When It Comes to Your Health, Your Zip Code Matters More Than Your Genetic Code

Today is the one year anniversary of the passage of the Affordable Care Act and guess what? According to a recent survey, over one half of Americans don't think health reform is actually a law.

It is folks.

I'm marking the one year anniversary by attending the National Association of Black Journalists Media Institute on Health, Health Policy and Health Disparities in Washington, DC.

I heard two very profound statements today that tell the story about rampant health disparities impacting communities of color. Those two statements were not long prognostications about the social determinants of health or the root causes of these racial and ethnic inequities.

The comments indeed were about those things, but they were short enough for Twitter but utterly profound in answering those questions.

Comment #1: "Your zip code may be more important than your genetic code when it comes to health disparities."

Comment # 2: "We have a sick system not a healthcare system."

Comment 1 struck me because it alarms me that where you live is one of the key drivers of your health. According to the World Health Organization, Report on the Social Determinants of Health, avoidable health inequities arise because of the circumstances in which people grow, live, work and age and the systems put in place to deal with illness. In turn, the conditions in which people live and die are, in turn, shaped by political, social and economic forces.

That's why I was really impressed with a new initiative by The Joint Center for Political and Economic Studies, called Place Matters, which seeks to address conditions in the natural environment, built environment and social environment that lead to poor health. The goal is to eliminate health disparities by identifying the complex underlying causes and defining strategies to address them.

I am convinced these issues play a significant role in maternal and child health.

Comment # 2 was just too simplistically truthful to ignore. Healthcare is a misnomer for our system. It takes care of your sickness but does little to protect your health. In fact, today I learned that for every $1 spent on healthcare only 5 cents goes to prevention.

This is pathetic because so many mothers wouldn't needlessly die if there were more prevention programs and community-level interventions.

Battling the Bulge from Birth

This is the time of year when everyone is thinking about eating lots of good food with family. Then in a few weeks, we will all make new and not-to-be kept resolutions about losing the weight gained by eating those same meals and many others throughout the past year.

But to really battle the bulge, not just for ourselves but for our children, we have to start early, avoid empty promises and face the facts.

Now, for the most part we black women love our curves and really have no use for the latest crash diets. The way we walk, talk, and dress says "I am bold and beautiful, love it or leave it!" But at as fabulous as we think we are, obesity is still a prominent issue in the black community.

I have heard every excuse from "My family is big- boned" to "queen- sized" and my favorite "That just means there's more of me to love!" And, while these statements and mantras seem to scream I am confident and love my body, we need to address why statistics show that six out of every ten African American women are overweight and four out of every ten is morbidly obese. There is a huge difference between having a little belly or being a little hippy and packing on 30 to 100 extra pounds or more. 50 percent of African-American women are obese compared to only 40 percent of Mexican-American women and only 30 percent of White women.

While we already know that the high rates of obesity in our community is linked to the prevalence of diseases such as heart disease, diabetes, high blood pressure, stroke, arthritis and cancer. We don't see too many people addressing prevention strategies for all of these diseases that start at birth. If we really want to curb the obesity epidemic in our community we have to start well before childhood. We can start as soon as the baby is born.

Breast-feeding helps us lose the weight we gained during pregnancy and has many other health benefits for us too.

Breastfeeding is proven to reduce your baby's chance of being obese. The breastfeeding-obesity link is now recognized by key government agencies and professional groups, Including the U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics. Experts at the CDC in Atlanta estimate that 15 percent to 20 percent of obesity could be prevented through breastfeeding. Here are some of the reasons why:

• Breastfed infants may be better at self-regulating their intake. Mothers cannot see how much milk their child is drinking, so they must rely on their infant's behavior, not an empty bottle, to signal when their infant is full. Thus, breastfed babies might be better able to eat only as much as they need.
  
  
• Breastfed infants are more likely than formula-fed infants to try and accept new foods. Acceptance of new foods is important because a healthy diet should include a wide variety of foods, especially fruits and vegetables. Because breast milk contains flavors from foods eaten by mothers, breastfed infants are exposed to a variety of tastes early in life. In contrast, artificial baby milk (formula) always tastes the same.
  
  
• Breastfeeding has different effects than formula feeding on infant's metabolism and hormones such as insulin, which tells the body to store fat. Formula-fed infants tend to be fatter than breastfed infants at 12 months of age.
  
  
• For us to make a real impact on obesity in our community, we have to start at birth. It's really that simple. Resolving to breastfeed more and support any breastfeeding mother you know, is a real resolution for change.

-- Kimberly Seals Allers is on vacation this week. --

Intensely aware of what health care advocates gently refer to as "health disparities," members of state coalitions meeting over the weekend confessed that they were struggling to find a best strategy to promote breastfeeding among African-American mothers.

Studies to date indicate that African American mothers are least likely to breastfeed--even though they are more at risk for breast cancer, obesity and high blood pressure. In addition, they are more likely to give birth early and breast milk can literally save the lives of preemies in a way formula does not.

As more than 300 breastfeeding activists--physicians, nurses, lactation consultants, and health activists-- gathered in Arlington, Va. to expand the support for breastfeeding in hospitals, families, law and workplaces, the toughest question was how can we be more successful with African American mothers and mothers-to-be?

http://www.usbreastfeeding.org/

Part of my work at the conference was to discuss at a breakfast table how Women's eNews is changing the media narrative about African maternal and infant health. I talked about Women's eNews'Black Maternal Health project and the value of shifting breastfeeding news focused on babies to the lives of the mothers, particularly black mothers.

http://www.womensenews.org/story/090922/black-maternal-health-legacy-and-future

Black moms are three-to six times more likely to die during pregnancy and during the post-partum weeks and thus they are the face of our country's most acute maternal health problems. If the United States can mend poor health outcomes among black women and their infants, certainly the entire health care system will benefit.

