[00:00:00] Welcome to the Health Policy podcast. I'm Brian Hyde, and today I'm joined by Dr. Gail Christopher. She's the executive director of the National Collaborative for Health Equity. And Dr. Christopher, thank you so much for joining us. Um, would you mind taking a moment just to tell us a little bit about who you are and what you do? Oh, I'm very happy to do that, Brian, and thank you for, uh, having us here to, to talk about this issue. I am the executive director of the National Collaborative for Health Equity. It's an organization that I co-founded over 20 years ago, uh, before joining the W.K. Kellogg Foundation and serving as a vice president and senior advisor there. Uh, I was honored to be invited to return to the National Collaborative, and, and we work to improve the health of those who are most at risk for poor health outcomes in this country. Now, I understand that, uh, you were the keynote speaker at the Black [00:01:00] Maternal Health Conference recently. What can you tell us about that? It was a wonderful conference, and I really was impressed with their theme, which is to reimagine a future where we don't have the health disparities and the health inequities that have plagued, um, Black women and Black families in this country for s- for so many decades. Uh, the exciting thing about that conference is that thousands of people came together, and they really are working hard and accomplishing and making progress, really, on this issue. Talk to me a little bit about, uh, what you see as the most promising policy news, uh, about the dilemma of poor birth outcomes, uh, that has, has been a problem within the African American community. I am so excited to say that thousands of people have worked on this issue for so many [00:02:00] years, and, and there is something that's called the Momnibus- Act, right? It is a comprehensive piece of legislation, a very creative piece of health and social policy. This, this act includes over 14 different bills that address in, in a most comprehensive way, the factors that will change outcomes. The bill includes, uh, a call for the data, the following of progress, so there is accountability for real results. The bill addresses the needs of special populations like veterans, like those who are inc- incarcerated. It leverages our, our health policy, uh, resources by extending and expanding Medicaid to cover those things that are unique to the pregnancy and birthing process. Uh, it addresses the issues of [00:03:00] coverage for mothers in, in WIC, the Women's Infants and Children nutrition program, through postpartum after the baby's born, and through the breastfeeding era. Uh, there are just so many factors that we call the social determinants, which include, you know, access to housing, affordable housing and, and transportation and, and environmental risk factors. So it's really a beautiful piece of legislation, and to date, although the federal bill hasn't passed, at least 17 states have passed this legislation. And the caucus that introduced it, they have managed to acquire, to get, uh, $200 million in funding to help support the efforts that are going on across the country. So for those of us that have been in this for so many decades, this is really good news. I love that name, Momnibus Bill. That's - Uh-huh that's a stroke of genius. [00:04:00] Has this- It is ... has this been in the works for a long time? Yeah. Well, at least the last five years, do you know? Uh, maybe more like seven. But the work of getting to where such a piece of legislation could be drafted, uh, that work's been going on for, you know, at least the last four decades that I know of. And let's talk a little bit about, uh, I- I'd love to get a little bit more in depth on some of the, the poor birth outcomes that, you know, that have prompted, you know, this effort to, to, to reform and to find improvement. What are some of the major challenges that have been faced regarding those, those poor birth outcomes? Well, to be honest, uh, Brian, you know, Black women are at least twice, if not three times, as likely to die from childbirth-related complications, uh, things like hemorrhaging, um, and, and cardiovascular [00:05:00] challenges. So, so the death rates for mothers in the Black community in, in close proximity to giving birth or while giving birth are just unacceptable. Uh, the other issues, of course, are the loss of the babies, infant mortality. Uh, we have premature births. We have low birth weights. Uh, y- we have multiple challenges and outcomes that can be addressed when, um, we could say there's a comprehensive embrace of the expectant mother and family, uh, when we reduce the stress, when we provide the support and the resources throughout the pregnancy, when we optimize nutrition. Uh, and, and some of these things will be made possible by the suggested policy changes. We have twice the, the infant death rate as, as well, and so this is... You know, this has been going on for too long, and, and I, I [00:06:00] anticipate some real progress. Boy, those, those are some formidable challenges. Talk to me about, uh, the practices and the programs that, that are being, um, implemented or being suggested to, to support healthy outcomes for both the moms and the babies. I'm happy to do that, and, and, you know, the key issue during pregnancy, because it is a, it is a natural stress experience for the mother, uh, but the key issue is to ameliorate and mitigate the unnecessary stresses. And so we do that by providing support, um, and that there's a new approach to that, at least it's new for Western medicine. It's called the doula, uh, where a, a companion provides compassionate, empathetic, and informed support for the mother during the, the pregnancy and birthing experience. And we have now programs in over 40 [00:07:00] states that are covering the cost of doula services, that companion, that supportive care, uh, for expectant mothers and families. W- we also know that i- supportive circles, uh, what we call centering approaches, where the mother is engaged in a, a supportive group throughout the pregnancy. You know, it's amazing how much compassion and empathetic support can matter in, in all of our lives, but certainly in the lives of a mother who is experiencing the stress of creating a new entity within, within her body. Even though pregnancy only, uh, and fetal development only constitutes 1% of the average lifespan, the things that happen during that experience can really predetermine our potential for wellbeing throughout