US Public Health Emergencies: Maternal Mortality and Gun Violence

The first of three essays chosen in PHP’s first essay contest “Dear Paul Ryan…”

Non-Violence, a bronze sculpture by Swedish artist Carl Fredrik Reuterswärd of an oversized revolver with a knotted barrel and the muzzle pointing upwards

Read Time: 6 minutes


We’re pleased to publish the first of two finalists in PHP’s first essay contest “Dear Paul Ryan… Read our second finalist here. The winning essay will be published on Thursday, January 18, 2017.

Dear Mr. Speaker,

As a student of health policy, I urge you to make public health a chief priority as you consider new health reform legislation in 2017. Your own bill in 2009, The Patients’ Choice Act, emphasized the importance of public health, with the first section devoted to “Preventing Disease and Promoting Healthy Lifestyles.” I strongly agree that to restrain health care costs and improve quality of life for Americans, “investments in public health and disease prevention” are of the utmost importance.

As a country, the United States spends about three trillion dollars each year on health care. Discussion of this figure often concerns strategies to reduce health care expenditures, yet rarely addresses why the US has poorer health outcomes than other developed nations. Public health is intrinsically linked to individual health and health care, and as such must be prioritized in order to improve overall health and to reduce U.S. health care expenditures in the long run. Historically, national public health initiatives like mass vaccination campaigns and the enforcement of seat belt laws have saved the lives of millions of Americans. Of particular importance, the United States faces two public health emergencies that require the government’s immediate attention: maternal mortality and gun violence.

…maternal mortality is one of the principal markers of a nation’s health and the foremost indicator by which public health and human rights are assessed.

Despite the fact that the United States spends more on health care than any other country, it ranks 50th in the world for maternal mortality. In 2013, the US pregnancy-related mortality ratio, or maternal mortality rate, was 17.3 deaths per 100,000 live births. Significant racial disparities in US maternal mortality rates exist; pregnancy-related mortality ratios were 12.1, 40.4, and 16.4 for white women, black women, and women of other races respectively. Examination of these differences is critical to understanding their cause and in devising maternal mortality prevention efforts. In conjunction with life expectancy and infant mortality, maternal mortality is one of the principal markers of a nation’s health and the foremost indicator by which public health and human rights are assessed. The US must make maternal health a national priority, and can reduce the maternal mortality rate through comprehensive public health initiatives.

According to the American Public Health Association (APHA), health risks for pregnant women are amplified by unmanaged chronic conditions such as diabetes, obesity, and hypertension. A successful way to improve maternal health and reduce maternal mortality is therefore to increase access to contraceptives, reproductive health services and family planning to ensure that pregnancies are intended and well planned. This strategy is also cost effective; for every dollar spent on family planning, a government can save up to 6 dollars in future expenditures.

To prevent pregnancy-related complications and deaths, maternal mortality surveillance and identification must be strengthened. The federal government should mandate that all states adopt the US standard birth and death certificates, including five CDC-recommended checkboxes that indicate whether a woman was pregnant at the time of death or at any time during the year preceding death. Ideally, funding to state governments would increase with the goal of establishing maternal mortality review boards. As Speaker of the House, you have the power to support and pass legislation that will reduce maternal mortality by improving data collection and implementing performance measures, and by increasing funding and coordination of maternity care at the Department of Health and Human Services as recommended by the APHA.

The United States faces a second, more polarizing public health emergency: gun violence.

The United States faces a second, more polarizing public health emergency: gun violence. According to the CDC, there were over 30,000 US firearm deaths in 2014. Americans are 10 times more likely to be killed by a gun than people of other developed countries. In comparing the US to 22 other high-income nations, our gun-related murder rate is 25 times higher. The American Medical Association, the largest association of physicians and medical students in the country, recently joined the American College of Physicians in calling U.S. gun violence a “public health crisis.

The United States cannot wait for another mass shooting, or for another toddler to accidentally shoot and kill his sibling, before taking action. Gun control measures, including comprehensive background checks and waiting periods for all firearm purchases, must be implemented. To obtain an epidemiological analysis of gun violence and understand how to prevent gun injury and death, Congress must overturn the ban preventing the CDC from using federal dollars for gun violence research and from advocating gun control. That the foremost federal agency dedicated to improving the health of US citizens is hindered in investigating a gun violence epidemic unrivaled in any other developed country, because of NRA lobbying and a Republican-controlled Congress, is reprehensible. Though in the past you have fought against gun control agendas promoted by the Obama administration and lobbyist groups, and were given an “A+” rating by the NRA for the 2016 election, I strongly urge you to view gun violence as a public health issue rather than a political one as you move forward with health legislation in 2017.

In conclusion, it is time for the country that calls itself the greatest on earth to have the greatest health care system, and a bipartisan public health focus is crucial if we are to make headway. It is your responsibility as a congressional leader and respected political figure to take direct political and legislative action to reduce the US maternal mortality and gun death rates. These two particular issues are by no means the only public health issues in the United States that need consideration and reform, but they demand immediate attention. Ignoring these exigent public health emergencies would be detrimental to the economy and to the American people.

Featured image: Martin FreySculpture NON VIOLENCE, Knotted Gun, used under CC BY-NC-ND 2.0 license/cropped from original