Related NCHEC Competencies: 5.1 and 5.2

As defined by the Cambridge Dictionary, the American dream is “the belief that everyone in the [United States of America] has the chance to be successful and happy if they work hard” (Cambridge University Press, n.d.). But how can individuals achieve "success and happiness" when more than 66% of them, report living paycheck to paycheck (Henderson & Dunn, 2024)?

Paycheck-to-Paycheck Living

Why is it so excruciatingly challenging to live the American dream? It all boils down to money. Before, the archaic idea was that one individual would live at home and care for the children, while the other worked. However, recently, the United States Census Bureau (2024) reported the median housing cost is $417,300, which is simply not possible to afford when the average annual salary is $59,384 (United States Census Bureau, 2024; U.S. Bureau of Labor Statistics, 2024). Not to mention, the other added expenses to consider with living. If one has children, the average cost of a child in Michigan is $11,086, and if this child is from a single-parent household, these costs contribute to 41.8% of the parent’s income (World Population Review, 2024). This leads to a cycle of living paycheck to paycheck while trying to afford essentials like groceries, childcare, and medical bills, resulting in a 20th-century American nightmare.

A Public Health Emergency

In a study by Denary et al. (2021), individuals who allocated 30% of their paycheck to housing, were found to suffer from health conditions, such as anxiety and depression. In layman’s terms, a public health emergency is when the public is at risk of health issues (Marion County Health Department, n.d). As shown, by the Denary et al. (2021) study, when an individual cannot pursue housing, one’s health suffers, which falls under the classification of a “public health emergency.” But at what point will the inability to live in the United States of America be considered a “public health emergency”?

A Call to Action

In recent years, the current presidential administration has begun to address the inability to afford housing by creating affordable housing units, limiting the rent increase, and repurposing abandoned land for housing purposes (The United States Government, 2024). While this is a start, more states and local governments need to section their public land for affordable housing, and, rent stabilization needs to occur and be advocated for, in every state (The United States Government, 2024). In the next election, it is important to involve the candidates in the importance of rent control and increasing affordable housing so that change can occur effectively. This is only the initial step in addressing the issue, but, without a beginning, the American dream cannot truly become a reality.

Alignment to NCHEC|HESPA Competency: 5.1

Education stands as the pivotal gateway to enhanced opportunities, a brighter future, and wields a profound influence on health outcomes. Research indicates that adults with higher educational attainment live healthier and longer lives compared to their less educated peers (Zajacova & Lawrence, 2018). Over the following decades, numerous studies revealed that lower educational attainment is strongly associated with poorer health outcomes, including worse general health, more chronic conditions, greater functional limitations and disability, and higher biological risk levels (Zajacova & Lawrence, 2018). Recognizing this relationship is essential for addressing

healthier disparities and enhancing overall well-being.

Access to Quality Education

Access to quality education is crucial for fostering better health outcomes. Individuals who receive quality education throughout their lives tend to enjoy better health than those who do not (Tulane University, 2021). Education promotes upward mobility, enabling people to secure better financial situations that allow them to afford quality healthcare and make informed decisions. For instance, a college graduate is more likely to evaluate complex health information, such as managing prediabetes, while someone with less formal education may struggle to discern reliable sources (Tulane University, 2021). Ultimately, education equips individuals with the knowledge and skills to navigate the healthcare system effectively, understand medical information, and make informed health decisions (Tulane University, 2021). Disparities in educational access can lead to significant differences in health outcomes across populations, underscoring the critical role of education in promoting overall health and well-being.

The Impact of Education on Health Literacy

Health literacy is the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Centers for Disease Control and Prevention [CDC], 2023). Although limited health literacy and general literacy are not the same, they are closely related. Strong literacy and numeracy skills enhance one’s capacity to comprehend and utilize health information and services (CDC, 2023). Low health literacy is associated with more hospitalizations, greater use of emergency care, decreased use of preventive services, poorer ability to interpret labels and health messages, poorer health status, higher mortality, higher health care costs, and individuals presenting with advanced illness, resulting in delayed diagnosis, treatment, and poorer outcomes (Coughlin et al., 2020).

Economic Benefits of Education on Health

Education is closely linked to economic stability, which significantly influences health outcomes. In today’s economy, individuals with higher educational attainment are more likely to secure employment that offers health-promoting benefits such as health insurance, paid leave, and retirement plans (Center on Society and Health, 2015). Conversely, those with less education often work in high-risk jobs with fewer benefits. Higher education typically leads to better job opportunities and higher earnings. Economic stability, afforded by higher earnings, enables individuals and families to purchase healthy foods, engage in regular exercise, and access necessary health services and transportation (Center of Society and Health, 2015). On the other hand, job insecurity and low wages associated with less education can lead to poor nutrition, unstable housing, and unmet medical needs, all of which negatively impact health (Center of Society and Health, 2015).

