Promoting Health Equity: Overcoming Implicit Bias in Public Health

May is Maternal Mental Health Month, a time dedicated to raising awareness about the intersectionality of motherhood and mental health. It serves as a reminder that behind the joy and anticipation of becoming a mother, there may also be hidden struggles and challenges that need to be acknowledged and addressed, like access to quality care, particularly for Black women.

Women of color frequently encounter healthcare providers who hold unconscious biases that impact the quality of care they receive. These biases can lead to misdiagnoses, inadequate pain management, dismissive attitudes, and a lack of culturally sensitive care. Such experiences jeopardize the physical health of women of color and erode their trust in the healthcare system.

In a recent report released by the CDC, 89% more women died from pregnancy-related issues in 2021 than in 2018. Black women are nearly 3 times more likely to die than White women and 2.5 times more likely than Hispanic women. The majority of these deaths were preventable.

In this episode of The New Mainstream podcast, Denise Evans, Principal, CEO & Founder of Consult Me, and Senior Learning & Development Specialist at Corewell Health, discusses the impact of implicit bias on Black maternal health and how to advance health equity in public health.

Meet Our Guest:

Denise Evans is a trained facilitator, public health educator, and Truth Racial Healing Transformation practitioner. She has specialized training in health equity and social justice, cultural intelligence, and unconscious/implicit bias, as well as technologies of participation facilitation. Denise serves as a content expert for the National Healthy Start Association and the National Institute for Children’s Health Quality and served the National Association of County & City Health Officials and state and local health departments on issues of equity, justice, bias, diversity, belonging and inclusion.

For the past 25 years, she has worked diligently to connect community organizers, faith-based organizations and public health professionals from New York City to Los Angeles in a collective effort to disrupt systems of oppression and build a more equitable future for those living in our nation’s most vulnerable communities. Ms. Evans is a two-time past chair of Spectrum Health’s (now Corewell Health) System Inclusion Council and a founding member of the Greater Grand Rapids Racial Equity Network.

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Honoring the Fallen: Government Agencies Must Leverage Data to Strengthen Veterans' Mental Health

Memorial Day is a federal holiday intended to pay respect to our country's fallen heroes. However, for many, Memorial Day is a personal experience that lasts longer than 24 hours and is much more than a BBQ and pool party.

My Memorial Day began at 9 pm ET on May 5th, 2006, with a satellite phone call from my husband, a Team Leader in the Army deployed to Hillah, Iraq. He said, "Hey babe, the worst happened today." I am an Army Veteran, so I knew exactly what that meant.

The Battalion was due home in less than a week. They had received their campaign medals, and unit and team photos were taken. Back home, family and friends were getting ready to celebrate their return to Fort Bragg with "welcome home banners."

My husband's replacement, Captain M (using initials for family privacy), arrived in the country and was briefed on the current efforts in and around Hillah. Captain M asked if he could borrow the Team to take him "out of the wire" and show him their area of operation. They mounted up in their HMMVVs, leaving my husband behind. For 30 minutes, he listened in horror over the radio as his Team Sergeant, Master Sergeant S, ran over an IED and called for medivacs. My husband and another officer took off to the blast site and saw his team sergeant being loaded into a Blackhawk helicopter. Master Sergeant S bled out on the way to the CASH (combat hospital). Two others died instantly. Captain M was flown to Germany expecting to survive but later succumbed to his injuries.

What struck me the most was that these mothers and wives I knew and grew close to would have a government official or Army Chaplain knock on their doors within the next 4-24 hours to be told their soldier had been killed. Moreso, these mothers and wives would receive Mother's Day Cards and flowers a few days later as they laid their sons and husbands to rest. I would meet them in Arlington at section 60, but only after I returned from Fort Bragg to help as my husband escorted their personal effects to Mortuary Affairs.

As the soldiers, loaded with all their gear, walked off the plane into the "Green Ramp," I desperately searched for my husband. They were all battle-worn, solemn, and still in shock. They weren't greeted with cheers or celebrations, only tears, hugs, and a sudden realization that, as Army Reservists, they would go home to familiar strangers and weren't particularly ready to pretend that the last few days had never happened. Yet, the bond of these brothers and sisters who had just spent twelve months in battle would not be broken.

