HJAR May/Jun 2023

PUBLIC HEALTH AND MEDICINE 26 MAY / JUN 2023 I  HEALTHCARE JOURNAL OF ARKANSAS community about risks, how to protect yourself, and what to look for. And I don’t know if it’s that I’m an ER doc or in public health, but I think in both, you learn to be versatile. And so, when COVID hit, we were able to use this system to do the same thing to monitor exposures. We looked at COVID during pregnancy and were able to use this to inform clinical changes — things like if a mom had COVID 14 days prior to delivery, they were less likely to have the infant room-in with them and then had breastfeeding difficulties. They needed lactation services. Thinking about that early on to address it. We also saw that if you had COVID in your second or third trimester, you were about four times more likely to have a preterm delivery than those with a mild infection. Really, really stress- ing the importance of COVID vaccination in pregnancy, which was one of the under- vaccinated populations that we were seeing. Just last week, we released our new dashboard on maternal mortality. One of the things we’re trying to do is much more provisional data so that it’s more timely. Unfortunately, we’re seeing that disparities are still occurring, and maternal mortality is still a significant issue in the U.S. About 700 moms die a year in the U.S. We are working with state teams, called “perinatal quality collaboratives,” in about 39 states now — working with nurses, physicians, health- care systems — to identify how you can have more quality care and each group identi- fies different initiatives that they can focus on. One example in New England was they looked at both opioid use disorder and also breastfeeding and they found that they were able to increase counseling by 20% as well as naloxone use and distribution by about 25% in these groups. And then the “Hear Her” campaign, for me, was pretty personal. I lost one of my staff a few years ago. She was a brilliant, up-and-coming African American PhD — a scientist that worked for me. She died a few weeks after giving birth, and she fit all of those warning signs. She’d been to the hospital, she’d been back, she was having complications. And when you look at the data, race is what’s driving a lot of this. You separate socioeconomics ... Shalon, was well-educated. She had a good social sup- port system, but she died. So, we’re trying to do more of these Hear Her campaigns to, when you have these warning signs, get clinicians to really listen and for women to feel empowered to say, “I’m having these symptoms.” We need much more aware- ness of what’s going on because, again, maternal mortality for our country is a staggering number of deaths that we should be preventing. And, I promise there’s happy stuff at the end; I don’t want to appear unoptimistic about all of this. Climate and health is one of those things where I kept thinking, “This is abstract, this is environmental, what do we do about it?” And there’s so much that we need to know about it from the healthcare field. There are about 700 heat related deaths a year now. And as we’re seeing these climate changes, there’s a lot that we can do. Hot weather is associated with an increase in heat related illness, but also cardiovascular and respira- tory complications, renal failure, impacts on fetal health and preterm birth. We can do things like making sure that when there are more of these extreme heat events, we have cooling centers and water sites, and also have heat health alert systems. We’ve seen several states now change the number and the temperature to be able to issue these on a more regular basis. This just shows many other areas that are now being impacted by climate and health. The two that really strike me are in Geor- gia, nowwe might see Lyme disease because we’re seeing a lot of these pathogens change because of the temperatures. Similarly, there are now a lot more harmful algal blooms Image 2 More Information: CDC Vital Signs: Adverse Childhood Experiences (ACEs). https://www.cdc.gov/vitalsigns/aces/index.html