Public Health Elective: Week 3

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"More than 80% of women in the United States will become pregnant and give birth to one or more children. 31% of these women suffer pregnancy complications, ranging from depression to the need for a cesarean delivery. Many of these complications are associated with obesity during pregnancy. Although rare, the risk of death during pregnancy has declined little over the last 20 years." - Healthy People 

"Maternal health remains a staggering challenge, particularly in the developing world. Globally, a woman dies from complications in childbirth every minute. " - Jessica Capshaw

“Access to providers, even family physicians, is a problem. If you want to go to an OB/GYN, depending on where you live in the country, you may have to go 200 miles.” - Gary Hart, PhD University of North Dakota School of Medicine and Health Sciences

Learning Objectives:

• Explain reasons for poor maternal outcomes in U.S.
• Describe the disparities in pregnancy-related deaths.
• Describe how adverse childhood events affect health. 

Watch:

• TEDMED.  How we can improve maternal healthcare—Before, during and after pregnancy.  July 2019.  (15:33)

• TEDMED.  How childhood trauma affects health across a lifetime.  February 2015.  (16:12)

Read:  (in E-Reserves unless linked below)

• Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician-patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences of the United States of America, 117(35), 21194–21200. 
• Helldén, D., et al.. (2021). Climate change and child health: A scoping review and an expanded conceptual framework. The Lancet Planetary Health, 5(3), e164–e175.
• Stumbar, S. E., Garba, N. A., & Holder, C. (2018). Let’s Talk About Sex: The Social Determinants of Sexual and Reproductive Health for Second-Year Medical Students. MedEdPORTAL: The Journal of Teaching and Learning Resources, 14, 10772. 
• Commonwealth Fund.  Maternal Mortality in the United States: A Primer. 2020.
• World Health Organization.  Reproductive Health.
• Kaiser Family Foundation.  Racial Disparities in Maternal and Infant Health: An Overview - Issue Brief.  2020.
• Petersen, E. E. (2019). Racial/Ethnic Disparities in Pregnancy-Related Deaths—United States, 2007–2016.  MMWR. Morbidity and Mortality Weekly Report, 68. 
• Centers for Disease Control.  Pregnancy Mortality Surveillance System.  2020.

"The neighborhoods people live in have a major impact on their health and well-being. Healthy People 2030 focuses on improving health and safety in the places where people live, work, learn, and play. Many people in the United States live in neighborhoods with high rates of violence, unsafe air or water, and other health and safety risks. Racial/ethnic minorities and people with low incomes are more likely to live in places with these risks. In addition, some people are exposed to things at work that can harm their health, like secondhand smoke or loud noises."

Learning Objectives:

• Explain the importance of the built environment in health.
• Describe Universal Design.

Watch:

• Stanford Medicine X. (2019). Why the Built Environment? - Matthew Trowbridge. (11:05) 

• TEDx Talks.  Improving Public Health Through Community Design.  2017.  (15:00)

• TheCIL.  The 7 Principles of Universal Design | Ed Roberts Campus. 2019.  (5:51)

Read:  (in E-Reserves unless linked below)

• Healthy People 2030.  Neighborhood and Built Environment.
• Perdue, W. C., Stone, L. A., & Gostin, L. O. (2003). The Built Environment and Its Relationship to the Public’s Health: The Legal Framework. American Journal of Public Health, 93(9), 1390–1394.
• Environmental Protection Agency.  Basic Information about the Built Environment.  2017.
• Collaborative on Health and the Environment. Built Environment. 
• Frumkin, H. (2021). COVID-19, the Built Environment, and Health. Environmental Health Perspectives, 129(7), 075001.
• Villanueva, K. et al. (2016). Can the Neighborhood Built Environment Make a Difference in Children’s Development? Building the Research Agenda to Create Evidence for Place-Based Children’s Policy.  Academic Medicine, 16, 10-19.
• Rzotkiewicz, A., Pearson, A. L., Dougherty, B. V., Shortridge, A., & Wilson, N. (2018). Systematic review of the use of Google Street View in health research: Major themes, strengths, weaknesses and possibilities for future research. Health & Place, 52, 240–246.
• Aerts, R., Honnay, O., & Van Nieuwenhuyse, A. (2018). Biodiversity and human health: Mechanisms and evidence of the positive health effects of diversity in nature and green spaces. British Medical Bulletin, 127(1), 5–22.
• HAPI. (2015). Mobility, Universal Design, Health, and Place. (E-reserves) 
• Center for Universal Design NCSU - Publications. Chapter 1: A Brief History of Universal Design.

Supplemental Materials:

• Birmingham's Railroad Park
• Nashville Civic Design Center
• Commission for Architecture and the Built Environment. (2008). Inclusion by Design: Equality, Diversity, and the Built Environment.

"Environmental Justice (EJ) is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation and enforcement of environmental laws, regulations and policies."

"Fair treatment means no group of people should bear a disproportionate share of the negative environmental consequences resulting from industrial, governmental and commercial operations or policies."

Learning Objectives:

• Explain what environmental justice is.
• Describe how environmental injustice affects community health.
• Provide some examples of environmental injustice.