Education and Mental Health

Education plays a pivotal role in shaping mental well-being, with higher levels of education consistently associated with better mental health outcomes (Williams, 2023). Education emerges as a strong predictor of positive life outcomes, including employment opportunities, income levels, and social standing. Higher education equips individuals with expanded choices, fostering greater autonomy and stability in life, yet it also presents challenges such as heightened expectations that may impact job and life satisfaction (Williams, 2023). Conversely, lower education levels correlate with diminished psychosocial resources, increased stressors, and higher susceptibility to mental health issues like depression. Understanding these dynamics underscores the importance of holistic strategies that integrate education, mental health support, and socioeconomic empowerment to foster well-being across diverse populations and generations (Williams, 2023).

Conclusion

The relationship between educational attainment and health outcomes is undeniable. By ensuring access to quality education for all, we can improve health literacy, economic stability, and mental health, ultimately leading to better health outcomes. Addressing educational inequities is a crucial step toward reducing health disparities and promoting a healthier, more equitable society. Investing in education is not just an investment in knowledge but also an investment in the health and well-being of future generations.

References

Centers for Disease Control and Prevention. (2023, May 19). Understanding Health Literacy. Centers for Disease Control and Prevention.

https://www.cdc.gov/healthliteracy/learn/Understanding.html

Centers for Disease Control and Prevention. (2023, July 11). What is Health Literacy? Centers for Disease Control and Prevention. https://www.cdc.gov/healthliteracy/learn/index.html

Center on Society and Health. (2015, February 13). Why Education Matters to Health: Exploring the Causes. Virginia Commonwealth University. https://societyhealth.vcu.edu/work/the-projects/why-education-matters-to-health-exploring-the-causes#gsc.tab=0

Coughlin, S. S., Vernon, M., Hatzigeorgiou, C., & George, V. (2020). Health Literacy, Social Determinants of Health, and Disease Prevention and Control. Journal of environment and health sciences, 6(1), 3061.

Tulane University. (2021, January 27). Education as a Social Determinant of Health. Tulane University. https://publichealth.tulane.edu/blog/social-determinant-of-health-education-is-crucial/

Williams, N. (2023, April 6). How does Education Affect Mental Health? News Medical & LifeSciences. https://www.news-medical.net/health/How-does-Education-Affect-Mental-Health.aspx#:~:text=Educational%20attainment%20and%20mental%20health,their%20lives%20and%20better%20security.  

Zajacova A., & Lawrence, E. M. (2018). The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach. Annual review of public health,39, 273–289. https://doi.org/10.1146/annurev-publhealth-031816-044628

Related NCHEC Competencies: 5.1 and 5.1.2

April marks Sexual Assault Awareness Month (SAAM). Sexual violence is a public health concern and impacts all communities. Although some folks would rather believe that sexual assault doesn’t happen in their community or impacts anyone they know, anyone can experience sexual assault. The Rape, Abuse & Incest National Network (RAINN) reports that every 68 seconds an American is sexually assaulted. There is much violence prevention work to be done surrounding the issue that we can all participate in.

Raising Awareness

Teal is the color recognized as sexual assault awareness. Wear Teal Day was April 2nd, but to show support for survivors and to raise awareness you can wear teal ribbons or pins all month.

Denim Day is the last Wednesday of April and this year falls on April 24th. Denim Day was established in 1999 in Los Angeles, California, but wearing denim as a form sexual assault protests began in Rome, Italy the same year. In 1992 in Rome, Italy, an 18-year-old student driver was sexually assaulted by her 45-year-old driving instructor. The student reported the assault, and the instructor was arrested and prosecuted. In 1999 the instructor appealed the sentence and stated that he had consensual sex with the student. The case made its way up to the Italian High Court where the conviction was overturned, and he was released from prison. A statement from the court argues that because the student was wearing tight jeans, she had to have helped the instructor remove them, therefore resulting in consensual sex. Since then, Denim Day has evolved into a global campaign.

Taking Action

Wondering what you can do to make a difference?

1. Believe survivors of sexual violence. Due to deep rooted social norms and personal biases, there are lots of people and communities that do not believe survivors of sexual violence. To support survivors and prevent future violence, we first need to believe survivors.

2. Engage in work that focuses on systems change. When survivors have the willingness and courage to report an assault, they may have harmful interactions with systems that they try to navigate i.e. law enforcement, legal system, medical system. Systems change work needs to be done to address responses to and interactions with survivors.

3. Keep yourself informed. According to the 2019 Michigan Sexual Violence Prevention Survey Report, “over 1 in 3 Michiganders agreed with the most popular myths, including those that blame survivors and excuse

