Neonatal death, low birthweight, and pregnancy complications are serious outcomes of reduced prenatal care in the United States. A low birthweight alone causes 30,000 infant deaths. Inadequate care is seen particularly for low-income minority women, so these populations are at a greater risk for complications. In addressing these disparities, healthcare systems fail to consider all possible causes. Language barriers, poor housing, and transportation can all contribute to reduced access to prenatal care. Instead, financial barriers are generally targeted for solutions (C. Cook, K. Selig, BJ Wedge, 1999). Prenatal care is one of many aspects of women’s health in inner cities that desires attention.
Compared to non-minorities, minority women’s health issues and healthcare are not given adequate importance. Because minorities have a higher level of morbidity than their Caucasian American counterparts, they require more medical care. Ironically, though, minorities have less access to the same care (Williams, 2002). Health institutions, including research institutions, fuel this disparity by ignoring health issues that affect minorities.
There is also a surprising lack of awareness of prominent women’s health issues in not only the general public, but also in the minority women population itself. African American women have a cancer mortality rate that is 30% higher than that of Caucasian American women. Low-income African American women are more likely to report that they did not receive sufficient risk counseling during healthcare visits. Minority women have an increased chance of experiencing cardiovascular complications from smoking than non-minorities and have statistically less access to smoking cessation resources (Houry, et al., 2011). Collectively this data helps elucidate a glaring health inequity that exists in inner cities, such as in Baltimore.
A health inequity is defined as an inappropriate allocation of resources. Simply providing the same resources to all populations is not an effective means of providing healthcare. Different demographics may require drastically different types of medical attention. Due to the greater rate of illiteracy in inner cities, for example, health information should be communicated at a lower education level in order for these areas to receive sufficient care (R. S. Safeer, 2005). A variety of medical interventions and health policies designed to increase access to appropriate forms of care are required to address the inequities faced in the United States by minority women.
The targeted care mentioned previously was achieved by Emory University in an inner city emergency department in a southern city of the United States. A fifteen minute survey was given to those minority female patients who were capable and willing. The survey posed several questions related to general health and health behaviors and included screenings for intimate partner violence (IPV) and nicotine, drug, and alcohol dependence. Randomly chosen patients that indicated positive for these health risks participated in an educational intervention.
Patients that tested positive for a certain health risk were given a corresponding brochure with information about the risk as well as resources for additional assistance. The brochure for IPV, for example, discussed unhealthy relationships and resources for legal help and support groups. The three month follow-up surveys indicated that women in the intervention group exhibited less risk-related behavior and showed an increased probability of reducing alcohol or tobacco usage. A simple educational brochure was able to raise awareness of health risks in minority patients. The study demonstrates that focused attention to the needs of minority women resulted in an increase in healthy behavior.
Persistent inequities in minority healthcare are witnessed not only in the emergency room or clinic, but also in educational institutions that conduct research on health issues and work to produce medical interventions to address them. Too few laboratories conduct investigations on minority women’s health issues, and therefore, a gap in knowledge about these conditions exists.
For example, a grant application was released by the NIH in 1998 requesting research institutions to pursue investigations about liver and biliary disease in minority women. Conditions including gallbladder cancer in Mexican Americans and chronic hepatitis C in African Americans are major concerns, but the pathogenesis, or the development mechanism of the diseases is still unknown. Mortality due to liver disease is higher in minorities, but the liver transplantation rate and the survival rate after transplantation is significantly lower than in Caucasian Americans. The reasoning behind this inequity is unknown but could be due to less access to healthcare, which is rarely considered when deciding between therapies for liver diseases (“PA-98-086: Liver and Biliary Diseases Among Women and Minorities,” 1998). By filling in information about liver diseases and the effect of the female sex on complications from these diseases, the mortality rate of minority women due to liver disease may be significantly reduced.
The labs of Dr. Richard Cone and Dr. Justin Hanes in the Johns Hopkins Biophysics Department and the Center for Nanomedicine at the Johns Hopkins School of Medicine, respectively, have played an active role in filling the gap of knowledge about women’s health. A primary focus of these labs is Bacterial Vaginosis (BV), a condition that affects a third of adult women in the United States, particularly African American women. Despite its high incidence in the United States, little information has been published about the condition. Yet, it is the most common infection in outpatient gynecological clinics.
Bacterial vaginosis develops when the natural flora in the vagina is disrupted by an abnormal pH, causing the colonization of other forms of bacteria. The pH in the vagina can be altered by unnatural cleaning products or methods. The standard treatment for BV is simply the use of antibiotics; however, no absolute cure exists and long-standing, untreated cases can potentially lead to more serious complications, including HIV, pregnancy complications, pelvic inflammatory disease, and compound infections (Cone, 2014).
BV is a prevalent, though treatable, condition in the United States that has the potential to cause more serious illnesses if left to itself. Prevention is mostly achieved by patient education. Informing the patient about the pathogenesis and risk factors of the infection may serve to decrease its prevalence. This intervention, in addition to the work that Dr. Cone and Dr. Hanes are conducting in their respective labs to develop a cure, may prove effective in reducing the incidence of BV and, thereby, its complications.
Combining the effects of providing health education to underserved populations, such as low-income minority women, and the effects of high-impact research conducted by academic institutions has demonstrated a way to improve health statistics in inner cities and other underserved areas. In addition, healthy policy may provide a wide-reaching impact to allow for increased access to necessary care. Inadequate healthcare for minority women and inequitable treatment in healthcare settings is a priority issue for governmental and health-related institutions. The joint effort of all of these organizations is required to reach equitable care for all populations in the United States.
Cook, K. Selig, BJ Wedge, E. G.-B. (1999). Access Barriers and the Use of Prenatal Care by Low-Income, Inner-City Wome…: EBSCOhost. Retrieved April 2, 2017, from http://eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=914f292e-aacf-4619-9006-8bc60ba709d8%40sessionmgr103&vid=1&hid=119
Cone, R. A. (2014). Vaginal Microbiota and Sexually Transmitted Infections That May Influence Transmission of Cell-Associated HIV. Journal of Infectious Diseases, 210(suppl 3), S616–S621. http://doi.org/10.1093/infdis/jiu459
Houry, D., Hankin, A., Daugherty, J., Smith, L. S., & Kaslow, N. (2011). Effect of a Targeted Women’s Health Intervention in an Inner-City Emergency Department. Emergency Medicine International, 2011, 543493. http://doi.org/10.1155/2011/543493
PA-98-086: LIVER AND BILIARY DISEASES AMONG WOMEN AND MINORITIES. (n.d.). Retrieved April 12, 2017, from https://grants.nih.gov/grants/guide/pa-files/PA-98-086.html
RICHARD S. SAFEER, J. K. (2005). Health Literacy: The Gap Between Physicians and Patients – American Family Physician. Retrieved March 11, 2017, from http://www.aafp.org/afp/2005/0801/p463.html
Williams, D. R. (2002). Racial/ethnic variations in women’s health: the social embeddedness of health. American Journal of Public Health, 92(4), 588–97. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11919058