The Legacy of Slavery and the Socialization of Black Female Health and Human Services Workforce Members in Addressing Social Determinants of Health.

BACKGROUND: One legacy of slavery and colonialist structures is that minority populations, particularly the Black populations, experience higher rates of poverty, disease, job insecurity, and housing instability today - all indicators of poor health or negative social determinants of health (SDOH). While the historical legacy of slavery may explain why certain populations currently experience social determinants, they may also embody Post Traumatic Slave Syndrome (PTSS) through manifestations of negative health outcomes. MATERIAL AND METHODS: Black female health and human services (HHS) workforce members, who have taken SDOH trainings through a medical-legal partnership (MLP), were recruited for an ethnographic study to determine how historical context, specifically PTSS, can help Black female HHS workforce members understand and advocate for their patients as well as challenge the medial and legal institutions. RESULTS: Themes emerged around how Black women in HHS have persisted and resisted, struggled, and strived to protect and raise a resistant community that is perpetually threatened. Black women constantly exist in the past, present, and future, negotiating their identities and reproducing the modeled behavior of the parents, particularly their Black mothers, who taught them how to exist in the world as Black women. CONCLUSIONS: As sufferers of negative social determinants, Black women, especially those working in HHS, use their lived experiences and historical trauma to challenge the systems within which they work. They use their intersectional identities and their reimagined definitions of SDOH to rethink how the HHS workforce can move forward in working in the best interests of their patients. Future SDOH trainings may consider integrating historical legacies to challenge medical-legal institutions.

Alliance for Innovation on Maternal Health: Consensus Bundle on Cardiac Conditions in Obstetric Care.

Cardiac conditions are the leading cause of pregnancy-related deaths and disproportionately affect non-Hispanic Black people. Multidisciplinary maternal mortality review committees have found that most people who died from cardiac conditions during pregnancy or postpartum were not diagnosed with a cardiovascular disease before death and that more than 80% of all pregnancy-related deaths, regardless of cause, were preventable. In addition, other obstetric complications, such as preeclampsia and gestational diabetes, are associated with future cardiovascular disease risk. Those with cardiac risk factors and those with congenital and acquired heart disease require specialized care during pregnancy and postpartum to minimize risk of preventable morbidity and mortality. This bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people with cardiac conditions and to respond to cardio-obstetric emergencies. This bundle is one of several core patient safety bundles developed by the Alliance for Innovation on Maternal Health that provide condition- or event-specific clinical practices for implementation in appropriate care settings. The Cardiac Conditions in Obstetric Care bundle is organized into five domains: 1) Readiness , 2) Recognition and Prevention , 3) Response , 4) Reporting and Systems Learning , and 5) Respectful Care . This bundle is the first by the Alliance to be developed with the fifth domain of Respectful Care . The Respectful Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into elements in each domain.

Perpetuating Commodification of Suffering: How Social Determinants of Health Framing Prolongs Historical Racial Inequities.

Background: In the United States, social determinants of health (SDOH) and the marginalization of Black and Indigenous people of color (BIPOC) populations often result in negative health outcomes, but may miss the underlying historical causes for these disparities. While the health and human services (HHS) workforce is trained to recognize and address negative SDOH, it is unclear how historical trauma impacts this contemporary work. Materials and Methods: As part of a broader ethnographic study, 2 MLP affiliates and 6 BIPOC women HHS workforce members who had taken SDOH trainings were interviewed using semi-structured interviews. Themes were explored around the language of SDOH and how the medical and legal system responses to SDOH results in negative health outcomes and historical trauma. Results: Themes emerged around American medical and legal institutions, meant to care for patients, have been wearied by the power struggle between politics, budgets, and the value of financial profit. Under such competing loads, workforce members feel trapped in financially-based hierarchies and established risk-designations. This current conceptualization of the language and coding of SDOH has created a globalization or commodification of suffering that mirrors historical hierachies in slavery. Conclusions: The variable naming of SDOH draws attention away from the root causes of inequities and the individualization of the social risks creates a cycle of commodification of suffering, instead of addressing the historical and structural antecedents. Future work should explore how to adapt to these intersections.