NCHEC Competencies: 5.1, 5.3.1, and 7.4

It is no surprise that communities, organizations, and individuals are feeling the burden of rising food costs, especially post pandemic. From 2010 to 2019, pre-pandemic, food prices increased at an average of 1.2% per year (USDA, 2021). In the years 2020 and 2021, grocery store/supermarket food purchase costs increased by 3.5% each year according to authors of the Consumer Price Index (CPI) (USDA, 2023). The trend of increasing food costs continued in 2022 with a staggering 11.4% increase; from November 2022 to November 2023, these food costs increased by another 1.7% (USDA, 2023). Although the rise in food costs is now decelerating, there was still a slight increase in 2023. The United States Department of Agriculture (USDA) predicts that food costs will increase again during 2024 (USDA, 2023). The implications of rising food costs affect public health outcomes at an individual, community, and organizational level which correlates with the social ecological model (SEM) (Bronfenbrenner, 1979). We know that when people’s health is inequitably socially determined, it poses a burden on their wellbeing. The SEM associates changes in individual health outcomes with interactions across different levels of factors, including individual/intrapersonal, interpersonal, institutional/organizational, community, and public policy (Ohri-Vachaspati et al., 2015; Rural Health Information Hub, 2024). Using the SEM, we can assume that healthy eating behaviors result from factors beyond individual factors (e.g., healthy food knowledge and cooking skills) such as combinations of one or more factors (e.g., community, organizational, policy); namely, healthy eating behaviors can be influenced by increased CPI. We may be asking ourselves – what is the significance of the CPI on public health? how does this affect people in my community? how does the CPI affect individuals? 

CPI and SEM Implications on Public Health Outcomes

Eating behaviors are influenced by factors that are more than just individual behaviors, such as social determinants of health (SDOH), food security, and nutrition security. According to the U.S. Department of Health and Human Services, SDOH are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (US Department of Health and Human Services, 2023). Therefore, systems or environmental changes that contribute to the rise in food costs have a profound effect on population health. When such systems and environmental changes are paired with a lack of and/or weak policies that centralize around nutrition related public health outcomes, socially determined influencers inhibit optimal individual nutrition behaviors.

Sharp increases in food cost impact consumers purchasing power which aligns with the way SEM calls out the complex interactions between influencing population level and individual level health outcomes. When the CPI increases, consumers restrict the amount of food they buy or must buy less expensive, less healthy foods. Foods that cost less and are more accessible tend to be lower quality and higher in saturated fats, sodium and added sugars, and consuming these less healthy foods puts an individual at higher risk for developing a chronic disease (American Heart Association, 2021). Low-income individuals are particularly affected by this because low-income consumers spend roughly 30% of their total income on food alone (U.S. Government Accountability Office, 2023). While grocery delivery and the Supplemental Nutrition Assistance Program (SNAP) could buffer the impacts of CPI, grocery delivery can be expensive and stores accepting SNAP are not always available to those who need them to mitigate the burden of CPI (Cantor et al., 2020). Since diet is linked to chronic diseases, such as cardiovascular disease and type II diabetes (CDC, 2022; CDC, 2023; CDC, 2024) and people with low-incomes and low-access have more burden to acquiring healthy, affordable, and quality foods, the rise in cost of food most greatly affects low-income individuals compared to higher income individuals (USDA ERS, 2023).

Access to nutritious food, beyond price or affordability, is another SDOH and can be attributed to policy, institutional, and/or systems levels of SEM such living in a food dessert (Jones et al., 2022). A food desert is a geographical area that lacks access to healthy, affordable food, and people living in them do not have easy access to supermarkets and/or grocery stores (Jones et al., 2022). A study found that within food deserts in Florida, the average food prices were 36% more than prices in non-food deserts (Wright et al., 2019). With food deserts consisting mostly of low-income households, the people are more affected by the rising cost of food. Another study found that people at risk of food insecurity possessed nutrition knowledge, however their actual eating behavior was influenced by other social determinants, such as access to food that were culturally relevant and the physical environment (Van Der Velde et at., 2019). This demonstrates how eating behaviors are influenced by more than just individual knowledge, skills, and abilities and are a result of complex interactions across the SEM. 

CPI and SEM Implications on Community Health

Organizations are also feeling the burden of rising food costs, which aligns with how the SEM explains the interplay between organizations, institutions, and individuals. Grant money that is given to organizations does not always correlate with inflation and food cost increase. While it is difficult to deal with rising food cost on an individual level, the burden CPI poses on organizations is also something to consider, especially organizations that use food to promote nutrition related behaviors to influence health behavior. While organizations may still be providing services per usual, it could be likely that organizations have had to adjust to the rising food costs as well. For example, organizations that deliver SNAP-Ed programming provide direct education and policy, systems, and environmental (PSE) change work to SNAP-Ed eligible individuals throughout their local communities. Direct education and PSE are used in conjunction to foster positive outcomes regarding health behavior, such as increased fruit and/or vegetable intake. With the rise in food costs, it is more expensive to buy food materials for health promoting direct education events that offer food tastings or food demonstrations. Therefore, less volume of food may be purchased, types of food tastings may be modified, and the frequency of food demonstrations may change.  

CPI and SEM Implications on Individuals

Rising food costs affects people on an individual or household level which aligns with the intra and interpersonal levels of the SEM. With rising costs, people may end up having to choose between certain necessities in life, such as food, utility bills, or healthcare. Choices such as this can lead people to a very difficult decision, such as skipping meals or purchasing lower cost, less nutrient dense foods. One study found that the price of healthier foods (dairy, fruit juice, and frozen vegetables) was almost twice as much as unhealthy foods (soda, sweets, and salty snacks) across almost 2000 supermarkets in the USA (Kern et al., 2017). Rising food costs also affect middle income individuals, as one in five middle-income families reported that they or their children have skipped a meal due to the rise in food costs (Amoakohene, 2023). Skipping meals can lead to health issues, such as lower diet quality (Ramsay et al., 2018). 

