Black women are three times more likely than white women to die during pregnancy, and twice as many black babies as white babies die in infancy. Yet researchers know little about why pregnancy and infant health differ by race, despite massive efforts to address this persistent problem.
Now, researchers at the University of Michigan will examine the issue from an interdisciplinary perspective to help solve this problem. More than a dozen widely varied U-M schools and centers will be involved in the effort, from public health and medicine, to business and engineering.
“The whole issue of health care disparities is mostly unsolved. While there has been tremendous effort and a lot of money spent to address the problem, in my opinion almost nothing has been accomplished with all that investment. Individual niche programs are a Band-Aid that doesn’t solve the problem,” says Scott Ransom, D.O., MBA, MPH, director of the U-M Program for Healthcare Improvement and Leadership Development and scientific director of the U-M’s Griffith Leadership Center.
“I believe the answer will require an interdisciplinary solution. That’s what’s unique about our effort. Business, information and engineering haven’t looked at this issue at all, while social work, nursing, medicine and public health haven’t looked at it together,” says Ransom, an associate professor of Obstetrics and Gynecology at the U-M Medical School and of Health Management and Policy at the School of Public Health.
Ransom is principal investigator on this new three-year initiative, which received a $1.7 million grant from the National Institutes of Health as part of its Roadmap for Medical Research, a series of far-reaching initiatives designed to transform the nation's medical research capabilities and speed the movement of research discoveries from the laboratory bench to the bedside.
While compliance with traditional prenatal care among black women has improved in recent years, it still lags behind white women: 75 percent of black women seek prenatal care vs. 89 percent of white women. The discrepancy continues after the baby is born too: 58 percent of white infants get all recommended well-child care, compared to 35 percent of black infants.
Further, previous studies have shown traditional medically oriented prenatal care has minimal impact on improving pregnancy outcomes. The new project will look at whether more comprehensive and coordinated prenatal care strategies may improve pregnancy outcomes.
U-M researchers will tackle the issue of racial disparities from three perspectives: leaders, health care providers and patients.
Researchers have not typically looked at how the perspectives or principles of leaders at hospitals, government agencies and prenatal clinics can influence health care disparities. Government and private organizations have provided money to fund prenatal programs, but these have made little difference in the overall problem. In this new study, an interdisciplinary group of U-M researchers, led by Lynn Wooten, Ph.D., an assistant professor in the U-M Stephen M. Ross School of Business, will look at how leadership affects access to and improvements in prenatal care, as well as the leader’s role in managing the racial gap in birth outcomes.
Providers, including obstetricians, nurses, midwives and social workers, come into contact with pregnant patients regularly. Are these providers injecting personal bias or stereotypes onto their patients that ultimately affect care? Are their interactions with patients impacting whether the patient accepts the treatment recommendations? A project led by Ransom will evaluate and make recommendations on how providers can improve care and interact with all races and ethnicities. The team will evaluate possible augmented prenatal care strategies that coordinate traditional prenatal care with education, social services, technology and other approaches.
Patients also contribute to racial disparities in care through cultural attitudes toward health care, as well as socioeconomic status, family situations, education and transportation issues. This area, led by Briggett Ford, Ph.D., an assistant professor in the U-M School of Social Work, will evaluate the patient’s role in health care disparities and look at how better coordinated and augmented prenatal care programs address possible social and environmental factors.
“When we think of ‘multidisciplinary’ in medicine, we usually mean two medical departments collaborating. With the resources and the longstanding collaborative spirit at the University of Michigan, we can truly make this effort interdisciplinary,” Ransom says. “We’ve brought together people who have widely different perspectives to add focus to the issue of health disparities. These are people who have tackled other huge issues in the past and can bring a unique perspective to a question that the medical field alone has not been able to answer.”
The U-M areas involved in the project are the Institute for Research on Women and Gender, the Program for Healthcare Improvement and Leadership Development, the Medical School, the School of Public Health, the Griffith Leadership Center, the Institute for Social Research, the Center for Research on Ethnicity, Culture and Health, the Institute for Social Research, the School of Nursing, the Center for Health Disparities, the Center for Health Promotion, the School of Social Work, the Stephen M. Ross School of Business, the School of Information, the College of Engineering, the Research Center on Poverty, Risk and Mental Health, and the departments of Obstetrics and Gynecology, Health Management and Policy, and Psychology.