My family and I would hike down from Fort Myer every Memorial Day in Section 60 in Arlington Cemetery and lay flowers on three friends laid to rest there. We could tell others had also visited by small personal items left on the headstones. As the years passed and the conflict continued overseas, Section 60 became the final resting place for over 900 servicemembers.

Veterans are underresourced

In total, we lost 7,057 U.S. military service members in the wars in Iraq and Afghanistan. I wish I could say that was the end of that sad statistic, but it's not. Over 30,000 active-duty personnel and veterans who served in the post 9/11 wars have since died by suicide and about 76 percent of U.S. veteran and active service survey respondents in a recent study report having experienced post-traumatic stress disorder (PTSD) as a result of their military service after 9/11.

While the Department of Veterans Affairs (VA) is responsible for providing healthcare and other services to veterans, many veterans have reported difficulties accessing the help they need. Veterans are sometimes turned away from VA hospitals or clinics because their needs aren't deemed urgent, whereas others struggle to obtain appointments for care due to a shortage of mental health professionals. Burdened by red tape, many veterans no longer have the fight to tackle the bureaucracy obstructing access to mental health care.

Data-driven wraparound services for veterans are needed

The VA has made efforts to address these issues by increasing funding for mental health services and hiring more mental health professionals. However, more must be done to ensure veterans have access to the care they need. This could include expanding the number of VA facilities and mental health professionals, conducting continuous market research surveys among veterans to gauge whether they can access the services they need and the effectiveness of those services, and increasing awareness about the importance of seeking treatment for mental health conditions. Equally as important is dismantling the stigma around mental health, particularly for men and minorities, who frequently encounter societal biases about seeking care.

The sacrifices made by these veterans should not go unrecognized, and we owe it to them to ensure they receive the care and support they need to live healthy and fulfilling lives. (If you're a veteran experiencing a mental health crisis or concerned about one, qualified responders at the Veterans Crisis Line can help. Click the link or dial 988 and press 1.)

Never Forget

May 25th is when I turn off the news and social media and tune out all the world's nonsense. I think of a young man or woman's sacrifice and those who grieved over their loss. I think of the Gold Star families and the service members who made it home but are still lost in that moment in battle. It's a day that I put aside all personal struggles, gains, and aspirations of the future and think of our fallen heroes that died in a battle far away from home to protect our nation's peace.

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The End of COVID-era SNAP Benefits is Impacting Vulnerable Communities

What’s Happening?

As a result of the COVID-19 pandemic, Congress added emergency funds to the Supplemental Nutrition Assistance Program (SNAP) to help families facing food insecurity resulting from the economic slowdown. That emergency funding ran out at the end of February 2023. This means that around 30 million Americans will receive less money in their EBT cards at a time when inflation is wreaking havoc on food prices. The end of enhanced SNAP benefits is compounded by the concurrent end of other relief programs that helped with housing and healthcare costs.

Who’s Affected?

Some states had already stopped the enhanced COVID benefits, but SNAP recipients in 32 states, Washington D.C., Guam and the U.S. Virgin Islands will see their benefits reduced this month. The enhanced benefits gave participants the maximum allowable benefit if they qualified for SNAP. The change will bring participants back to amounts tied to household income and will average about $6 per day per person. The steepest decrease will hit individuals who, during COVID, qualified for the minimum SNAP benefit and were receiving $281 per month and will now only see a benefit of $23. Since the reductions are per person in the household, larger households will see bigger overall reductions. Seniors on Social Security may be surprised to learn that the recent 8.7% cost of living increase counts towards their SNAP eligibility and reduces benefits further. Sixty-five percent of SNAP participants are households with children and one in three food stamp households is headed by an African American. The reduction will, therefore, be disproportionately felt in low-income communities of color.