On a larger scale, individuals are affected by federal, state, and local policies. For example, there was a temporary boost to SNAP benefits during the COVID-19 pandemic, which helped millions of people during that time. However, those emergency allotments ended after February 2023 (USDA, 2023). This example shows how there are complex interactions across the SEM levels, as policy can trickle its way downstream and affect the actions and behaviors of an individual, such as a reduced budget for healthy foods/groceries or having to eat less expensive, less healthy foods. 

The above showcases how the CPI affects public health at different levels, and using this information, we can advocate for systems change and educate others on why systems change is needed in regard to food cost. We are all a part of a larger system and should understand that health and health behaviors are part of larger, more complex issues. We, as public health professionals, need to advocate for lower food cost and more access to healthy, affordable foods, especially for those who cannot advocate for themselves. 

NCHEC Competencies: 1.1.3, 1.2.6, 5.3.1

It is a very exciting time for a woman when she is pregnant and lots of things are thought of and discussed. However one important factor of pregnancy and childbirth is sometimes overlooked. Pregnancy and childbirth is probably one of the most dangerous things a woman can do in her lifetime. It is estimated that more than 700 women die from complications during pregnancy, childbirth, or within one year of the end of a pregnancy (Michigan Department of Health and Human Services, 2022). No one should have to lose their mother, wife, or daughter during what it supposed to be an exciting time.

First and foremost, every women should have access to affordable prenatal care. It is important that pregnant women go to all of their prenatal appointments to detect possible pregnancy-related health concerns that could end up as a pregnancy-related complications (National Institute of Child Health and Human Development, n.d.). Fortunately, there are places that provide low-cost or free prenatal care, such as community health centers or Planned Parenthood, for those that need that benefit (Planned Parenthood, 2019). 

Over the counter pregnancy tests, instruct women to contact their doctor when there is a positive result. However, this could cause a dilemma for women that do not have a doctor. The Centers for Disease Control and Prevention has a website that states and provides information on how to get in contact with each State’s Health Department within the United States (Centers for Disease Control and Prevention, 2020). For example, a pregnant woman in Michigan could use this link to find the Michigan Department of Health and Human Services to locate health care coverage for herself while pregnant, food assistance programs, and plenty of other resources she may need during her pregnancy (Centers for Disease Control and Prevention, 2020). Having this information either directly on the box or in the paper insert of a pregnancy test could help a woman that tested positive and does not have a doctor to go to, find the resources she may need to find proper prenatal care.

Pregnant women should eat healthy diets with plenty of nutrients and vitamins because their maternal health can be affected by their diets (National Institute of Diabetes and Digestive and Kidney Diseases, 2019). Pregnant women that have poor diets that lack essential “nutrients – like iodine, iron, folate, calcium and zinc – can cause anemia, pre-eclampsia, hemorrhage, and death” (Unicef, n.d.). For women who have financial struggles, they can reach out to government programs like Women, Infants, & Children (WIC) or Supplemental Nutrition Assistance Program (SNAP) (U.S. Department of Agriculture, n.d.) for help with the cost of food supplies (SOMPortal, 2020). When women have their first doctor’s appointment for their pregnancy, it would be helpful if providers provided a list of places women could receive food assistance or assistance on how to get prenatal vitamins in efforts of reaching women who possibly struggle getting these resources.

Care needs to be continued after birth for continued monitoring if the mother’s physical and mental health as she heals. Postpartum checkups had been limited to one visit 4-6 weeks after birth but the first checkup should happen within three weeks after birth (Ramos, 2022). It would be beneficial to do research and collect data on when women are going to their postpartum checkups. If we noticed a higher number of women going around the 4-6 week mark, a couple of questions could arise. One question being, did the woman not feel that they needed to go earlier than 4-6 weeks? If so, why? Secondly, how many of these women were not going earlier due to cost, means of transportation, or other reasons? And finally, are medical practices not informing these women that they are able to schedule as early as within three weeks? If women were going to their postpartum checkups within this three week timespan after having a baby, medical providers could potentially catch warning signs of pregnancy-related complications earlier on, treat it faster, and ultimately they could decrease the maternal mortality rate. 

Postpartum depression (PPD) onset occurs “between one week and four months after childbirth” (Degner, 2017) and accounts for “20% of all maternal deaths” (Osborne & Standeven, 2019). A woman that had pregnancy complications, are an adolescent or above 35 years old, have a history of depression or other mood disorders, or have obstetric factors, like gestational diabetes, are at a higher risk for developing PPD (Silverman et al., 2017). When discharged from the hospital after giving birth, women are given information on medications take took in the hospital or can take when they get home, reminders for follow-up appointments, self-care instructions, and more (John Hopkins Medicine, n.d.). Postpartum discharge paperwork could include contact information for Substance Abuse and Mental Health Services Administration Helpline (SAMHSA) or the 988 Suicide & Crisis Lifeline (SAMHSA, 2023). Many mothers hold onto their discharge paperwork for some time after so this would be a good way to reach those mothers who are struggling mentally to let them know there are free, confidential, 24/7 help (SAMHSA, 2022).