our lives. So by investing in this [00:08:00] period of development, we're actually, uh, benefiting, I think, the society as a whole. I love to hear you, uh, mention doulas, and that's, that's something actually that, uh, my wife and I have had some experience with in the birth of- Uh-huh ... at least two of our children. Um- Mm-hmm ... and to have that, uh, that moral support as well as someone who, who advocates and then, you know, in, in some cases it was home birth, in some cases it was at- Uh-huh the hospital, but, uh- Mm-hmm ... we had an advocate there to help us. It was... Yeah, look, I'm, I'm speaking from the dad's point of view. It took a lot of the stress off of me because, uh, I'm, you know, I'm trying to assist, but really all I can do is stand there and look concerned. But, uh, but the role of the doula is, is really something and, uh, and it makes me happy to hear that, to, that's something that, that's gaining, um, you know, more exposure and, and I would hope more acceptance. It is. Uh, as I indicated, over 40 states now have training and certification programs, and they are, they are covered by Medicaid. So, and the [00:09:00] majority of the births in America are paid for through Medicaid. So having the doula services there, and it's also expanding the workforce. You know, we just don't have enough, uh, diverse individuals in the healthcare workforce in a formalized way, and so certainly this is a way to expand that workforce. So that's exciting to hear that you and your wife had that service. Uh, it does, it does help really. And I, I also appreciate you framing, you know, that that period of time, you know, when, when a pregnancy is taking place and, and before the child is born, that, uh, that is a good... Uh, th- well, it's, it's, it's a small percentage of life, but it sets the stage in so many ways. Yeah. What would you say expectant parents need to know in order to help, uh, mitigate risks and to, to optimize the outcomes of their pregnancies? You know, I think the most important thing is to know that there is [00:10:00] love and support and care available. Um, with all of the focus on poor maternal and child outcomes at this point, too many women and families are really frightened, and one of the key messages I try to send is that be not afraid. Know that there is loving, supportive care available, and it, it is available usually in your local community. The other thing is to know that the wellbeing of the mother translates into the wellbeing, if you will, of the developing child, which means doing those things, those, those... They call them lifestyles, you know, but, but making sure that the food intake is healthy, it's optimal, staying away from ultra-processed foods. Exercise is critically important. Moderate, healthy exercise, like walking, you know? And also being [00:11:00] mindful that this is a, a very special time. Nothing more miraculous ever happens than the creation of a new life. And, and giving yourself the, the gift of, of the time and, uh, the reduced stress and anxiety to focus on this privilege of bearing new life. Talk to me about some of the, uh, allies that you have found along the way in, in moving forward. And I'm, I'm kinda looking back to the Momnibus, um, uh, you know, policies. Um, that's something that, that's a, that's a big, heavy rock to move. It is. Um, who have you found along the way that, that is helping to, to make that happen? I think the first thing I should say, which is really good news in these polarized times, this is a bipartisan effort. Uh, we had bipartisan support in Congress. Um, and the medical profession is right there, the nursing profession. Uh, it is a- [00:12:00] And certainly, you know, communities are stepping up. The, the faith communities are stepping up. I think there's a, a growing understanding that it is in our collective interests to do this, and it's just been, uh, a joy to see how many people are responding to the call. And, and for that matter, people who are hearing this podcast and wish to become more involved, let's talk a little bit about, uh, your organization, the National Collaborative for Health Equity. Um, are, are there ways that you, that people can, can get involved, either as, as volunteers or as donors? By all means. You know, the nationalcollaborative.org is certainly... You can visit our website. It's a robust site that, that talks about our work. Uh, we're coming up on the 20th anniversary of a commission that we s- we created, you know, two decades ago, uh, called The Courage to Love, and in it we called for comprehensive [00:13:00] approaches. And it's, it's really wonderful to be able to see the progress that's been made since that time and to know that we now have the collective momentum to make a, a real difference. So we certainly encourage, uh, donors. We encourage people to get involved in our programs. We have a leadership program where we support, uh, community leaders that are trying to close the gaps in terms of health and wellbeing. Uh, so definitely we would welcome engagement and support. And I'm just curious, are, is it ma- is this organization making inroads, um, across the country? Is, is it more regional at this point? We, we are national. We have, uh, representatives or leaders that have gone through our program from, I believe, every state right now. Uh, our principal funder of our work has been the Robert Wood Johnson Foundation, as well as the W.K. Kellogg Foundation, the de Beaumont Foundation. We partner with [00:14:00] the American Public Health Association, uh, and other organizations. So we work with community-based groups to advocate for and, and really help to generate the, the critical mass of support for change to improve the health and wellbeing. One final question for you, Dr. Christopher, and that is, if there, if there's a, a single idea that a, that a listener could take away from our conversation today that you would want to stick in their mind, what would that be? That we can collectively overcome this persistent challenge. Um, that it is a gift, this gift of life, and together we have made progress, and we will continue to make progress by creatively thinking and creatively working together. Again, the website is nationalcollaborative.org. We have been talking with Dr. Gail Christopher, [00:15:00] with the, uh, she's the executive director of the National Collaborative for Health Equity. And Dr. Christopher, thank you so much for joining us today on the Health Policy Podcast. It's been my pleasure. Thank you, Brian