Posts Tagged ‘ CDC ’

Infant Mortality and Inequality

Larry Adelman is co-director of California Newsreel  and the creator and executive producer of Unnatural Causes: Is Inequality Making Us Sick? and RACE-The Power of an Illusion.  “When the Bough Breaks”, the episode from Unnatural Causes exploring African American infant mortality, can be screened on-line for free during the month at www.newsreel.org.

I still remember when first researching our documentary series Unnatural Causes: Is Inequality Making Us Sick?  being steered to the work of two neonatologists from Chicago, Drs. James Collins and Richard David.

It’s well-known that African Americans have infant mortality rates more than twice as high as white Americans.  Collins and David wanted to know why.  According to the CDC, complications due to low-birth weight are the leading cause of African American infant deaths. In one study, Collins and David compared the birth weights of newborns of three different groups:  white Americans, African Americans and African immigrants born in the U.S.

They discovered that while African American babies are born, on average, about half a pound smaller than white Americans, babies born here to African immigrants are about the same weight as white American babies.

In a subsequent study, Collins and David found that just one generation later, the daughters of those very same African immigrants were giving birth to lower birth-weight babies.

What changed in a generation? Not genes; genes don’t change in a generation. But kids born to African immigrants grow up here as African Americans, their bodies subject for decades to the cumulative stressors of racism experienced by other African Americans (many studies show that large racial gaps in birth outcomes remain even after controlling for pre-natal care, education, nutrition and other factors).

Our earlier documentary series, RACE – The Power of an Illusion , tried to help viewers negotiate a two-step:  the idea of ‘race’ as innate biological difference between population groups makes little scientific sense, yet race as lived experience is very real – and can even have biological consequences.

And among the most enraging as well as heart-rending of those consequences is high infant mortality.  Why enraging?  Because it doesn’t have to be this way.

Nancy Krieger and colleagues found that in the aftermath of the Civil Rights movement and the War on Poverty both racial and class infant mortality gaps narrowed between 1966 and 1980. But progress ceased as the Reagan presidency initiated a 30-year binge of rollbacks of social programs, tax cuts for the rich and corporate deregulation which helped spawn unprecedented growth in inequality.

Health tracks wealth as well as race. On average, the wealthier you are, the healthier. And our growing inequality is taking a toll on white American babies as well.  I just took a look at the infant mortality tables at CIA’s World Fact Book. By my calculation, if white Americans were a separate nation, their infant mortality rate of 5.6 / 1000 would rank them about 33rd in the world (even lower if small entities like Guernsey and Andorra are included).

There are many exciting initiatives tackling infant mortality one city, one county at a time. They are each important. But if we want to make a lasting difference, if we want to give all our children the opportunity for a healthy start, shouldn’t we also be reversing those policies which have increasingly channeled the nation’s wealth, power and resources into the hands of what FDR used to call the plutocrats and the financial elite?

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Influenza and Pregnancy: After 2009 H1N1

Contributed by: Sonja A. Rasmussen, MD, MS, Centers for Disease Control and Prevention, Atlanta, GA

Pregnant women have long been known to be at increased risk for severe illness from influenza.  For this reason, flu shots have been recommended for pregnant women by key professional groups for many years.  However, before the 2009 H1N1 pandemic, vaccination rates among pregnant women were low, the lowest of any of the adult groups for whom influenza vaccination was recommended.

We are now well into the first influenza season following the 2009 H1N1 pandemic.  However, we entered this flu season armed with considerably more knowledge about influenza and pregnant women than we ever had before.  The focus on influenza and pregnancy that occurred during the 2009-2010 flu season led to unprecedented collaborations between CDC and its partners in maternal and child health.  These collaborations resulted in research to better understand influenza during pregnancy.   We now know that pregnant women with influenza who are otherwise healthy can become severely ill and die, even in the 21st century.  We also now know that early treatment can prevent severe illness and death. Pregnant women with 2009 H1N1 who were treated early with antiviral medications were less likely to require admission to an intensive care unit and less likely to die.  And we have more data to show that getting a flu shot during pregnancy can protect infants from influenza for up to 6 months after birth. These babies are at high risk of complications from influenza, but the flu shot is not recommended for them because it doesn’t work well – their immune systems are too immature to respond appropriately.

Equally as important, we know more about what motivates pregnant women to get the flu shot.  Surveys conducted by CDC colleagues have shown that health care providers’ recommendations are powerful:  pregnant women whose health care providers recommended flu vaccination are much more likely to receive flu shots.  Based on this research, messages targeting pregnant women and their health care providers were developed, and these messages were disseminated in new ways – moving beyond the brochure to social media, videos, and posters.  And the great news is that these efforts paid off — recent data suggest that influenza vaccination coverage among pregnant women was higher last year than ever before.  Data from 10 states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) showed vaccination coverage during the 2009-2010 flu season for pregnant women was 50.7% for seasonal influenza and 46.6% for 2009 H1N1.  This compares to 11.3% of pregnant women receiving the seasonal flu shot during the 2008-2009 season, according to data from the National Health Interview Survey.

But how do we build on this success, now that the media attention has faded?  As professionals who care about the health of mothers and babies, we need to continue to work together to do the research and to develop and disseminate messages that work. I’d like to thank you for your continued partnership – together our efforts are making a difference in the lives of mothers and babies!

My CDC colleagues have developed influenza communications materials that target pregnant women:

  • Posters to promote flu vaccination for clinics and patient rooms:

Print posters yourself:

http://www.cdc.gov/flu/pdf/freeresources/pregnant/preg.pdf (English)

http://www.cdc.gov/flu/pdf/freeresources/pregnant/preg_esp.pdf (Spanish)

http://www.cdc.gov/flu/pdf/freeresources/pregnant/flu_pregnancy_poster_508.pdf (English)

Or order from the warehouse http://wwwn.cdc.gov/pubs/ncird.aspx (scroll down to Flu Materials/Pregnant Women)

  • Patient-friendly educational DVD movie and PSA for your waiting room:

You can preview the movie or send patients to this link: http://www.cdc.gov/CDCTV/ProtectBaby/

Order from the warehouse http://wwwn.cdc.gov/pubs/ncird.aspx (scroll down to Flu Materials/Pregnant Women)

  • Podcasts for pregnant women:

Pregnant Women: Know the Signs and Symptoms of Flu http://www2c.cdc.gov/podcasts/player.asp?f=4062255

Pregnant Women Need a Flu Shot   http://www2c.cdc.gov/podcasts/player.asp?f=4061727

Additional information about flu and pregnancy can be found below:

The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.