Watch:

• NRDCflix.  What Is Environmental Justice?  2017.  (1:56)

Read:  (in E-Reserves unless linked below)

• Marwah, H., & Sood, N. (2021). Calling a Rapid Response on Environmental Racism: Medical Students Sound the Alarm. Academic Medicine: Journal of the Association of American Medical Colleges, 96(7), 932–933.
• Environmental Protection Agency.   Learn About Environmental Justice.   2015.
• Ceccaroni, L., et al. (2020). Citizen Science, Health, and Environmental Justice. The Science of Citizen Science, 219–239.
• Commission for Racial Justice.  Toxic Wastes and Race In the United States: A National Report on the Racial and Socio-Economic Characteristics of Communities with Hazardous Waste Sites. 1987.
• Smith, G. S., & Roland J. Thorpe, J. (2020). Gentrification: A Priority for Environmental Justice and Health Equity Research. Ethnicity & Disease, 30(3), 509–512. 
• Allen, S., et al. (2019). The Search for Environmental Justice: The Story of North Birmingham. International Journal of Environmental Research and Public Health, 16(12), 2117. 
• Guidry, V. T., et al. (2018). Connecting Environmental Justice and Community Health: Effects of Hog Production in North Carolina. North Carolina Medical Journal, 79(5), 324–328. 
• Lewis, J., Hoover, J., & MacKenzie, D. (2017). Mining and Environmental Health Disparities in Native American Communities. Current Environmental Health Reports, 4(2), 130–141. 
• Johnston, J., & Cushing, L. (2020). Chemical exposures, health and environmental justice in communities living on the fenceline of industry. Current Environmental Health Reports, 7(1), 48–57.

" Rural Americans—who make up at least 15 to 20% of the U.S. population—face inequities that result in worse health care than that of urban and suburban residents. These rural health disparities are deeply rooted in economic, social, racial, ethnic, geographic, and health workforce factors. That complex mix limits access to care, makes finding solutions more difficult, and intensifies problems for rural communities everywhere."

“When you don’t get your health care taken care of, you wind up with disease presentations that are much farther along. People with cancer show up with metastatic cancer, people with diabetes show up with end-organ damage,” said Joseph Florence, MD, professor of family medicine and director of rural programs at Eastern Tennessee State University Quillen College of Medicine. -- AAMC

Learning Objectives:

• Define rural health.
• Describe some of the health challenges for people living in rural areas.

Watch:

• Rural Health Info Hub.  Understanding Health Disparities in Rural America—Insights from the CDC MMWR Rural Health Series. 2017.  (57:16)

• The Atlantic. The Hidden Crisis in Rural America.  2019.  (13:58)

Read:  (in E-Reserves unless linked below)

1. US Health Resources & Services Administration.  Defining Rural Population.  2021. 
2. Rural Health Information Hub.  What is Rural?  2019.
3. Centers for Disease Control.  About Rural Health.  2017.
4. Saint Onge, J. M., & Smith, S. (2020). Demographics in Rural Populations. Surgical Clinics of North America, 100(5), 823–833.
5. UAB News.  Hospital closures in rural America means longer drive times for patients needing care—News. (2020).
6. Many Alabama women drive 50+ miles to deliver their babies as more hospitals shutter L&D departments. (2015, February 10). AL.com.
7. McCarthy, S., et al.  (2021). Impact of Rural Hospital Closures on Health-Care Access. The Journal of Surgical Research, 258, 170–178.
8. Nielsen, M., D’Agostino, D., & Gregory, P. (2017). Addressing Rural Health Challenges Head On. Missouri Medicine, 114(5), 363–366.
9. Barone, E.  Rural U.S. Hospitals Are on Life Support as a Third Wave of COVID-19 Strikes. Time. 2019.
10. Rural Health Information Hub.  Evidence-Based Toolkits for Rural Community Health.

Supplemental Materials:

• AMD Global Telemedicine.  Webinar: Understanding Clinical Telemedicine for Rural Applications.  2016.  (5:37)

"Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have,” says Tom Boyce, MD, chief of UCSF’s Division of Developmental Medicine within the Department of Pediatrics. Socioeconomic status is a term that often includes measurements of income, education, and job prestige – individually or in combination. The predictive power of income alone is perhaps most obvious when considering life expectancy. Impoverished adults live seven to eight years less than those who have incomes four or more times the federal poverty level, which is $11,770 for a one-person household, whether you live in Silicon Valley, the Rust Belt or the rural South."  - Poor Health. (2015). Poor Health | UCSF Magazine. 

Watch:

• FUSION.  The Black Belt Citizens Fight for Clean Air and Water in Uniontown.  2017.  (10:50)

• AL.com.  Visit at your own risk: Uniontown’s residents plagued by sewage disaster. 2018.  (6:36) 

• VICE News.  Alabama Has A Raw Sewage Problem Causing Parasites. The State Isn’t Doing Much About It.  2018.  (7:11).

Read:  (in E-Reserves unless linked below)

• Pillion, D.  Sewage problems still plague Uniontown after $4.8 million in repairs.  AL.com.  2018.
• McKenna, M. L., et al. (2017). Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama. The American Journal of Tropical Medicine and Hygiene, 97(5), 1623–1628. 
• Pilkington, E.  Hookworm, a disease of extreme poverty, is thriving in the US south. Why?  The Guardian.  2017
• Silver, M., & Whitehead, N.  The U.N. Looks At Extreme Poverty In The U.S., From Alabama To California.  NPR.  2017.
• Nast, C.  The Heavy Toll of the Black Belt’s Wastewater Crisis. The New Yorker.  2020.
• Brink, S.  Why It Can Be Harder To Fight Hookworms In Alabama Than In Argentina. NPR.  2021.
• Davies, D.  “Waste” Activist Digs Into The Sanitation Crisis Affecting The Rural Poor. NPR.  2020.
• McDonald, G.  Uniontown Mayor & Residents Express Frustrations Over Sewer Project.  Alabama News.  2021.
• Engelman-Lado, M., Bustos, C., Leslie-Bole, H., & Leung, P.  Environmental Injustice in Uniontown, Alabama, Decades after the Civil Rights Act of 1964: It’s Time For Action. Human Rights Magazine. 2021.