse; or mental illness in the family, among other experiences. Although these stressors take place in childhood, they have lifelong effects. I was startled to learn that a person with six or more ACEs dies an average of 20 years earlier than a person with no ACEs.
Instead of simply talking about infant mortality in a vacuum, Curry put it into context by explaining how an infant mortality rate reflects the effects of demographics’ different stressors. One surprising takeaway from the presentation was the connection between infant mortality and institutional racism. A 2002 Vital Statistics Report by the Centers for Disease Control and Prevention showed that black college graduates had a higher infant mortality than white high school dropouts (10.2 versus 9.9 per 1,000, respectively).
The stress from institutional racism, among other economic, social, and environmental disadvantages, contributes to health inequities. This inequity is evident through the varying infant mortality rates across different demographics.
How can a physician help?
People in each demographic experience a unique set of stressors within their SDOH and carry a physiological make-up that is diverse in its resiliencies and predispositions. For instance, Curry compared the different modes of transportation in a rural setting versus an urban one. Rural settings have fewer options for public transportation. Compared with someone who resides in an urban setting with a variety of public transportation options, it can be more difficult for someone living in a rural environment to travel to a physician’s office or grocery store if they don’t have a vehicle. As a future health care provider, I realized that I will need to recognize the health disparities that result from different stressors on various populations.
In addition, most people have experienced the maladaptive implications of ACEs. Sixty-four percent of respondents in the landmark ACEs study had experienced at least one ACE. To better serve these patients, physicians can take more extensive patient histories and talk about patient backgrounds to understand how SDOHs and ACEs affect a person’s well-being. Possible SDOHs that physicians can ask about include neighborhood and built environment, economic stability, social and community context, and education. Physicians can also look for signs of household dysfunction within a child’s family.
Curry suggested that lasting effects would necessitate preventative measures spearheaded by various institutions, such as the Infant Mortality Reduction Plan instituted by the Ohio Department of Health.
—Katherine Wu (M1), third from left, contributed this report.
Additional comments from two other College of Medicine students, both in the Rural Medical Education (RMED) pathway:
“I think that the topics that Marie Curry covered are essential for every physician to know. It is outrageous that white women without high school degrees have better infant mortality rates than college educated black women. I think that all physicians should know the way that racism affects infant mortality in America, and the first way to facilitate change is education and awareness.”—Laura Yeater (M2)
“I thought the lecture was very informative. There are many factors that can affect the health of a family and community. I was unaware of the infant mortality disparity and would love to see more on this. I also learned how Adverse Childhood Experiences (ACEs) are prevalent across multiple races, sexes, creeds, etc. This seminar increased my interest in how resources are allocated to address inequities, and how to minimize the long term affects for both rural and urban populations.” —Stephen Grossi (M1)