But confronting the reality of black maternal health and breastfeeding at the conference is not so easy.

"Nooo," said Lorine Bizzell, a regional nutritionist with the United States Department of Agriculture, in Atlanta. That was her response when I asked for her input on the fact that that college-educated black women breastfeed less than low-income moms, teen moms, and moms with only 12 years of schooling.

http://www.womensenews.org/story/black-maternal-health/090922/breastfeeding-not-you-sisters-listen

"That's hard to believe. Young black career women that I know are all nursing their children under a variety of challenging circumstances."

Laura Sinai is a North Carolina-based pediatrician. She works in a private practice outside Charlotte and a third of her clients are black. Talking to black mothers about breastfeeding has been difficult. "They just say, 'You don't know my life. I will not breastfeed.'"

Melissa Bartick, a physician with the Massachusetts Breastfeeding Coalition, spearheads efforts for hospitals in the state to become Baby Friendly, an award given for prioritizing breastfeeding in maternity wards and backed by the World Health Organization.

After I asked Bartick how she's targeting black mothers, she took a deep breath and said: "Yes, there are disparities. They do exist."

"Where do I find black women who want to be lactation consultants?" said Anna Uttar, the regional director of the International Board of Lactation Consultant Examiners in Falls Church, Virginia. "They are not coming out to get trained."

As the conference was coming to an end, I was starting to worry that the question of how to increase breastfeeding among black mothers was left hanging, like a great news story unpublished.

Right as I gathered my bags and headed out the conference hall, Napiera Loveless approached me.

She is co-founder of MamaTotoMatema, a Cincinnati agency urging breastfeeding among African-American families. We got to talking and laughing and sharing how we wished the conference had a dance party.

http://www.mamatotomatema.com/

Loveless told me about how she reports to black women and activates their interest. Immediately I realized she should have been a keynote speaker; she was a guru of connecting ideas to messages, to challenges.

When talking to low-income black women, Loveless appeals to fashion. Many young black women like the bling, she said. The shiny things. The nice clothes. "I tell some mothers, 'You know how you like your Dereon jeans and Gucci? Well breast milk is the name-brand jeans. Formula is the rip-off!'"

When talking to upper-income black women, Loveless said that family support systems may be lacking. Many families look to a high-earning black woman for financial and emotional support, so a lot is riding on her shoulders.

"I want to find out who their support system is," she said. "It might be her best friend or her co-worker. Can your co-worker help you on the job? Watch your work while you get a chance to pump?"

She said her strategy is gaining effect in Ohio.

As I left the Third National Conference of State/Territory/Tribal Breastfeeding Coalitions, my heart was warmed by Loveless, and the many leaders talking about black maternal health. My mind was racing.

There is always a way to get through.

Malena Amusa is a reporter living in New York City.

Folic Acid and You—What Every Woman of Color Needs to Know

It’s the New Year! And who knows what 2010 will bring. According to recent stats approximately 50 percent of women aged 15-44 have at least one unplanned pregnancy in their lives. That means a good number of us may have an surprise in 2010.

 

That also means every woman of childbearing age, should be thinking about their health all day, every day. That’s why I wanted to tell you that this week, January 4-10^th, is Folic Acid Awareness Week. Sponsored by the National Council on Folic Acid (NCFA) http://www.folicacidinfo.org/pages/folicacid_info.php, the week is intended to educate all women about folic acid. If taken before and during early pregnancy from a multi-vitamin or fortified foods, folic acid can prevent from 50 percent to 70 percent of some forms of serious birth defects of the brain and spine, called neural tube defects (NTD).

 

Getting the right amount of folic acid is particularly important to Black and Latina women. Not only do Latinas have higher rates of NTD-affected pregnancies, they also have the lowest awareness about folic acid than women of other ethnic groups, and lower consumption of folic acid than white non-Hispanic women, according to recent studies.

 

In addition to preventing NTDs, increased folic acid has been linked to preventing preeclampsia, a form of severe high blood pressure that usually occurs after 37 weeks of pregnancy. The potentially fatal condition is more common in black women. Studies indicate that when black women have preeclampsia they tend to have a severe form of the disorder and experience it as early as six months in the pregnancy compared to the typical ninth month. 

 

Doctors have not yet pinpointed exactly why this disparity exists, however, one study found that black women had less folic acid and more of a certain amino acid than white women as a pre-existing condition, which put them at a higher risk during pregnancy. The findings suggest that black women take more folic acid before and during pregnancy and as early as possible. (http://www.msnbc.msn.com/id/4781703 )

 

The easiest way to make sure you’re getting enough folic acid all the time is by taking a multi-vitamin, B vitamin complex pill or folic acid pill and eating fortified foods like grains, pastas or breakfast cereals. Folate is found naturally in foods such as leafy green vegetables, beans, liver and some fruit. But for some reason, scientists have found that folic acid, the synthetic version of folate, is actually easier for your body to absorb than folate.

 

Even if you don’t have a planned or unplanned pregnancy in the cards, folic acid is pretty important to your healthy living. Studies show that folic acid reduces the risk of certain cancers; cardiovascular diseases including coronary heart disease and stroke; and cognitive diseases or mental conditions such as Alzheimer's disease, age-related dementia or cognitive decline and depression. We can all use that.