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.

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.

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.

Optimism

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.

Gender

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.

Conclusion

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.

ThinkNow recently fielded a comprehensive quantitative study that compared attitudes and behaviors related to health and wellness among minority groups. After reviewing the survey results, I assumed I would write a blog about mental health issues impacting Black or Hispanic Americans. While there were certainly findings that I could have written about among those groups, the results that really struck me were specific to Asian Americans. The Asian American narrative usually revolves around the model minority myth promoting positive stories about education and financial success. However, mental health in the Asian community does not get as much press. The findings were eye-opening.

Statistically, Asian Americans are doing well collectively when it comes to educational and financial attainment. However, our data shows they lag other ethnic groups in seeking mental health services when needed.

Cultural Barriers

Seeking help for oneself runs contrary to the collectivist ideal in Asian culture of placing the needs of others and society before one’s own. This is true in both East and South Asian cultures. The belief is so ingrained that some segments of the Asian American community, especially the foreign-born, don’t have the language to discuss mental health issues. They, instead, think of mental ailments as a physical condition without considering possible psychosocial origins. The concept of mental health was developed in the U.S. and Europe and mainly used western cultural concepts in diagnosis and treatment. The lack of connection to mental health awareness shows up in the data where most Asian Americans surveyed stated not perceiving mental health as a significant contributor to overall health and well-being.

Even when they recognize they might need help with mental health issues, Asian Americans are less likely to feel comfortable seeking that help.

The Dark Side of The Model Majority Myth

Suicide is the leading cause of death among Asian American young adults ages 15-24. Asian youth can become overwhelmed by the expectations to succeed. Although the model majority myth may have its origins in Asian immigrants’ desire to succeed in the U.S., it is perpetuated in mainstream culture by teachers, business leaders, comedians, and the media. Asian students may perceive struggling with school pressures as letting both their parents and society down. Without good examples of what self-care looks like, fewer than 20% of Asian Americans know what to do to keep themselves mentally healthy.

Culturally Appropriate Support

Since fewer Asian Americans currently seek mental healthcare compared to other groups, they are less likely to see other people like them in places that could help them, such as student health centers or clinics. This inadvertently confirms their belief that they don’t belong there. Recognizing this disparity is the first step toward creating inviting spaces for Asian Americans to seek mental health services. Language is not as much of an issue for Asian youth but is a real barrier for older, foreign-born groups. Having in-language material and resources available can be lifesaving.

Training healthcare providers to recognize the additional barriers their Asian American patients may be experiencing can also help increase the uptake of services in this demographic group. Healthcare workers must be culturally competent, understanding the nuances impacting their Asian American patients’ decisions.

How We Can All Help

The model minority myth requires society at large to perpetuate it. Reflecting on our beliefs about what a scientist, artist or carpenter looks like can help open more doors for Asian Americans struggling to conform to certain ideals. Also, asking Asian Americans “where they’re from” is still far too common. What seems like an innocent question to get to know one better actually “others” that person for it makes assumptions about what an American should look like.

Finally, normalizing mental healthcare as something everyone in society can benefit from is vital. By sharing our own challenges, we can inspire Americans of all ethnic backgrounds to accept mental healthcare as an integral part of a well-rounded healthcare routine.

I am co-owner of a successful marketing research company that employs 45 people across the US, India, Ecuador, and Mexico. When I started ThinkNow with my business partner, Mario X. Carrasco, in 2011, I thought I needed to project a certain strength to inspire my employees and give them confidence in our leadership. Back then, most of my social media content focused on the firm’s achievements but very little on personal subjects like work/life balance.

A decade of business ownership and the past two years of the pandemic have taught me that leadership is more than projecting strength. Or rather, what is commonly considered to be strength. Over the years, I’ve found that empathy and vulnerability are in many ways stronger than the “grit” we’ve been conditioned to emulate. I’ve learned these lessons the hard way. I often worked 12-hour days early in my career and sometimes worked 36 hours straight. For the first couple of years after starting my firm, I worked seven days a week without taking a vacation. In retrospect, I see that much of my work was a thinly veiled attempt to run from my emotions.

Let me explain. At age 27, while working at Warner Bros., I lost my 60-year-old father to suicide. I knew he was depressed, so a couple of days before he died, I called him from work to see how he was doing. His response was to ask why I was wasting company time on a personal phone call and that I should get back to work. I wasn’t surprised since I had watched him put work and achievement before his physical and mental health his whole life. I wish I could say that I resolved then and there to put myself first, but the work habits I was taught were too ingrained. I spent the next 20 years burying myself in work to avoid the crippling anxiety I felt when I stopped.

Around four years ago, however, something changed. I was sitting alone in the stands at my daughter’s high school homecoming football game and realized I was intensely lonely. The decades of putting work first while neglecting friends and family had taken their toll. Within a few weeks of that evening, I was in therapy, had joined a men’s group and started making more time for family. I also resolved to bring my whole self to work and encourage my employees to do the same. That means we treat each other as human beings first, co-workers second. If someone has health or family obligations, we work around them. If they’ve experienced a personal tragedy, we create space for them to heal.

Interestingly, treating people like people instead of machines improves the quality of our work. I recently heard Wendy York, the College of Business Dean at Clemson University, summarize this idea as, “If you create a trusting environment, you create an innovative environment, and when you let people come to work as their whole selves they bring all sorts of talents, skills and passions.” We’ve seen this firsthand at ThinkNow. Many of our most successful products and services started as an idea that someone felt safe enough to share. Ideas need space to develop, and we give each other that space by listening to each other’s needs and making room for them. We have employees who work from home, some who live in motor homes and some who travel from country to country. Each of those options is the best for them, so it’s the best one for us.

Last month, I took a two-week vacation completely disconnected from e-mail and screens. I spent most of that time in the Peruvian Amazon. That’s not something I would have allowed myself to do four years ago. I did it because I recognized that I needed it. The pandemic has been wearing, and I knew that unless I recharged my batteries, I wouldn’t be able to contribute my whole self at home, with my friends or at work.

As Americans, we often don’t take vacations in fear that the work will suffer. As a business owner, I’m here to say that the work suffers if we don’t take vacations. I want our employees to know that I don’t judge them for taking vacations. It makes me happy to know that someone from my team is in Belize or Italy since I know they’ll be in a better headspace when they return.

These lessons came to me too late to share with my father. Hopefully, putting it out there now and normalizing the fact that we are humans with needs, not “workers,” will help someone turn off their work screens and turn their attention to themselves, friends and loved ones. The work will be there tomorrow. Your physical and mental health, friends and loved ones may not.