The month of April is recognized as National Minority Health Month — a month-long initiative to advance health equity across the country. As the COVID-19 crisis continues to disproportionately affect communities of color, we see worsening family stress, poverty, child hunger, and child and adolescent mental health in Maryland and across the globe. This April, amplifying and addressing the need for health equity has never been more critical — and provides an important opportunity to uplift the important steps we are taking now in the right direction.
A critical way to advance health equity and improve the overall and long-term health of our state is to invest early in the lives of Marylanders. According to the Centers for Disease Control and Prevention, Maryland’s maternal mortality rate from 2013 to 2017 (24.8 maternal deaths per 100,000 live births) ranked 22nd among all states. For infant and neonatal mortality, Maryland ranks 35th and 39th among the states, respectively.
In addition, in Maryland, the maternal mortality rate for Black women is almost four times that of white women, demonstrating vast inequities and the urgent need for investments in the health and well-being of Black mothers and children, and other communities of color.
Maternal and child health (MCH) forms the foundation for healthy and thriving lives. Children have unique developmental needs that require consideration and investment to improve population health. Growing evidence highlights opportunities to address the early conditions that cause individuals to become high-need and high-cost patients later in life. Research shows that the path to becoming an unhealthy adult starts as early as in utero and infancy, and that conditions during childhood greatly affect individual health trajectories across the entire life course.
Improving health outcomes while bending the cost curve is a powerful win-win opportunity, but it demands that we focus our efforts on upstream factors and eliminate racial/ethnic and socioeconomic disparities. Our hospital and health care funding priorities must be aligned in order to achieve these goals. Therefore, we are thrilled that this month, due to work that started in 2019 and because of many advocates and policymakers, we have done just that.
In the 2019 legislative session, legislation (Senate Bill 406/House Bill 25) sponsored by Del. Brooke Lierman and Sen. Bill Ferguson established the Task Force on Maryland Maternal Child Health. The first recommendation of the task force report was to make MCH one of the three population health goals of Maryland’s Statewide Integrated Health Improvement Strategy. These goals were to establish domains of health care quality and delivery that the state could impact under our state’s unique Total Cost of Care Model, which would have the potential to make significant improvement in not just Maryland’s health care system, but in the health outcomes of Marylanders. Diabetes and opioid/substance use disorder were selected as the first two goals — leading to funding and programs.
Thanks to the hard work of experts and advocates across the state, Maternal and Child Health was recently approved as Maryland’s third goal, with a focus on maternal and infant mortality and childhood asthma. This selection as a priority goal reflects the critical importance in Maryland of improving health outcomes for mothers and children and acknowledges both the long-standing history of inequity and disparities, as well as the large potential for improvement in outcomes.
Additionally, in this last legislative session two additional recommendations from the task force were in bills that passed in support of MCH, including augmenting prenatal care and expanding Medicaid coverage for pregnant women to one year postpartum. Both of these policies promise to improve the health of mothers, their children and families.
As Congressman Elijah Cummings often remarked, “children are living messages that we send to a time we will not see.” Investment early in life — including investments in maternal health — sets the foundation for healthier children, adults, and future generations. While children constitute only 9% of U.S. health care spending, they are 100% of our future.
This National Minority Health Month, Maryland can celebrate the recent strides made in proactively building better health for all while recommitting to ensure all our mothers and children have access to the world-class health care they deserve.
Brooke Lierman (brooke.lierman@house.state.md.us) is a Democrat representing Baltimore City in the Maryland House of Delegates. Dr. Tina Cheng (Tcheng61@gmail.com) is chief medical officer and chair of the Department of Pediatrics at Cincinnati Children’s Hospital Medical Center and the former director of pediatrics and co-director of the Johns Hopkins Children’s Center.