Social determinants of perinatal mental health.

Social inequities and mental health are public health and medical conditions that are inextricably linked. Perinatal mental health is influenced by social, physical, and biological factors, with additional stressors related to pregnancy. The social determinants of health (SDOH) encompasses all conditions in which people live and grow, inclusive of cultural norms that reflect the diverse populations we serve. To best understand the mechanisms by which the SDOH affects perinatal mental health, we introduce the Urban Stress Model and describe the link between urban realities to stress response and potential mechanisms that link urban living to increased risk of adverse perinatal mental health. Given the increased diversity of patient populations, cultural considerations are paramount in understanding the utility and best practices in screening and interventions among ethnically diverse communities. Building on our Urban Stress Model and a structural determinants of health framework, we present examples of interventions to address the social inequities of perinatal mental health from the policy to community levels.

Divisions of health equity in departments of obstetrics and gynecology.

Disparities in maternal morbidity and mortality remain vivid reminders of the role of racism in obstetrics and gynecology. If a serious attempt is to be made to purge medicine of its ongoing role in unequal care, then departments must commit the same intellectual and material resources as they would to the other health challenges in their remit. A division that understands the unique needs and complexities of the specialty, including translating theory into practice, is uniquely positioned to keep health equity as a focus of clinical care, education, research, and community engagement. To achieve reproductive justice, an approach addressing the intersectionality of race, ethnicity and gender identity is critical. In this article, we detailed the ways in which divisions of health equity within departments of obstetrics and gynecology can dismantle impediments to progress and can move our discipline closer to optimal and equitable care for all. We described the unique educational, clinical, research, and innovative community-based activities of these divisions.

Social Determinants of Health: The Fifth Vital Sign.

INTRODUCTION: Since the last decade, social determinants of health (SDOH) have become a vital component of the liturgy of public health. From that time, the number of articles on SDOH cited in PubMed has increased from approximately 775 to over 4,700. ISSUE: In obstetrics, social determinants of health have particular resonance in discussions of maternal mortality and health disparities and the number of articles on SDOH in obstetrics has increased sixfold during the same interval. However, while most obstetricians are now aware of SDOH, many are unsure about how to address them within the context of their own practice. SUMMARY: In this piece, we will discuss the importance of SDOH in obstetrics, the reasons why most obstetricians have not engaged with it and suggest steps to help bridge the gap between merely accepting SDOH's importance and implementing strategies to mitigate their effects. KEY POINTS: · Obstetricians believe SDOH can lead to adverse outcomes but few feel confident addressing social needs.. · Three suggested steps in addressing SDOH are identifying needs, identifying resources, and then linking the two.. · Organizations are as vital as individual physicians in implementing strategies to address SDOH..

Reducing Perinatal Health Disparities by Placing Equity at the Heart of Performance Improvement.

Multiple studies have demonstrated that low income and Black women in the United States are more likely to suffer from severe maternal morbidity and mortality during childbirth, even when accounting for the site of service. Structural racism, social determinants of health, and personally mediated racism are factors that may play a role. Assessing them is, therefore, critical in the attempt to deliver safe and equitable health care, which is a fundamental charge of performance-improvement committees. We argue that, for performance-improvement committees to fulfill their mandate, they must include equity as an organizing principle. A low rate of adverse outcomes in the overall population served by a hospital is not sufficient if, when stratified by race, a particular group is found to have rates above acceptable limits. In this piece we outline the process by which those charged with assuring optimal quality in departments of obstetrics and gynecology can include equity in their portfolio. This is a key step in moving beyond the recognition that disparities exist and toward a consideration of the specific ways in which inequity contributes to morbidity, and then to implementing steps to mitigate its effects.

An Introduction to Structural Competency for Haitian-Identified Patients: History, Culture, and Access to Care.

INTRODUCTION: The Haitian population within the US represents the largest diaspora outside of Haiti, with most Haitians residing in major urban communities. Despite clear differences in health outcomes specific to Haitians, the community has traditionally been aggregated into the general Black population. To address specific health disparities, this workshop was designed to distinguish and elaborate on the health care problems affecting Haitians. METHODS: We created an interactive 60-minute workshop including a PowerPoint presentation, two case presentations, and a 5-minute informational video to bring awareness of the historical perspectives impacting Haitian/Haitian American health, access to care, and health care disparities to providers. Knowledge was assessed by pre- and postworkshop evaluation forms. The module was aimed at health care professional learners. RESULTS: Seventy-four people with diverse ethnoracial identities, including medical students, residents, academic faculty, physicians, nonmedical graduate students, and health care staff and administrators, attended three workshops. All learning objectives were met, with pre- and postworkshop data indicating a statistically significant increase in participants' reported confidence. Workshop attendees commented positively on the group discussion component, the workshop's interactive nature, the opportunity to apply taught knowledge to case presentations, and the historical context provided. DISCUSSION: As the number of Haitian immigrants continues to rise throughout US urban communities, providers must increase their culture competency in training and delivery to improve care for a major population. This module can help better prepare health care providers and trainees to offer competent care to Haitian/Haitian American patients.