Lack of Information

While the Biden administration is scheduled to declare the end of the COVID pandemic on May 11, 2023, the SNAP program expired on February 28th because Congress passed the Consolidated Appropriations Act which revamped that program. Many recipients, however, are unaware of, or don’t understand, the changes they’ll see in their March benefits. The different deadlines for the end of COVID era benefits add to the confusion. This will likely lead to families being caught off-guard by the reductions, leaving them scrambling to fill the hole in their food budgets.

Who’s Picking Up the Slack?

A 2019 study found that families whose SNAP benefits were reduced or cut off were more likely to experience food, healthcare and energy insecurity. Affected individuals must now turn to state and county agencies and nonprofits to make ends meet. Some states, like New Jersey, passed legislation to increase state-level food assistance, but most have not. This will force most affected individuals to lean on food banks already struggling due to the recent inflation-fueled rise in food costs and lower-than-expected donations.

Next Steps for SNAP

Ideally, the SNAP reductions would have been made more gradually. That said, some steps should be taken to reduce the impact. The Federal Government has an opportunity to address SNAP benefits in the upcoming Farm Bill, and states that have yet to pass legislation to fill the shortage can either address food insecurity directly or consider how reduced SNAP funds are affecting household budgets when discussing housing and healthcare subsidies. Hunger and poor nutrition don’t exist in isolation, and there will be increased societal costs if they aren’t mitigated.

The plight of hungry Americans isn’t always visible to those in a position to help. In addition to passing emergency funding, there needs to be increased awareness of the problem among Americans who may be able to donate to their local food banks and among businesses who can direct their 2023 charitable giving to non-profits tackling hunger.

State and federal agencies should also better communicate available services to people in need through outdoor, online, radio and television PSAs. There is a silver lining in that the Consolidated Appropriations Act added funds for summer nutrition to the National School Lunch Program. Vulnerable kids will at least be able to rely on those meals. Ideally, seniors and others affected will also get the help they need.

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Black Americans are Savvy About Health and Wellness

Black Americans have historically had a strained relationship with the U.S. healthcare system. Insufficient access to quality care and affordable medication, negative health outcomes, and inadequate cultural competency have defined healthcare delivery for People of Color for many years. How Black Americans view their own health, however, differs. To gain a deeper understanding of Black Americans' views on health and well-being, ThinkNow and Quantasy + Associates conducted a multi-wave study on the current state of Black Americans. This wave's findings suggest Black health is more encouraging than the prevailing narrative implies.


While the disparities mentioned above are real, and the rate of uninsured Black adults is slightly higher than the general population, they are more likely to say they have the support they need to manage their health than non-Blacks (73% vs. 70%). In fact, Black Americans rate their current state of health on par with non-Black Americans. Seventy-nine percent believe their state of health is good compared to 76% of non-Blacks. Black Americans are also more likely to claim that being healthy is something they're intentional about, with 72% stating that being healthy is something they work hard at compared to 66% of non-blacks. Being healthy was also more likely to be mentioned as a life goal in this community, and that desire increases with education and income.

Natural Remedies

Black communities have strong cultural traditions of healing and wellness. The use of alternative and complementary medicine is popular regardless of income or health coverage status. When given a choice, 57% of Blacks prefer to use natural remedies over prescription medication compared to 49% of non-Blacks. This does not mean, however, that they aren't aware of prescription drug options since 63% state they pay attention to advertising about health and medications compared to 52% of non-Blacks.


Black men have some of the worst health indicators among racial and ethnic groups in America. They don't, however, view their own health negatively. Their positive attitude may be counter-productive since they're less likely to visit doctors than Black women. Fifty-three percent of Black men state that they only see doctors when they're sick vs. 43% of Black women. They are also more likely to state that good health runs in their family (57%) than Black women (38%). This optimism may influence their decisions on whether to seek the preventive or early care needed to improve health outcomes.