According to the CDC, “black mothers in the U.S. die at three to four times the rate of white mothers” (Martin & Montagne, 2017). Some factors that attribute to the increased maternal mortality rate in black women include implicit bias, structural racism, and underlying chronic conditions of the mother (Centers for Disease Control and Prevention, 2023). The protection of black mothers maternal health takes efforts from all of us; the mothers themselves, their families, healthcare providers, hospitals, and states/communities (Centers for Disease Control and Prevention, 2023).

There will always be something to work on towards improving maternal health and pregnancy-related complications because health constantly changes. We could add the link of every State’s Health Department websites provided from the Center for Disease Control on pregnancy test inserts or boxes. We could address food insecurities for pregnant women at their first obstetric appointment. We could perform a study on when women are going for their postpartum checkups. We could make mental health hotline numbers as a mandatory requirement on discharge paperwork from hospitals. And we could continue our efforts to knock down health disparities revolving around black mothers. By addressing these suggestions, we could bring our care for maternal health and pregnancy-related complications to the next level. 

References

Centers for Disease Control and Prevention. (2020, May 1). State and Territorial Health Departments - Public Health Professionals Gateway - CDC. Www.cdc.gov. https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html

Centers for Disease Control and Prevention. (2023, April 3). Working Together to Reduce Black Maternal Mortality - Health Equity Features - CDC. Www.cdc.gov. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html

Degner, D. (2017). Differentiating between “baby blues,” severe depression, and psychosis. BMJ, j4692. https://doi.org/10.1136/bmj.j4692

John Hopkins Medicine. (n.d.). Hospital Discharge. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hospital-discharge

Martin, N., & Montagne, R. (2017). Nothing Protects Black Women From Dying in Pregnancy and Childbirth. MATERNAL HEALTH. https://assets.propublica.org/pdf/Lost-Mothers-Black-Women.pdf

Michigan Department of Health and Human Services. (2023, September 14). Hear Her. https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2023/09/14/hear-her

National Institute of Child Health and Human Development. (n.d.). What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care#:~:text=Pre%2DPregnancy%20and%20prenatal%20care

National Institute of Diabetes and Digestive and Kidney Diseases. (2019). Health Tips for Pregnant Women. 

NCHEC Competencies: 5.1, 6.5, 7.2.1, 8.1.2

Birthing People Are Dying

According to the Michigan Department of Health and Human Services (MDHHS), more than 700 women die during childbirth. Michigan loses 25 women to childbirth each year (MDHHS, 2023). Childbirth, an act that should be straightforward, is claiming the lives of birthing parents all over the country. MDHHS goes on to say that 6 out of 10 of the deaths are preventable! Now is the time to act! The Hear Her campaign seeks to educate, encourage, and inspire birthing people and their communities to speak up when the birthing person feels as if something is not right. Some signs and symptoms to look out for include headaches, fainting, fever, chest pain, vaginal bleeding, and overwhelming tiredness.. Listen to them, believe them, and act for them when it comes to pregnancy. Know the urgent warning signs to ensure your birthing person and their baby are in good health and have access to quality care before it's too late.

Clinicians Are Here to Help

MDHHS reports that approximately 1 in every 50 mothers who have an inpatient delivery hospitalization experience severe maternal morbidity in Michigan (MDHHS, 2019). Clinicians must learn to hear their patients and respect the birthing person and their decisions with their babies. MDHHS has found disparities where Black women are disproportionately impacted by birthing complications and morbidity. They go on to say that nationally, Black women are three times more likely to die from pregnancy–related complications compared to White women (MDHHS, 2023). We must train culturally competent clinicians to address this problem and focus on patient–centered care, allowing the birthing parent to take control of their birthing experience and do what they think is best for their baby. Lastly, timely care is a necessity. Small concerns can become big emergencies if left untreated. Delays in recognizing risk factors and escalating care can result in severe maternal morbidity and even pregnancy-related death (MDHHS, 2023). Clinicians must educate the entire support structure about

pregnancy–related health concerns and when symptoms turn into emergencies. To. ensure clinical warnings are being taken seriously, clinicians can familiarize themselves with regional, state, and national efforts to improve maternal child health. They can also join groups like AIM (Alliance for Innovation on Maternal Health) and other organizations that will give them an understanding of what to look out for and how to assist should a problem arise.

SHARE Approach

Clinicians are a huge part of the equation when it comes to childbirth. MDHHS has found clinicians’ use of the 5-step SHARE approach to engage patients to be the most optimal way for care. SHARE was designed by the Agency of Healthcare Research and Quality (AHRQ) to help engage patients in their healthcare decision-making. SHARE stands for Seek your patient’s participation, Help your patient explore and compare treatment options, Assess your patient’s values and preferences, Reach a decision with your patient, and Evaluate your patient’s decision. Birthing parents should be at the heart of the decisions they make for their child and family. AHRQ has a collection of reference guides, posters, and other resources designed to support the patient and the physician in decision-making.

