Health of Latinos in New York City: A Report

The Health Department has released “Health of Latinos in New York City,” a comprehensive report detailing the health of Puerto Ricans, Dominicans, Mexicans, and Central and South Americans, New York’s largest Latino groups. The report highlights key demographics, as well as socioeconomic, housing, and neighborhood conditions that impact the health of Latino New Yorkers.

The full report is available in English and Spanish.

Take Care New York 2020

Take Care New York 2020 is the City’s blueprint for giving everyone the chance to live a healthier life. Its aim is to improve every community’s health, especially among groups with the worst health outcomes, so that our city becomes a more equitable place for everyone. TCNY 2020 looks at traditional health factors, as well as social factors, such as how many people in a community graduated from high school or go to jail. This second annual report shows our progress toward the 2020 goals; highlights four partners that are working to improve the health of their communities; provides suggestions for organizations, businesses and health care providers on how they can support the health of their neighborhoods.

Read the full report here.

Turning the Tide on Maternal Deaths Among Black Women—One Case at a Time

In Public Health the focus is population-wide efforts to prevent sickness and premature death. We are often so focused on population-level statistics we forget that behind every single number there is a human being. We forget that it is a collection of individual stories that make up the whole. Sometimes in public health, to find a way forward, we have to look beyond the numbers and hear the individual stories to uncover the truth.

In Public Health the focus is population-wide efforts to prevent sickness and premature death. We are often so focused on population-level statistics we forget that behind every single number there is a human being. We forget that it is a collection of individual stories that make up the whole. Sometimes in public health, to find a way forward, we have to look beyond the numbers and hear the individual stories to uncover the truth.

One of the biggest public health triumphs in recent years has been the worldwide drop in maternal mortality—about a 44 percent reduction, over the last 25 years, according to the World Health Organization. Nonetheless, every day approximately 830 women die from preventable causes related to pregnancy and childbirth. Of those deaths, 99 percent occur in developing countries where mothers in rural and poor communities face a much higher risk of complications.

In the United States, roughly four million women give birth every year. In a country that has some of the finest medical care that money can buy, none of us should go into the experience fearing for our lives. We may worry about a lot of things, like the pain of labor and delivery, the health of the child and uncertainty about being a good mom, but we should be able to approach the experience fairly certain that we will come out alive. But while overall maternal deaths in the industrialized world have mirrored the worldwide trend, the United States has actually seen an alarming increase in maternal mortality and morbidity. In fact, we have the highest rates of any wealthy country. The Center for Disease Control and Prevention reports that in the United States around 700 women die each year as a result of pregnancy or delivery complications and another 60,000 women have a “near miss” or almost die. Research suggests that at least half of them are preventable.

Experts agree that there are probably three major factors contributing to the upward trend: inconsistent obstetric practice, particularly in managing emergencies; the increasing number of women who are presenting with chronic health conditions; and a lack of good data and related analysis on maternal health outcomes.

It appears race is also a factor.

Last fall when Serena Williams shared the story of her near-death experience following the birth of her daughter, she shone a startling spotlight on a growing concern in the United States—an unacceptably high rate of pregnancy-related deaths and disabilities among Black women. In the wake of her disclosure, several other articles were published and radio segments aired, many detailing examples of complications Black women from all walks of life faced while giving birth, many of them fatal.

Unfortunately, in New York City, the trend holds. In NYC, each year approximately 30 women die of causes related to pregnancy with the largest number of deaths attributed to women of color. In our city, Black women are 12 times more likely than White women to die from pregnancy-related causes.

In 2016, funding from Merck for Mothers helped the Health Department and the Fund for Public Health in NYC develop a system for tracking the number of women affected by severe maternal morbidity (SMM) or life-threatening complications. Severe maternal morbidity includes heavy bleeding, blood clots, organ failure, stroke and heart attack that result in the woman almost dying.

The results of the new system, the first of its kind in the nation to track SMM at the municipal level, showed some alarming trends. We learned that each year approximately 2,500 women in NYC experience a life-threatening complication during labor and delivery. For every woman who dies, there are 100 who almost die.

We also uncovered blatant racial disparities. Black women were three times more likely to experience a life-threatening event than White women even after taking educational attainment into account, which is frequently the equalizer. In fact, Black women with college degrees or higher were still more likely to experience a life-threatening event than women of other races and ethnicities that didn’t graduate from high school.  The story of Shalon Irving, an epidemiologist at the CDC, who died shortly after delivery, is a tragic and heart-wrenching example of this inequity.

We need to act to right this injustice but first we need to understand it.

This year, FPHNYC and the Health Department announced a new grant from Merck for Mothers to build on the work accomplished during the first grant period. The new grant will work with three hospitals to support detailed reviews of each SMM case to analyze and apply lessons learned to hospital quality improvement processes. In addition, the grant will support efforts to integrate SMM cases into the city-wide Maternal Mortality Review Committee to better understand the root causes of poor maternal health outcomes, the glaring disparities across race, and to help inform individual and community strategies to affect change.

This award opens up new possibilities. It offers the opportunity for public health officials to look beyond the big picture numbers and learn from individual mothers’ experiences to find the answers.

New Funding Supports Improvement in Maternal Care Across the City

In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the Centers for Disease Control and Prevention (CDC), Black mothers in the U.S. die at three to four times the rate of White mothers. In New York City, Black mothers are 12 times more likely than White mothers to die from pregnancy-related factors.

In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the Centers for Disease Control and Prevention (CDC), Black mothers in the U.S. die at three to four times the rate of White mothers. In New York City, Black mothers are 12 times more likely than White mothers to die from pregnancy-related factors.

The Fund for Public Health in New York City (FPHNYC) in collaboration with the New York City Department of Health and Mental Hygiene (Health Department) has received a $1.8 million award from Merck for Mothers to address persistent racial and ethnic disparities in maternal health.

This new funding will build on the Health Department’s efforts to focus on severe maternal morbidity (SMM), which is defined as life-threatening complications during or after childbirth, such as heavy bleeding, kidney failure, stroke or heart attack. In New York City, instances of SMM happen at about 100 times the rate of maternal deaths. These instances give researchers the opportunity to learn directly from the women who survive them.

The grant supports the integration of detailed SMM case reviews into ongoing hospital quality improvement processes in three hospitals; tests a model of integrating SMM into a citywide Maternal Mortality Review Committee; develops community interventions to address conditions that lead to SMM and maternal mortality; and develops a how-to toolkit for other jurisdictions interested in replicating the work.

This is FPHNYC’s and the Health Department’s second collaboration with Merck for Mothers; the first funded the establishment of the first-ever citywide SMM monitoring system and resulted in the Severe Maternal Morbidity in New York City, 2008-2012 report, released in 2016. The report shows that SMM affects approximately 2,500 New York City women a year. Black, non-Latina women have significantly higher rates than Whites, even when controlling for education and socio-economic status, which is likely a result of structural racism.

“We are pleased to continue our partnership with the Health Department and Merck for Mothers,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “This is an important opportunity to integrate the experiences of new mothers so we can better understand what causes racial disparities and support the development of effective interventions.”