Mental Health

Black Americans are prioritizing their mental and emotional well-being. They are more likely than non-Blacks to "completely agree" that mental health is a significant part of overall health (58% vs. 50%), and Black women are especially attuned to the importance of mental health with 63% in complete agreement that it's significant. There also appears to be less stigma in seeking medical help for mental health issues with 48% of Black respondents stating they're comfortable doing so vs. 42% of Whites, 36% of Hispanics and 27% of Asians. Additionally, Blacks are more likely to state they know what they need to do to stay mentally healthy than non-Blacks.

Diet and Exercise

Black Americans are on par with other segments in understanding the components of a healthy diet. Seventy-seven percent choose fruits and vegetables when looking for healthy food, which is the same percentage as non-Blacks. They are slightly less likely to go for 'low sugar or sugar-free' products, but they shift to this more with age. Younger generations were more inclined to look for fortified, keto or high protein, low carb, and plant-based/vegan products. Rates of exercise were also similar to non-Blacks though they are slightly less likely to do cardio exercise and slightly more likely to engage in team or competitive sports.


Despite prevailing systemic obstacles, the Black community is taking ownership of its health outcomes and seeking to stay healthy. Black Americans increasingly rely on natural and plant-based approaches to wellness, prioritizing mindfulness and valuing mental and spiritual well-being. Marketing to this segment should be grounded in these truths and focused on preserving health, which aligns with Black Americans' optimism, as much as preventing and treating illness. By listening to and embracing Black voices, we take a positive step toward achieving health equity in the U.S. that serves the entire community's needs.

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FinTech's Impact on Private Practice Growth

According to a 2020 study by the American Medical Association, fewer clinicians are starting their own practices and instead seeking jobs at hospitals or larger medical groups. The economic fallout of the pandemic hit private practices hard, and many are still struggling to get patients back into the office. Some clinicians are willing to forgo autonomy in favor of the paycheck security and benefits hospitals provide, particularly Black and Latino individuals, who may graduate with more debt and less support than their White counterparts.

Fintech innovations enable minority clinicians to reimagine private practice and use it as a means to return to their communities to start, scale, and sustain these small businesses and improve health outcomes in their communities.

Ease is an all-in-one financial practice operations platform that helps clinicians build new practices online in minutes, offering the first and only corporate card for private practices and other automated financial systems.

In this episode of The New Mainstream podcast, Mario Amaro, Founder and CEO of Ease, discusses how fintech can help clinicians accelerate the growth of their private practices and provide equitable healthcare.

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Advancing Latino Health Equity Through Community Health Workers

The patient journey starts with vulnerability. There is a need yet all too often within minority communities, that need isn’t met with adequate resources. Latinos, in particular, face several obstacles to accessing health care, from difficulties finding information in their native language to a shortage of Latino or bilingual doctors. Additionally, lack of transportation and reluctance to take time off work, alongside the fear of deportation for undocumented Latinos, further exacerbate the problem. As a consequence, some Latinos forgo care, and that decision could prove fatal.

To address these barriers and improve health outcomes for Latinos, it’s essential to understand their patient journey and identify the friction points, one being the lack of community navigators. Community navigators, more commonly known as community health workers, are the bridge between the healthcare system and patient care. Community health workers are essential to underserved communities as they attempt to simplify and demystify the complex systems that have historically ignored the needs of minority communities.

In Latino communities, these navigators are known as promotores de salud (promotoras). Promotoras play a critical role in educating Latinos and directing them to resources, like primary care physicians, which is in stark contrast to them relying on informal information sources like social media or family. These individuals, seen as trusted messengers, are often Latino and understand the plight of Latino families and make recommendations that align with the Latino lifestyle in efforts to close the health equity gap.

Zócalo Health has its finger on the pulse of Latino health care and champions the use of promotoras. Through its innovative virtual-first family medicine service for Latinos, it’s committed to helping remove barriers to healthcare by offering convenient, transparent, and culturally-aligned care to members.

In this episode of The New Mainstream podcast, Mariza Hardin, Co-Founder, Head of Strategy and Operations, and Erik Cardenas, Co-Founder, CEO of Zócalo Health, share the importance of promotoras (community health workers) in improving health care outcomes for Latino communities.