Infant Mortality Rates by Different Demographics in Kalamazoo

MDHHS; epidemiology center has been able to compile data on infant mortality in Region 6 (Kalamazoo region). Compared to White women, Hispanic and Black mothers are losing their babies before the age of one at twice the rate! Another study shows that the younger you are when pregnant, the more likely you will suffer from a negative infant outcome. Babies born to parents who are 20 years or younger are at a 59% higher risk of losing their child compared to 20 – 30-year-olds. Insurance is another major concern when it comes to infant mortality. MDHHS found that those on Medicaid are twice as likely to lose their child compared to those with private insurance. Lastly, 16% of Black babies are born with low birth weights compared to 7% of White babies. Low birth weight is one of the leading causes of infant death. The disparities Black and Brown women face compared to White women are astounding. Michigan needs to fix these disparities so that all can prosper.

Planning for the Future

Birthing people need support before, during, and after their pregnancy. An important part of pregnancy is family planning. MDHHS provides services to men and women who wish to exercise personal choice in determining the number and spacing of their children (MDHHS, 2023). Planning for the future is a critical part of any birthing plan and needs to be discussed with both parents and systems of support. It is dangerous to have back-to-back pregnancies, making birth spacing an important tool. It is important to note that abortions are a form of birth spacing but it is not the only way. Contraception is a very common medical intervention that allows for safe sex without the risk of pregnancy. The Michigan Family Planning Program offers contraception to low-income families (they do not provide abortions). In 2021, 40% of female clients and 41.5% of male clients were between the age of 20 – 30-years-old when they sought birth spacing counseling (MDHHS, 2021). They also found that the most common form of birth spacing is oral contraception pills. This, along with education around birth spacing, shows that birthing people can take control of their own pregnancy and are able to provide structure and support for their growing family.

References

Family Planning Epidemiology. (2023). Retrieved October 1, 2023, from

https://www.michigan.gov/mdhhs/adult-child-serv/childrenfamilies/mchepi/family-

planning-epidemiology

Hear Her. (2023). Retrieved October 1, 2023, from

https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2023/09/14/hear-her

Information for Health Care Professionals. (2023). Retrieved October 1, 2023, from

https://www.michigan.gov/mdhhs/adult-child-serv/childrenfamilies/mchepi/hear-

her/information-for-health-care-professionals

Maternal & Child Health Epidemiology. (2023). Retrieved October 2, 2023, from

https://www.michigan.gov/mdhhs/adult-child-serv/childrenfamilies/mchepi

The SHARE Approach. (2023). Retrieved October 1, 2023, from

https://www.ahrq.gov/health-literacy/professional-training/shared-decision/index.html

It is a difficult time to be a health educator. Many of us would say that there has neverbeen an easy time, but it certainly feels like the problems of today are bigger and scarier than ever. We are inundated with information and trying to wade through what’s real. Working to maintain interpersonal relationships and mental health in a time of increasing social isolation. Our communities are struggling and they often just need a shoulder to lean on and an ear to listen. But our listening skills are underdeveloped and when we bring less than a full platter to the table, our guests are walking away hungry and irritable.

Listening is a critical, but underused, tool in a health educator’s toolbox and focusing on the development of this skill will make for more effective communication and education (Usable Knowledge, 2017). Educating is just as much about listening as it is about speaking. Listening to communities means taking their concerns seriously and acknowledging that they are the experts of their own lives. 

Climate change may be the issue that defines our time and our youngest generation. Climate anxiety is understood as a heightened experience of distress in response toaggressive changes in the climate and is noted as being acutely felt among young people (Dodds, 2021). Fear surrounding climate change can have marked effects on an individual and community level. The individual may experience stress and depression, and may turn to unhealthy coping mechanisms like substance misuse (Dodds, 2021). Substance misuse has been a critical public health issue for years and only continues to negatively impact people’s lives. These issues permeate communities as well, making it difficult for young people to see what their future holds, contributing to a vicious cycle of anxiety and depression (Schechter, Rush, and Horner, 2023). In the cases of substance use and climate change, too often health education does not focus on holistic change or the lived reality of these circumstances. By listening to those struggling with substance misuse or climate anxiety, we can better understand these issues so that we can engage in much needed advocacy and we can be better prepared to support individuals and communities.

We must continue to develop our skills and continuing education is a critical part of that process. In an online age, webinars are one accessible way to learn about interesting work being done by experts in the field. Dedicating yourself to professional development by obtaining the CHES Certification from NCHEC is another way to continue learning. And if nothing else, remaining open and flexible, and listening, always listening, to the voices and experiences of those that we serve will only make us more engaged health educators and better able to help those in need. To tackle the issues of today, we must fundamentally change our approach. We must be able to listen.

NCECH Competencies

5.1 Identify a current or emerging health issue requiring policy, systems, or

environmental change.

6.1 Determine factors that affect communication with the identified audience(s).

References

Dodds J. (2021). The psychology of climate anxiety. BJPsych bulletin, 45(4), 222–226.

https://doi.org/10.1192/bjb.2021.18.

