Differences in women’s health that are influenced by exposures, socio-economic factors and racial disparities were the subject of “Environmental Impacts on Women’s Health Disparities and Reproductive Health”, a virtual workshop of the NIEHS which was held on April 27 and 28.
Researchers, community partners and academics from across the country described how environmental stressors can affect maternal and fetal health outcomes and assessed the role of racial and ethnic disparities in exposures. They also discussed how to build authentic partnerships in disproportionately affected communities, and they identified gaps and potential next steps to advance environmental health disparities and reproductive health research. women.
Compared to white women, black women in the United States experience disproportionately higher rates of death related to pregnancy and childbirth, participants said. Women of color are more likely to be uninsured and face greater financial barriers to care, and they are less likely to access prenatal care. Participants also noted that environmental exposures can worsen disparities related to preventable conditions, such as type 2 diabetes and cardiovascular disease.
The NIEHS Faculty of Environmental Health Disparities and Environmental Justice (EHD-EJ) sponsored the event, the second in a two-part series. The first workshop, held last December, focused on solutions to environmental racism through community partnerships.
“The most shocking and inhuman”
Of all forms of inequality, health injustice is the most shocking and inhumane,” Martin Luther King, Jr. said more than five decades ago. Erica E. Marsh, MDfrom the University of Michigan, shared this quote as part of his presentation on reproductive health disparities.
“When we talk about inequality, we are actually talking about equal access to opportunity,” she said. “Equity is when we are really thoughtful and personalize the tools that identify and address the inequality that exists to begin with.”
Marsh noted that economic stability, neighborhood and physical environments, education, and access to nutritious food all determine health outcomes and intersect with race. Race is also a social and structural component of health, as is ethnicity. These are important in medicine because they can affect a diagnosis a doctor can give a patient, according to Marsh.
For example, endometriosis – a disorder in which uterine tissue grows outside the uterus – was described in the mid-twentieth century as a disease of white women in a higher income bracket. Other women arriving at the emergency room would have been more likely to be diagnosed with pelvic inflammatory disease.
The experience of racism and the chronic stress that results from it drive differential health outcomes and ultimately inequalities, from deaths from COVID-19 to uterine fibroids, Marsh noted.
“Race and racism are factors that impact care,” she told attendees.
Epidemiology and Improving Health Equity
Risk factors for negative health outcomes in disadvantaged groups are higher than in other groups, says NIEHS recipient Tamarra James-Todd, Ph.D.from the Harvard TH Chan School of Public Health.
“The question really is, what can we do about it?” she says. “Why do they have a higher disease burden? »
Asking this question is key to building trust and developing lasting interventions that affect policy, drive social change and improve health, she noted.
Factors such as historical redlining (the practice of discriminatory mortgage lending practices), retailer redlining, food insecurity, domestic and gender roles, air and noise pollution, beauty and types of work can lead to environmental exposures that affect health.
Additionally, endocrine-disrupting chemicals — including pesticides, plasticizers and flame retardants — are associated with adverse health effects in women ranging from infertility to premature birth, according to James-Todd. His lab studies whether higher exposure to these chemicals creates differences in health outcomes.
According to James-Todd, a variety of approaches will be needed to reduce disparities in environmental health. Some examples include improving knowledge of environmental health and understanding structural factors – work environments, public policies, etc. – which may expose people to an increased risk of exposure.
Disparities in reproductive health and the environment
Researchers from more than a dozen institutions presented topics related to women’s reproductive health. In addition to Marsh and James-Todd, the following people offered their expertise at the workshop.
- “Racial and Ethnic Disparities in Environmental Exposures and Reproductive Health Outcomes – What do we know and what do we need to know?” by Michael Bloom, Ph.D. of George Mason University.
- “Investigation of the Interplay of Environmental and Social Stressors on Maternal Reproductive Health,” by Carrie Breton, Sc.D., University of Southern California.
- “Community Observations to Inform Environmental Health Research in Northeastern British Columbia, Canada,” by Élyse Caron-Beaudoin, Ph.D., University of Toronto Scarborough.
- “A Practical Approach to Elevating Reproductive Health Equity,” by Ebony Carter, MD, Washington University School of Medicine, St. Louis.
- “Context matters: the disconnect between animal models and the complexity of the human environment,” by Deborah Cory-Slechta, Ph.D., of the University of Rochester Medical Center.
- “Creating Authentic Partnerships Between the Columbia Center for Children’s Environmental Health (CCCEH) and Youth in the Community,” by Julie Herbstman, Ph.D., of Columbia University, and Yesibel Pimentel and Quincy Wise of CCCEH.
- “Abandoning Exclusivity for Authentic Community Collaborations,” by Tanya Khemet Taiwo, Ph.D., of the University of California, Davis, and Janette Robinson Flint of Black Women for Wellness in Los Angeles.
- “Linking negative childhood experiences and weight gain in women: insights from a mouse model of postnatal neglect,” by Analia Loria, Ph.D., University of Kentucky College of Medicine.
- “Racial Disparities and Preterm Birth: Clarifying the Problem and Identifying Potential Solutions,” by Tracy Manuck, MD, of the University of North Carolina at Chapel Hill.
- “Community Engagement in Women’s Environmental Public Health in Puerto Rico: PROTECT Responde,” by Carmen Milagros Velez Vega, Ph.D., University of Puerto Rico Medical Sciences Campus, and María Isabel Santana, PROTECT Team.
- “The MIEHR Center: Unraveling Environmental Health Disparities in Mothers and Their Children,” by Elaine Symanski, Ph.D., Baylor College of Medicine.
- “Measures of Structural Racism and Their Association with Inequalities in Reproductive Health,” by Maeve Wallace, Ph.D., of Tulane University.
- “Social-Structural Determinants of Environmental Exposures and Uterine Fibroid Outcomes Among Systematically Marginalized Populations,” by Ami Zota, Sc.D., of George Washington University.
The workshop also featured a session titled “Identifying Gaps and Next Steps in Environmental Health Disparities and Women’s Reproductive Health Research”. The panelists understood the following.
- Regine Douthard, MD, Office of Women’s Health Research, National Institutes of Health (NIH).
- Karen Parker, Ph.D., Office of Sexual and Gender Minorities Research, NIH.
- Devon Payne-Sturges, Dr.PH, University of Maryland School of Public Health.
- Checo Rorie, Ph.D., North Carolina Agricultural and Technical State University.
- ClarLynda Williams-DeVane, Ph.D., North Carolina Department of Health and Human Services, Division of Public Health.
- Tracey Woodruff, Ph.D., University of California, San Francisco.
- Tanya Khemet Taiwo, Ph.D., University of California, Davis, Center for Environmental Health Sciences.
Additionally, the following student presenters from the NIEHS Scholars Connect Program shared their work.
- Violet Evans, University of North Carolina at Chapel Hill.
- Ameena Hester, University of North Carolina at Chapel Hill.
- J’ya Hunter, North Carolina Agricultural and Technical State University.
- Tanae Lewis, North Carolina Agricultural and Technical State University.
- Jessica Wu, University of North Carolina at Chapel Hill.
(Susan Cozier is a contract writer for the NIEHS Office of Communications and Public Liaison.)