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Caregiving: Parenting A Medically Fragile Special Needs Child

Notes from the trenches

You may wonder why I'm publishing this article on this platform. It's a fair question that I'm not sure I have a simple answer for. In part, it is a bit therapeutic for me. As a sales and marketing professional, it’s also an opportunity to raise a flag. I've found that the media and brands in general are becoming more sensitive to the challenges of disabled individuals. Yet, they’re overlooking the challenges of the parents and extended families who are caretakers for loved ones with severe disabilities.

In honor of Disability Pride Month, I hope that sharing my experience will help others who find themselves in similar circumstances or prompt more research into ways society can help alleviate some of the burdens faced by parents of children with extreme special needs.

My Story

I am a proud father to a special needs boy born with Dandy Walker Syndrome. If you are not familiar with his condition, you are not alone. It's a fairly rare condition that affects about 1 in 25,000 children. Dandy Walker is a cerebellum malformation diagnosed or developed at birth or within the first year. The effects of the syndrome can range from mild to severe developmental delays to impairment of intellectual growth and gross motor skills. Other abnormalities and conditions often present with Dandy Walker, such as heart defects, malformations of the urogenital tract, extra or fused fingers and toes, abnormal facial features, vision and sight issues and potential seizures.

Our son was diagnosed with Dandy Walker and a missing corpus callosum (the connective tissue of your right and left side of your brain) as well as a partial cleft palate. It was not the trifecta you wanted to hear upon your son's birth. In fact, his condition was a complete surprise to us. During the pregnancy, the doctor missed signs of the disorder in check-ups and tests.

That said, I think back on that and realize it was a blessing in disguise. We were able to celebrate our pregnancy with no knowledge of a pending issue which would have caused incredible stress on both myself and my wife not to mention questions of what to do or not do in terms of carrying on. Upon birth we were faced with the very real situation of his condition but even then, we didn't have a full grasp on how challenging his condition would be for him and our family.

Our doctor told us in that moment that our son may never be able to hold his head up and that the road ahead would be difficult. But we knew we were all in for our son the moment we laid eyes on him.

A Dearth of Research

There are an estimated 5.9 million children with severe disabilities in the U.S. and most of them are cared for at home by their parents. Interestingly, there isn't a lot of research on families regarding special needs and even less so around the more medically fragile. I was able to find research on caregivers of older people and adults with disabilities and it shows that caregiving can take a mental and physical toll. "A substantial body of research shows that family members who provide care to individuals with chronic or disabling conditions are themselves at risk. Emotional, mental, and physical health problems arise from complex caregiving situations and the strains of caring for frail or disabled relatives."

The research that specifically addresses parenting special needs children seems to focus on divorce rates. Some reports cite high levels of divorce, while others state the research is inconclusive. I can tell you from first-hand experience it is not an easy life. My anecdotal observation is a strong family unit is key, and sharing responsibilities for care is a must.

Caretaking for the most medically fragile is both mentally and physically draining. The road will never be easy, and without progress in the child’s developmental skills, that road will get significantly harder as your child grows. Basic tasks like taking a bath will become even more challenging.

Tools and resources to help do exist. However, getting access to them is in and of itself a complicated and challenging endeavor. Early on, I was given great advice: to start tapping into resources as soon as possible as it will take a long time to get approved. I was also advised to work with our doctors to ensure our son's diagnosis was properly reported and to get all paperwork filled out quickly. Local and state agencies are often understaffed, so any questions or errors will lead to delays in getting help.

Even once you are accepted or approved for services you will still face an uphill battle for retaining them or justifying their existence for your child in the future. I understand that some additional steps are necessary to mitigate the risk of fraud, but it can be frustrating nonetheless.

Challenges for Caregivers

Hopefully, you now have services set up and potentially some kind of respite via caretakers, so everything should be OK, right? Not so fast. That is just part of the hurdle. Another large challenge is your own mental state. In my opinion, this is the aspect of special needs that is not addressed. I couldn't find data specific to caring for special needs children, but the AARP Public Policy Institute conducted research that shows that nearly 40% of caregivers of family members experience emotional stress from caregiving.


