BUSM Alumna Honored for Career in Public Health

Humanitarian Award Recipient Discusses Health Outcomes of Black Women

BUSM alumnus Dr. Cheryl Scott is the recipient of the BUSM Humanitarian Award.

The Boston University School of Medicine (BUSM) Alumni Association honored Cheryl Scott, MD, MPH (BUSM‘82) with the 2018 Humanitarian Award for her outstanding work in public health both in the United States and abroad.

During her 20 years as a United States Public Health Service (USPHS) Medical Officer with the Centers for Disease Control and Prevention (CDC), Dr. Scott helped shape maternal and child health state and national policies, contributed to building a global prevention, treatment and care infrastructure for HIV/AIDS, provided leadership to interrupt transmission of multidrug-resistant tuberculosis, and responded to multiple disasters throughout the world.

In describing her career, Dr. Scott said she saw public health as, “an opportunity to help people get to a point where they can capably address their public health issues, and also help individuals and communities to maintain their dignity.” Dr. Scott commended the work of the Black Women’s Health Study, which has been collecting health data on black women from its home at Boston University for 23 years, as a critical source that has enhanced our understanding of the unique health challenges and disparities faced by African-American women. “My goal for today is to make you a little more aware of what’s going on right now, in black women’s health.”

More than 70 students, faculty and friends gathered in Hiebert Lounge Sept. 19 to hear Dr. Scott lecture on the health disparities of black women, the research that has established a framework for U.S. maternal and infant mortality, and the growing body of literature that examines the important role of racism and chronic stress in the rising rates of maternal and infant death among African-American women.

Dr. Scott’s lecture highlighted selected health disparities of black women including diabetes, HIV, obesity, hypertension, fibroids, life expectancy, breast cancer and mortality. According to the research, breast cancer mortality rates are 43 percent higher among black women than they are for white women. Dr. Scott noted, “African-American women are twice as likely to get diabetes, and life expectancy for African-American women is three years less than it is for white women.”

According to the most recent CDC data, “Black infants in America are now more than twice as likely to die within the first year of life as white infants,” said Dr. Scott. During 2006-2016, infants born to black mothers experienced the highest rates of infant mortality among all racial/ethnic groups, and the percentage of low birthweight was more than twice as high for black as compared to white infants. Preterm births, one of the leading causes of infant mortality, is approximately 50 percent higher among black women than among white women.

Dr. Scott noted that maternal mortality is rising sharply in the U.S. as it declines steadily in similarly-rich countries, including the United Kingdom, Germany, France, and Canada. An increase in maternal deaths is extremely rare among rich countries. America’s current rate has put it above several poorer countries even, whose rates had declined with the global trend. However, while our African-American pregnancy-related mortality experience contributes to this bleak picture, it is not the only driver. Maternal mortality research has identified associated problems of hypertension, obesity other cardiovascular and chronic disease.

Dr. Scott also discussed the growing acceptance by and continuing research from the medical and public health community, on the impact of systemic racism on rising rates of infant and maternal mortality, preterm delivery, low birthweight and preeclampsia among African-American women. Such inescapable and comprehensive social structures appear to create a type of toxic, maladaptive physiologic stress and allostatic load that leads to adverse birth and pregnancy outcomes – and physiologically and prematurely wears down African-American women. This is also referred to as “weathering.” Several recent maternal deaths and near deaths of public figures have prompted articles in the popular media about the experiences of African-American women interfacing with medical establishments, and prompted public figures to speak out about health inequities experienced by and maternal health crisis faced by black women.

“It’s still unequal treatment for African-American women giving birth,” said Dr. Scott.

Additionally, what in the past has been preventive for adverse outcomes appears not so currently. Education and higher incomes do not have the expected “protective” effect seen with outcomes of other groups, when observed among pregnant black women. In fact, several research studies in her presentation corroborate earlier works that found higher educational attainment among African-American women to be associated with infant mortality rates that are often greater than observed among women with significantly less educational attainment. Furthermore, some studies have demonstrated that black women with advanced educational attainment and higher socioeconomics have the highest infant mortality rates, and higher low birth rates than poor white women who also have not completed high school.

Dr. Scott underscored what the research suggests about the perniciousness of current racism on birth outcomes with a family story of her mother leaving the terror of post-reconstruction U.S. in 1946 to work in postwar Japan. Regarding institutional racism, Dr. Scott said, “So, chronic racial stress has been here for a very long time. I think dismantling it is going to be … hard, but I do think things are going to change.” Some researchers are already showing us potential pathways.

Such infant and maternal preventive measures may include increasing social support and programs targeted for expectant black women; advocating for financed “centering” programs and doula support throughout pregnancy – both of which are having a promising impact on black birth outcomes; and standardizing systematic data collection and maternal mortality reviews on maternal and infant deaths in all 50 states.

To recognize racism and reduce the allostatic load of chronic racial stress, Dr. Scott believes one should start by making the doctor’s office and medical establishment healthier and equitable for black patients and pregnant women. She supports establishing curricular implicit bias training throughout medical school, during residency, and extending it to the wider provider community; anti-racism training that teaches recognition of structural racism and ways that groups in our society are differentially impacted; holding forums with experts in the field of critical race theory to help providers and community members increase their knowledge base and comfort level to “call out” racism when publicly evident and to recognize social responsibility; holding CME forums about the crisis of maternal and infant mortality in the U.S. and the increasing rates among African-American women and infants. On a policy level, it is important to begin to enforce established anti-discrimination laws.

Dr. Scott believes that chronic racial stress impacting black women actually impacts everyone in the U.S. As the infant and maternal barometers of our social health demonstrate, and our divergence from the optimal infant/mother outcomes enjoyed by similarly ‘rich‘ countries, living daily with this level of toxic racism, inequality and discrimination differentially affects everyone in our society with particular impact on the young. Dr. Scott said she believes our efforts to “auto-correct” can be far-reaching, impacting not just African-Americans but all communities, and we should target our efforts towards envisioning healthier generations for the future.