Federally funded health clinics in Newark face significant challenges in caring for the minds and bodies of some of the least healthy residents in New Jersey, all with limited resources.
But that hasn’t weakened the resolve of the system’s leaders, who are also spearheading the front-line work needed to tackle one of the state’s most gut-wrenching health disparities: the massive gaps in maternal and infant health tied to race.
That dedication drew first lady Tammy Murphy and state Department of Health Commissioner Dr. Shereef Elnahal to join Dr. Pamela Clarke, president and CEO of the Newark Community Health Centers; other facility leaders; clinical experts; and community members in the Brick City last week for the system’s third annual women’s healthcare symposium. Federally Qualified Health Centers, like the Newark network, “have arrived, we have matured, and we are doing an awesome job,” Clarke noted.
The event, which focused on the racial disparities in maternal and infant health, reflected a growing awareness of these clinical gaps, issues that have emerged as a priority for Elnahal and others in the administration of Gov. Phil Murphy. In New Jersey, black women are at least three times more likely to die giving birth than white mothers, and their babies also face mortality rates more than three times higher than white infants. The gap is among the nation’s largest disparities.
A ‘shameful’ situation
“Quite frankly, as a mother, I find it shameful that race persists as a factor in maternal health and infant mortality rates in our state,” Tammy Murphy said. “We can and must do better to make sure that mothers are not an afterthought and to ensure their health before, during, and after childbirth.”
Since Murphy took office in January, the state has increased funding for women’s health services by $7.5 million and expanded Medicaid to cover family-planning services for more women. The DOH also distributed an additional $4.3 million in grants to fund Healthy Women, Healthy Family programs in communities with high need.
In addition, Elnahal asked the DOH’s Family Health Services division to conduct a “root cause analysis” of the infant-mortality gap. This included a review of the data and literature and three regional focus groups with community health workers, the front-line caregivers who are in a unique position to help the state understand why these disparities remain.
Getting to root causes
The results, shared with NJ Spotlight, suggest the gap is related to a range of social problems for patients — including issues with transportation, childcare, and housing instability; lack of easily accessible and culturally and linguistically appropriate care; limited social support; little awareness of the services that are available; and high levels of mental distress and racial stigma.
These findings track closely with academic research that shows the importance of social determinants of health — issues like poverty, housing, and education — and a recognition that racism itself can create a toxic stress in the bodies of black women that leads more deaths related to childbirth. Advocates like the national Black Mamas Matter Alliance have worked to raise attention about the issue, hosting a public awareness campaign in April to correspond with National Minority Health Month.
“We’ve been doing a lot of work (to address racial disparities) in this department, but it has not reached the communities it needs to reach. That is a major diagnosis,” Elnahal told the group in Newark. “We’ve been putting out messages, but it hasn’t reached the people we need to reach.”
To correct that course, Elnahal said he will be meeting more with front-line providers and community partners — groups like the Newark Community Health Centers. In recent weeks he has visited with nursing groups, needle-exchange programs, faith-based organizations, and others in an effort to highlight the disparity and underscore the importance of early prenatal care and clinical standards that have been proven to reduce maternal and infant-mortality rates. The department is also embracing doulas, or birthing experts, who have a track record of improving outcomes.
“I’m going to be front and center advocating for these professionals,” Elnahal said, noting that doulas assisted with both of his wife’s deliveries. “Our partners are therefore going to look a little different” than in the past, he said.
Good news for front-line workers
This was good news to the community health workers and other providers assembled at the Newark Federally Qualified Health Center, on Broadway, including the session’s moderator Jill Wodnick, a trained doula and nationally recognized birthing expert who teaches at Montclair State University. Given New Jersey’s massive infant-mortality gap, improving outcomes “is everyone’s business,” Wodnick said.
Boosting maternal-health outcomes requires a number of approaches, Wodnick and others said, including increasing breastfeeding rates — which have been proven to lead to healthier babies — and reducing the number of unnecessary caesarean births. According to a recent report from the nonprofit national Leapfrog Group, 40 percent of Garden State hospitals surveyed delivered nearly one in three babies by C-section, which can cause short- and long-term complications. The goal is less than 24 percent.
“We can’t say it to shame or blame, but we have to say it with education. The method of birth matters,” Wodnick noted.
Kerri Logosso-Misurell, director of the Greater Newark Healthcare Coalition, a learning and planning collaborative that includes the Newark Community Health Centers, said her organization is working with several Brick City hospitals to identify the best practices involved with avoiding unnecessary C-sections. With assistance from the New Jersey Health Care Quality Institute and RWJBarnabas, the state’s largest healthcare provider, the group is drilling down on the data to identify clinical protocols, staffing requirements, reimbursement policies, and other elements that can be assembled into a statewide plan, which she expects will be released as a draft later this year.
At the Newark clinic, reducing these disparities is part of a wider push to make sure the facility is not just comprehensive and competent, but culturally relevant, Clarke said. It is important that staff looks like the community they serve, she said, in order to increase trust and improve communication.
A new City Health Dashboard data tool, unveiled last week by the Department of Population Health at NYU School of Medicine, revealed that Newark and Camden have among the steepest health challenges in New Jersey’s urban communities. Newark residents were below average on all 11 metrics, with a 40 percent higher rate of premature death.
Also critical is ensuring that the Newark health center, which was renovated in recent years, is inviting to patients, Clarke said. Board members now receive care at these FQHCs in an effort to improve their engagement and ensure quality is maintained. Most important, she said, is demonstrating respect for the patients they serve.
“We don’t look at people as poor people. We look at them as human beings, who need to breathe clean air, have safe housing, and want to raise healthy families,” Clarke said.