The impact on mental health for those caring for loved ones in extreme situations can manifest in several ways.

  • A prisoner to your home – That feeling that you can't leave your child alone in the care of others. I have both experienced this notion and seen it with other families. Even when you can have a respite care worker come into the home to relieve you, a trust factor comes into play. I found this incredibly hard my first time. I felt immense guilt and fear that something could go wrong and my not being there could tip the scales toward catastrophic results.
  • Going out as a family – It should be just a normal thing, and to a degree, it is. We are fearless in that we will go and do anything with our son (within reason, of course). However, you will "feel" the looks and the stares. It's unavoidable and another obstacle to overcome. The moment you are in the public eye there is always someone who will look a little bit longer or a child who stares out of curiosity. There is no age range to this, and I don't hold ill will as I understand at a basic level this is a natural reaction we humans have to things we don't understand or are not used to. Even with that understanding, you will still feel like you are in a fishbowl, and if you are sensitive to that, it can potentially drive you back to the safety of your home or your vehicle to escape prying eyes.
  • Traveling – One of the hardest things to do as a family. Now, don't get me wrong, I don't think I have ever encountered a company that didn't try and make our experience better. I am always appreciative of that, but the major hurdles often come from some fundamental things like food. If you are like us, you can't count on being able to find food that is suitable for your child on the road (Brutal reality check, not everyone has Mac & Cheese on their menu!). Also, keeping your child comfortable in situations like flying, which isn't exactly comfortable in the best of situations. There is one other major aspect that I'll cover in the next bullet point.
  • Toileting – If you have a potty-trained special needs child, I am 100% envious. Our son sadly is not, so we rely on diapers to meet his incontinence needs. Early on this was not an issue until around age five. After that, this is likely your number one nightmare scenario as a special needs parent. Diapers are great until it goes beyond wetting. Picture you with a seven-year-old who has soiled himself early on during a flight. Do you just let it go and have them stay in their dirty diaper? As a parent and human being, that’s the last thing you would want to do. Now the challenge, what do you do?I attempted a changing with my son in an airplane bathroom one time, and it was the first and last time I tried that. Being 5' 11 and 215 lbs., I barely fit into an airplane bathroom as is but somehow thought I could pull it off. I think I managed to make it worse than it was. Looking back on this I can laugh as it feels like I lived an episode of I Love Lucy with everything that could go wrong, going wrong.

    The same challenges are there in other public spaces. Accessible stalls, while great, are still not going to be the right fit for trying to change a diaper on a child that is older than five. Not to mention that the accessible stall seems to be coveted by practically everyone who "wants more space" for when they go to the restroom but somehow forget how to be clean about doing so.

How to Make Things Better

Above is just a small portion of the challenges parents of special needs kids face. These things and countless others like education pile up over time. It all can lead to unbearable stress on the family unit. How do we help? I don't have a magic bullet or plan. I am in the trenches every day, and I often can't see past what is in front of me. But if I had to put a few at the top of my list, I would say:

  • Tandem shopping carts are a huge game changer for a special needs family. I first encountered these carts in a Target in Florida and have since used them locally at Target and Safeway. If you are unfamiliar, these carts have a large seat built into a cart specifically designed to allow someone with a disability to be in the cart with you as you shop. This should be a no-brainer for every retail store that needs shopping carts.
  • Better restrooms and changing tables in the disability restrooms designed to be more than just a changing table for infants that are 4-feet high and can only bear 20+lbs. While we are at it, let's bring back the bigger bathrooms in future airplanes. Not one person on the planet thinks the current smaller form factor bathrooms are a good design, and I can guarantee every special needs caretaker would welcome this change.

If you are still here reading, I thank you for reading through what seems to be a bit of a rant and, again, certainly therapeutic for me. I feel a bit selfish in writing this. My burden isn't your burden, and no doubt you have your own, so please accept my apology and thanks. I guess I have heard so many times the phrase "I can't imagine what it's like" that I thought just maybe I could help paint that picture for those who, at some point in their mind or out loud said, "I can't imagine what it's like to be in your situation."

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