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- 9 - accessHealthNews.net August 2022 Volume 8 | Issue No. 60 A lthough social determinants of health (SDOH) are widely recognized as a potent influence on health outcomes, dissecting every variable that contributes to SDOH is a gargantuan task. It is impossible to fully account for SDOH without fully understanding all of its component parts. The barriers posed by SDOH are not without answers. The people most directly impacted by a problem have the most comprehensive insight into its nuances and solutions. Operating from this position is the Black Mamas Matter Alliance (BMMA), an organization dedicated to the health, wellness, and rights of Black birthing people which often brings together experts to discuss SDOH and relevant information. (The term "Black mamas," as BMMA uses it, encompasses all people of African descent across the diaspora, including trans and gender-nonconforming people.) Birth Justice Jamarah Amani of the Southern Birth Justice Network spoke about birth justice. "Discourse regarding health equity is ultimately a discourse about bodies," said Amani, quoting Dr. Camara Jones. "It necessitates analysis of power dynamics that have historically patterned and continue to shape our health experiences, exposures, and opportunities." The root causes of health disparity trace back to quality of care within the health care system, access to health care, especially preventative care, and other differences in SDOH. Black mamas' intersecting identities of gender and race compound the barriers they face, especially where culturally and racially appropriate care is concerned. "Having conversations about improving health that doesn't involve how we impact and increase people's power is an incomplete conversation," said Amani, and acknowledging that connection is critical in order to have a responsible conversation. Health disparities are the result of power disparities, or "the observable and unobservable differences in access, opportunity, and participation." Power, in this sense, is not something an individual holds, but is spread across the collective of a community and codified in SDOH and societal institutions, such as the health care system. Factors that contribute to this disparity are often classic examples of SDOH, such as lack of access to care, substandard care, lack of education about options, complications, and baseline health that would empower people to make informed health decisions for themselves, and culturally inappropriate care. Other factors may seem less obvious, like the chronic stress of racism, institutional bureaucracy that hinders access, previous birth trauma, and other identity-related oppression. "Structural and institutional racism are pre-existing conditions, and we really need to talk about them in this way," said Amani. "We're seeing that right now with the coronavirus pandemic and how it's disproportionately impacting Black folks, and that is 100% because of structural and institutional racism. Black maternal mortality is the same." The root causes of Black maternal mortality also include the white privilege encoded in the education of health care providers. The child welfare and health care systems still operate on the 1965 Moynihan report, which blamed Black women for their social and economic status. Moynihan's report was written from a worldview wherein a traditional nuclear family structure was necessary, with men as breadwinners and women tending to the home. Though many people lauded the report and its author as a champion of hard truths, the report is cited more often than it is actually read, and the realities of its message — and the policy and institutions built upon it — simply condemn Black families for the crises they face. Pathologizing Black women's bodies and lives became standard, and Black people's lives and bodies are still only treated as valuable insofar as they serve capitalism, rather than inherently valuable as people. "These are inalienable rights, these are human rights, these are natural-given rights. Just the fact that we live and breathe means that we should be able to have our values, our culture, our identity, our Blackness, our right to safety from violence, our families, our support networks, respected. We should never have to surrender our bodies to the system." - Jamarah Amani READ MORE

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