Schechter, D., Rush, H., & Horner, C. (2023). As climate changes, climate anxiety rises

in youth. CBS News. https://www.cbsnews.com/news/climate-change-anxiety/

#:~:text=Kids%20often%20worry%20about%20much,or%20that%20humanity%20is%2

0doo med.

Usable Knowledge. (2017). The Value of Listening. https://www.gse.harvard.edu/ideas/

usable-knowledge/17/09/value-listening. Accessed on 2023, August 11.

Sepsis is the body's extreme response to an infection. It occurs when an existing infection triggers the immune system to react in a way that is damaging to normal tissues and organs. Although anyone can get sepsis, those most at risk include folks with weakened immune systems such as infants, people with chronic illnesses, and the elderly. Sepsis is a burden to public health; in Michigan alone 1,262 deaths were attributed to sepsis (Centers for Disease Control and Prevention [CDC], 2023).

Sepsis is a life-threatening response and can lead to death. It is important for the public to know the signs and symptoms of sepsis to ensure that medical attention can be administered when necessary. It is critical that attempts are made by professionals to provide education and/or public service announcements (PSAs) and that they are received well by the public. Since vulnerable populations, like infants and older adults, are at higher risk for getting sepsis, it is imperative that they have someone to advocate for them and that their advocates are taken seriously by medical professionals. Even listening can contribute to better health outcomes. When the public listens to professionals and pays attention to early signs and symptoms, they are more likely to seek medical attention. Likewise, when medical professionals listen to individuals; concerns regarding signs and symptoms, they can intervene earlier rather than later.

Sepsis is not the only public health concern that can be somewhat alleviated by listening. The impacts of climate change and substance misuse could be very different is there was more listening. As public health professionals and health educators, it is vital that we do our part in efficiently communicating and educating as well as listening to the concerns of our community. The culture and environment that we contribute to matters and could impact the public's willingness to engage with us and the efficacy of our health education efforts.

This post supports Certified Health Education Specialist (CHES) Competency 6.2.1

The Kent County Food Policy Council (KCFPC) responded to recent violations of child labor laws by a west Michigan food processing manufacturer, Hearthside Food Solutions, who was found to be illegally employing migrant youth: 

Many violations of child labor law occur within businesses operating under the umbrella of the food system. For example: in 2022 1 total civil monetary penalties of $1,544,076 incurred by Packers Sanitation Services, Inc. (a group of meat processing and packing facilities in the Midwest); in 2019 thirty-eight Western Michigan fast food restaurants and manufacturing facilities were assessed more than $94,000 in civil money penalties; and the February 2023 discovery of the violation of child labor laws by Hearthside Food Solutions here in Grand Rapids is still under review with penalties still to be determined. These are only a few examples of a much larger problem - a problem that the collection of civil monetary penalties does not solve.

The U.S. Department of Labor’s Wage and Hour Division (WHD) appears to collect the civil monetary penalty but is not transparent about how that money is then used. The lack of transparency is troubling, as it generates the idea that the federal government is profiting from child labor law violations.

The violations in 2019 2 that incurred $94,000 in civil money penalties from 38 Western Michigan fast food restaurants and manufacturing facilities were discovered at the same time the WHD was conducting outreach events across west Michigan to educate the public on child labor standards. As part of the initiative, the Grand Rapids District Office conducted 15 outreach events at employer associations, public schools, and through webinars to educate the public on child labor standards. Could this be how the WHD is using civil monetary penalties? Educating the public on child labor standards also does not solve the problem of child labor. 

Throughout west Michigan and likely many other instances across the U.S. where child labor laws are violated, it is migrant children who are illegally employed.

Following the recent uncovering 3 of Hearthside Food Solutions who violated child labor laws by illegally employing young migrant workers across Kent County, WOODTV interviewed Teresa Hendricks, executive director & senior litigator at Migrant Legal Aid, who has worked as a migrant lawyer in Grand Rapids for more than three decades.

“(Migrant children) have to work to survive,” Hendricks explained. “They must be hired. And when they must choose between school or earning a living to cover their basic needs or cover expenses for their families back home, they will choose work over their health and over their education every time.” Hendricks has represented 4- and 6-year-old workers for wage claims. “It’s not surprising when I hear of exploitation in our food supply chain. It’s not surprising that it’s dealing with younger workers. Especially when we have a labor shortage right now, and it’s been growing,” says Hendricks. 

Addressing the root causes of child labor is the only way to stop child labor law violations. 

The Kent County Food Policy Council advocates for the following:

● The maximum civil monetary penalty under current law for a child labor violation is $15,138 per child. That is not high enough to be a deterrent for major profitable companies.

● Furthermore, it is not clear how the penalties for violations of child labor laws are used. KCFPC calls for transparency around civil monetary penalty usage by the U.S. Department of Labor’s WHD.

● Finally, the KCFPC proposes that the penalty money goes toward addressing root causes of (migrant) child labor by paying off the debts that many of the migrant children or their families have and is the reason many of them are working (to pay off these debts). KCFPC would like to see penalty money go to helping migrant youth and their family members obtain legal status here in the United States. Simply collecting civil monetary penalties allows for child labor to continue. 

