On, Saturday, October 10th (which happens to be International Human Rights Day), the Illinois Single Payer Coalition along with the IL Chapter of a Physicians for a National Health Program and the Chicago Single Payer Action Network, sponsored a Teach-in at Occupy Chicago. The teach-in not only focused on the overall heath disparities within Chicago, but more specifically on how a single-payer health care system will (or will not) address health disparities in Chicago and throughout the nation.
Community groups and organizers were solicited to join the discussion and were encouraged to provide action steps to move the movement of a national health program forward. I was excited to attend the event as I am familiar with single-payer health care program as a whole but never really sat down to think of specific concerns and or questions as to how this type of system will affect the maternal health & medical industrial complex.
The event began with a brief but truly thorough overview by Steve Whitman, PhD, Director of the Sinai Urban Health Institute, about the history of racial segregation and access in Chicago, health disparities amongst whites and blacks, and his research over the last 28 years. As highlighted in the event announcement on the Illinois Single Payer Coalition website:
Chicago is one of the most racially segregated cities in the country, with one of the worst records on health disparities by ethnicity and economic class. Responses by major public and private institutions have been ineffective at best, and at worst actively sacrifice public health to the interests of big corporations. Wall Street’s demand for ever higher profits for health insurance and pharmaceutical companies exacerbates disparities instead of addressing them.
Chicago has some of the worst health disparities in regards to maternal and child health. With the countless advances in medicine and improvements in technology, the medical industrial complex has continued to fall short in its ability to adequately provide evidence-based, scientifically proven care to lower income and racially oppressed people. According to the research Steve presented, in 1995 many of the 15 health outcomes his work focuses on were equal when comparing blacks and whites. 15 years later, in 2005 when they re-investigated the current data, 11 of these 15 measures were worst amongst Black people; including ones specific to maternal and child health.
Three of the 15 measures used in his research, Low birth weight, infant mortality, and no-prenatal care, were specific to maternal and child health. His research concluded that after the 15 year difference, Blacks ranked highest for all three measures. The most shocking and most well articulated realization that I have ever heard about the criminality of this segregation is, when you look at all of these measures and look at the “excess death” (meaning those preventable deaths due to lack of access) he says about 3200 Black people died 2005. These excess deaths are due to no other reason than racism. If you do the math, that’s about 9 folks a day. Breaking it down even more, 3 Black babies die each week due to this racism.
According to the 2005 publication of The Birth Outcomes and Infant Mortality in Chicago report compiled by the Chicago Department of Public Health Office of Epidemiology, the following data shows how desperate Chicago (and nationally) is for attention to these disparities in birth outcomes.
  • Out the highest amounts of births in Chicago, Blacks rank #2 after Hispanics*
  • % of births with no prenatal care; Blacks rank highest at 3.3%
  • % of births that were premature; Blacks rank highest at 16.1%
  • % of singleton babies born with low birth weight; Blacks rank highest at 13.2%
  • % of infant mortality; Blacks rank highest at 14.7%
  • % of neonatal mortality; Blacks rank highest at 9%
  • Lastly, there were 4 maternal deaths in the year 2004 and all 4 were Black
Knowing this information and overstanding the need for immediate action to reverse 15 years (really more) of the harm imposed by the medical industrial complex, what is in store for us within a single payer health care system?
In thinking about access, race, and the current state of affairs for maternal and child health care (i.e. birth justice) I can’t help but have a few questions about how this system will support low income, mothers of color.
One of my greatest concerns about a single-payer health care system is how will this program increase mothers of color’s access to those “evidence-based” practices that I mentioned earlier?
How will this system make maternal and child health more accessible to our communities (i.e. low income, POC, limited-no access to services, birth workers, and/or midwives)?
How will it provide options to poor and marginalized women to make decisions about their pregnancy, birth and parenting without the policing of their bodies and/or reproduction?
How will policies change to support birth justice within the medical industrial complex as well be provided to our sisters in the prison industrial complex?
How will a single-payer system allow greater opportunities (including financial) for birth workers (midwives, doulas, lactation specialists, childbirth educators), healers, and practitioners of color to achieve education and/or certification (if they choose) and practice?
How will this kind of health care reform close these gaps in disparities and improve outcomes for Black women thus improving community health?
Will holistic and modestly cost public health interventions and preventative care (i.e. massage, acupuncture, yoga, etc) be accessible and covered under a single-payer system?
To add, will the midwifery model of care and out-of-hospital midwifery practices be seen as an adequate and viable option for consumers or will the “standard of care” continue to be based on profit-driven, insurance company rules and regulations and not based on evidence and research?
Will a single-payer health care system hold space for increased accurate, client-centered, public health promotion and communication around most importantly, breastfeeding, SIDS, nutrition, fathering, postpartum depression, pre-conception health, and accessing prenatal/postpartum services?
Lastly, in contrast, will Obama’s Health Reform fill in any of these gaps and concerns I have mentioned in discussing a single-payer system?
Well, I am waiting… (crickets).
The International Center for Traditional Childbearing, the Midwives Alliance of North America, and Citizens for Midwifery all have statements that include recommendations** for some kind of health reform (mostly recommendations for Obama-Biden’s Health Reform); many of which can be applied to the single-payer system as well.
I challenge the administration to really step up and address the social and economic barriers that directly affect the overall health of Black and Brown people and in addition make the birth outcomes of those disproportionally affected a continued priority.
It’s clear that what we have now is not only broken but absolutely criminal and barbaric.
*Language provided by the researchers
**Resources for your enjoyment:
International Center for Traditional Childbearing President’s “Healthy Babies are Everyone’s Business”
Midwives Alliance of North America’s “Reforming Maternity Care in America: Recommendations to the Obama-Biden Transition Team on Maternity Health Care”
Midwives Alliance of North America’s Working Group Recommendations
Citizens for Midwifery’s “Maternity Care: A Priority for Health Care Reform.”
National Association of Certified Professional Midwives’ “Maternity Care and Health Care Reform: Opportunities to improve quality and access, reduce costs, and increase evidence-based practice”
Physicians for a National Health Program’s “International Health Systems.” Check out the Cuba and South Africa profile, written by me back in 2004.