Systemic Racism in American Health Care: An ER Doctor's Perspective

The Black Maternal Health Momnibus Act is comprehensive legislation consisting of 12 bills addressing every clinical and non-clinical driver of maternal death. Key provisions include growing and diversifying the perinatal workforce (midwives, nurse midwives, lactation consultants, doulas), addressing social determinants of health (housing, nutrition, transportation, environmental conditions), and expanding postpartum Medicaid coverage. The legislation requires an estimated $3 billion investment. The Protecting Moms Who Served Act was signed into law in November 2021, addressing disparities in the VA health system. The Build Back Better Act included most of the Omnibus but did not pass the Senate. The caucus is working to reintroduce legislation and build bipartisan support.

The Black Maternal Health Momnibus Act of 2021 represents a comprehensive legislative approach to addressing maternal mortality and morbidity in the United States. The act includes 12 bills calling for urgent investment to address maternal health disparities, allocate funding for community organizations and state governments, create training programs to address bias and racism in maternity care, grow the perinatal workforce, and increase investment in social determinants of health like housing, transportation, and nutrition. This legislation reflects the broader recognition that addressing maternal health requires coordinated action across medical, political, and public health sectors.

In the United States, Black women are three to four times more likely to die from pregnancy-related complications than White women, representing a significant healthcare disparity that Rep. Lauren Underwood and Senator Kamala Harris addressed through the Momnibus Act, a comprehensive legislative effort designed to address both clinical and non-clinical factors contributing to preventable maternal deaths.

Congressional advocacy is essential for addressing Black maternal health disparities through comprehensive policy solutions. The Black Maternal Health Momnibus Act is a sweeping package of 13 bills addressing every driver of maternal morbidity, mortality, and disparities. This legislation has secured over $200 million in federal funding, establishing maternal centers of excellence, supporting community-based organizations, funding midwifery education, and establishing a maternal mental health hotline. Congresswomen Alma Adams and Lauren Underwood co-chair the Congressional Black Maternal Health Caucus, fighting to pass this legislation amid threats to Medicaid and public health programs. Medicaid funding is critical for prenatal care, doula services, and midwifery care, with Black women and brown women being two to three times as likely to experience uncertain births compared to other races.

Black mothers in the U.S. face a severe maternal health crisis, dying at three to four times the rate of white mothers due to pregnancy-related complications. Native Americans face similar disparities at two to three times higher rates. Hispanic and Asian American populations also experience significantly elevated maternal mortality rates. Congresswoman Lauren Underwood introduced the Black Maternal Health Momnibus Act, a comprehensive legislative package containing 12 bills designed to address every driver of maternal mortality and morbidity through investments in culturally appropriate care, workforce diversification, implicit bias training, and addressing social determinants of health including housing, nutrition, and environmental conditions.

Medical schools also need to recognize the importance of integrating this cultural training into their curriculum for their med students. Surprisingly, this kind of training is not typically offered from the experience with medical schools in the area. Finally, and this is really important, the medical establishment, the hospitals need to constantly facilitate training in their continuing education classes, not only for their doctors and nurses but also for their staff. Every person that the patient comes into contact with from the minute they walk into the hospital or the clinic till they need to leave, because hospitals should be modeling these principles at the organizational level.

An anti-racist stance requires not centering whiteness, such as asking what Indigenous medical students need rather than assuming the current curriculum serves them. Cultural humility differs from cultural competency - it involves ongoing self-reflection about one's biases and how they impact clinical care. Cultural competency has fallen out of favor because it implies a binary state, while cultural humility recognizes this as an evolving journey. Healthcare systems must acknowledge hardships faced by people of color, women, and Indigenous people entering workplaces and healthcare systems, which can be harmful spaces requiring additional resilience.

Minimum requirements for medical education and training in health equity and anti-racism should include: (1) Mandated education rather than optional opportunities, as allowing educational opportunities to be sought voluntarily won't reach providers who need it most; (2) Training on implicit and explicit biases, but going beyond to interrogate personal makeup and experiences leading to biases; (3) Creating safe spaces for providers to share and work through biases; (4) Understanding literature linking biases to different treatment choices; (5) Understanding how health inequities are rooted in structural racism, going beyond social determinants of health to examine their foundations; (6) Teaching about historical and present-day traumas embedded within the medical system; (7) Training trainees about their own experiences of racism and discrimination; (8) Teaching about reporting tools and operationalizing responses to discrimination; (9) Educating about policing within hospital systems and how security systems add layers of trauma.

Cultural humility is an anti-racist, lifelong process of self-reflection, self-critique, and examining power imbalances to build mutually respectful relationships with patients, rather than simply learning about other cultures; this approach recognizes that healthcare disparities persist despite decades of awareness efforts, requiring healthcare professionals to critically examine their own identities, use intentional language to reduce barriers, and ask patients about their healthcare experiences to provide equitable care.

Anti-racism in medical education requires recognizing that racism is a system of structuring opportunity based on race, where racist policies and practices perpetuate inequities regardless of intent; effective anti-racist work involves intentional actions that disrupt white supremacy cultural norms (such as power hoarding, worship of the written word, and either/or thinking) through concrete changes in program structure, curriculum, relationships, and faculty development, with the goal of shifting power toward patients and communities rather than maintaining hierarchical structures.

Community-Based Participatory Research (CBPR) is an equitable partnership approach that involves all stakeholders in all aspects of the research process, from design to dissemination, to address health inequities by integrating community knowledge with academic expertise; the Detroit Community-Academic Urban Research Center demonstrates this through the Healthy Environments Partnership, which successfully reduced cardiovascular risk factors through multi-level interventions that combined walking programs, environmental modifications, and policy advocacy, showing that sustained community-academic partnerships can achieve meaningful health improvements while building local capacity and trust.

Community-Based Participatory Research (CBPR) is a collaborative approach to addressing health inequities that involves communities in all stages of research and intervention, using a four-component framework: Context (identifying community problems and strengths), Partnerships (building equitable relationships between communities, governments, and outside organizations), Programs/Interventions (developing locally-driven solutions based on community data), and Outcomes (achieving measurable health improvements through sustainable, empowering initiatives).

Community-Based Participatory Research (CBPR) is a collaborative research approach that equitably involves academic and community partners across all research phases—from identifying research questions to disseminating findings—with the goal of combining knowledge with action to achieve social change, distinguishing itself from other participatory approaches by being community-driven rather than merely community-placed, and drawing from both pragmatic problem-solving traditions and Paulo Freire's emancipatory education philosophy that positions oppressed communities as agents of change.

Community-Based Participatory Research (CBPR) is a collaborative research methodology that equitably involves community members, organizational representatives, and researchers in all aspects of health research—from problem definition to dissemination—addressing health disparities by building trust, leveraging community strengths, and ensuring sustainable solutions that respect community voices and needs.

Community-Based Participatory Research (CBPR) is an approach that incorporates non-academic community members in all stages of research to improve health and promote change. It recognizes the limitations of traditional research methods and values the social and experiential knowledge of community members. True CBPR partnerships share characteristics: building collaborative partnerships with power-sharing processes, recognizing community as a unit of identity, building on community strengths and resources, facilitating co-learning and capacity building, utilizing ecological approaches focusing on social determinants of health, seeking mutual benefit to all partners, disseminating findings to the wider community with all partners involved, and maintaining long-term commitment to sustainability beyond single projects. Benefits include all members feeling comfortable speaking openly, commitment to partnership sustainability, greater potential for research translation into relevant actions, and trust-building between academics and communities. Challenges include limited grant time for relationship-building, sustainability challenges maintaining resources and fairness, and community members having competing priorities requiring flexibility.