Justice is defined as "just treatment of all members of society with regard to a specified public issue, including equitable distribution of resources and participation in decision-making (usually used in combination)." As such, we should be seeing some of the penalty resources/money going to these children and see community participation in decision making around what justice really looks like in this specific public issue. 

Resources to consider: 

1 U.S. Department of Labor (). MORE THAN 100 CHILDREN ILLEGALLY EMPLOYED IN HAZARDOUS JOBS, FEDERAL INVESTIGATION FINDS; FOOD SANITATION CONTRACTOR PAYS $1.5M IN PENALTIES. https://www.dol.gov/newsroom/releases/whd/whd20230217-1

2 U.S. Department of Labor. (2019, December 12). U.S. DEPARTMENT OF LABOR FINDS NEARLY 40 WESTERN MICHIGAN BUSINESSES VIOLATED WAGE, CHILD LABOR LAWS; ASSESSES $94,000 IN PENALTIES. https://www.dol.gov/newsroom/releases/whd/whd20191212-1 

3 Tollefson, B. (2023, February 26). Company accused of employing migrant children in W. MI. https://www.woodtv.com/news/kent-county/company-accused-of-employing-migrant-children-in-w-mi/ 

Competencies highlighted in this blog submission and coupled resources to consider [1.3.1, 2.3.6, 3.3.2, 4.5]

It is well known that nutrition plays an important role in maternal and child health. However, studies have found that many new mothers are nutrient deficient, especially, and disproportionately in those who experience food insecurity [1] , [2] . While benefits like Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) aim to alleviate this disparity, there are still significant barriers present to nutritious foods. One growing incentive is prescription produce programs. These programs offer vouchers for eligible patients to receive nutritious fruits and vegetables at low or no cost to the recipient. They have increased access to produce, reduced barriers of cost, increased health and well-being of individuals, and decreased healthcare spending [3] . A pilot project implemented by Ceres Community Project found that providing meals for pregnant women and their families until birth, then continuing to provide produce bags after birth produced positive results. Participants reported better eating habits, eating more vegetables, experiencing less food insecurity, and less stress. [4]

Resources to consider:

1. Murphy, R., Marshall, K., Zagorin, S., Devarshi, P. P., & Hazels Mitmesser, S. (2022). Socioeconomic inequalities impact the ability of pregnant women and women of childbearing age to consume nutrients needed for neurodevelopment: An analysis of NHANES 2007–2018. Nutrients, 14(18), 3823. https://doi.org/10.3390/nu14183823 

2. Pratt, N. S., Durham, H. A., & Sherry, C. L. (2014, September 5). Nutrient intakes from food of lactating women do not meet many dietary recommendations important for infant development and maternal health. Food and Nutrition Sciences. Retrieved March 28, 2023, from https://www.scirp.org/html/4-2701362_49517.htm 

3. Michigan Farmers Market Association. (2021.). Retrieved March 28, 2023, from https://mifma.org/wp-content/uploads/2021/05/Produce-Prescription-Program-Health-Impact-Analysis-1.pdf 

4. Perinatal pilot. Ceres Community Project. (2023). Retrieved March 28, 2023, from https://www.ceresproject.org/research-and-policy/research-studies-and-pilots/perinatal-pilot

NCHEC/HESPA Competencies used: 5.1, 5.3.1, 6.2.1, 6.3.2, 6.5.6

Inspired by SOPHEs 2023 conference theme, “New Age of Civil Rights, Advocacy, & Equity”. Civil Rights, Advocacy, and Equity, have we “arrived”? I acknowledge that race, religion, or other personal characteristics have been a barrier to the GUARANTEES of equal social opportunities AND equal PROTECTION under the law. Do you have a safe space to make this acknowledgement? To act on this acknowledgement, I was privileged to act on several opportunities to speak directly to state and local representatives in Lansing and in D.C. over the last year. I see advocacy for a more just food system as an open window to discuss the topics of Civil Rights and Equity. What actions do you want to take for advocacy this year? From my perspective, we/I have not “arrived”, and we/I sit in opportunity to adopt curiosity as a lens for public and community health actions that lead to justice and equity.

How can leadership and supportive guidance inform the intersection of social justice, health equity, and research? Grounding myself in the truth – I invite you to try on my perspective and see if it resonates…leadership qualities exist within everyone, and each unique human has a lived experience that creates personal expertise. Justice in our social policies, systems, and environments is sustainable when diverse perspectives of thought and lived experience can be translated into effective messaging. To prioritize listening is to prioritize social justice. 

There are many broken patterns being model in the world which are grounded in historically explicit frames (ex., racism, sexism, ageism, ableism, classism, and more). [Men]torship- OR - supportive guidance in life, practice, or research is a mechanism that can narrow the cracks in the policies, systems, and environments that have been shaped in ways of thinking that have long promoted explicitly bias behaviors. Implementing supportive guidance through a health equity lens, be it from a youths lived and/or academic experiences to an adult OR an adults lived and/or academic experiences to a youth, is an opportunity to model behaviors that can foster healing and make the intersection of social justice, health equity, and research a different path to traverse.

Resources to consider. 

1. UCLA Review

2. Fighting for Public Health