The LamazeLive! 2018 event is just around the corner. This year's conference shakes up the traditional conference experience and takes it to the next level. A conference reimagined, you'll learn and brainstorm with experts in an immersive learning environment designed to provide you with concrete ideas, activities, skills, and knowledge to apply to your practice. You can earn continuing education credit and forge deeper connections during new, highly interactive sessions.

Today I am delighted to share a pre-conference interview with plenary speaker Natalie S. Burke, BA, President and CEO of CommonHealth ACTION. Natalie's presentation Equity in Childbirth During the Age of Chaos, Privilege, and Bravery will discuss equity in childbirth education and maternity care and challenge educators and others to lean in and step up in removing barriers and making change to systems and examine the role we play in the production of the public's health; infant and maternal mortality; healthcare; and the childbirth experience.

I am very excited to meet Natalie, hear her presentation and then connect with my colleagues in the Discussion Lab immediately following to dialogue how I can be a changemaker.

Sharon Muza: It seems obvious, but can you tell us why health inequities that impact communities of color disproportionately are a critical national problem for everyone and not just something that impacted communities need to solve on their own? Why is it not okay to 'stay in our own lane' and address issues that only directly impact each individual.

Natalie Burke: There are two important but starkly different ways to think about how health inequities are detrimental to our entire society. Think of it as being about the 'head' (logic, data, and facts) and the 'heart' (fairness, justice, and meaning). Logically, when entire segments of the population experience disease or poor-health that is avoidable, we all experience the impact through lost productivity in the workforce; increased costs for healthcare systems and insurance; increased rates of communicable diseases that could affect each of us or our loved ones; and the loss of generational wealth for families trapped paying uncovered medical expenses or dependent on social programs because they are unable to work. Morally and ethically, every human being deserves to have the opportunity to achieve their best possible health. The health inequities experienced by communities of color, people living in poverty, and in rural America are unjust and the result of inequitable decisions, behaviors, and actions by leaders, decision-makers, and powerbrokers - that's why they are inequities - not just disparities. To change that, we all need to recognize the important role we play in the production of the public's health. For those reasons, particularly our interconnectedness and interdependence, the public's health is everyone's 'lane.'

SM: We know that only 50 percent of people attend birth classes prior to their birth, What can childbirth educators and Lamaze do to increase this number, with a special focus on marginalized communities. How do we make childbirth classes more accessible?

Natalie Burke: Beyond taking the obvious steps towards being culturally and linguistically appropriate, I suggest the following:

• Make sure locations and times for classes are easily accessible and do not create an undue burden on people who work in the evening or who rely on public transportation.
• Childbirth educators should come from the communities in which they are teaching classes. It fosters trust and deeper engagement between the instructor and participants in the class.
• Communicate with participants using language and images that are respectful and balances power dynamics before and during classes.
• Solicit input from the intended participants on why they don't seek classes and solicit feedback from people who attend classes. Use that information to modify communication and methods of instruction.
• Take trainings to the intended audience instead of expecting them to come to you. How and where can you 'piggyback' onto another activity that easily reaches your intended audience?

SM: I struggle as an educator to find diverse images, videos, and materials that highlight people of color and many different family structures to use in my classes with my students. I have written several blog posts about the slim number of resources available to find materials that center people of color. Can you offer additional suggestions on how we might source material that is reflective of all communities?

Natalie Burke: An increasing number of organizations are self-funding stock photography that meets their needs. It can be cost-effective if well-planned and more importantly, you can select people/models who fit your intended audience while placing them in a multitude of scenes for future use. The goal is to take enough photos over one or two days to supply images for two to three years.

There are also a number of start-ups focused on stock photography that is intersectional and for people of color. In this Huffington Post article, they list several resources.

SM: Will changing the disproportionate health outcomes we see for people of color during the childbearing year, need to start from the top down or the bottom up? Where can we get the best traction for making important changes quickly and effectively so that people stop dying simply because of the color of their skin?

Natalie Burke: The greatest success we experienced in public health, where behavior and culture changed measurably, was through America's anti-smoking efforts. The reason that worked is that there was a national level narrative and campaign driven by large organizations and government ' where there was a constant flow of images and information on the dangers of smoking and how to quit. At the same time, there were local narratives that supported advocacy and leading to public policy, private action, and individual behavior change. These narratives were messages framed as strategies for action by individuals and groups.

To prevent people of color from dying in childbirth and better yet, to live well through childbirth, we must face how it started. It is critical to acknowledge the legacy of racism in the childbirth experiences of African American women and women of color throughout hundreds of years during which their bodies and their babies were devalued and dehumanized by people within and outside of healthcare. That painful truth is at the root of generational trauma that too often manifests as maternal or infant death.

To move forward, professionals and practitioners working in communities of color must work to re-imagine, rebrand, and recommunicate the childbirth experience as one in which women deserve and should have a voice and power. This effort should be led by women of color. Shifting this perception will likely take a generation but it will increase the value everyone places on the childbirth experience for people of color, the trust they place in instructors and instruction, and improve childbirth outcomes.

I believe that many of the strategies we used to combat smoking can apply to childbirth education for people of color. The key is to translate the data into real-world stories; make the narrative compelling and accessible to 'lay' audiences, intellectually and emotionally; and appeal to the head and the heart. It is particularly important to use social media and video for people of color (See the latest data from Pew regarding social media engagement by race). Their rates of use on YouTube and Instagram are higher than their white counterparts. Lastly, people of color must be intimately involved and engaged in the development, design, and delivery of classes, materials, and experiences. That is the most equitable and effective approach.

About Natalie S. Burke

Natalie S. Burke, President & CEO of CommonHealth ACTION is a nationally-known speaker, 'equity evangelist,' strategist, master facilitator, and public health leader, Natalie provides executive leadership for CommonHealth ACTION whose mission is to develop people and organizations to produce health through equitable policies, programs, and practices.

Since the mid-90s, Natalie has held leadership positions focused on creating opportunities for health through community, institutional, systemic, and policy change. Her public health and health care experience includes technical assistance and capacity building for hundreds of community-based organizations and collaboratives; universities and medical schools; national and international corporate entities; and philanthropy - as well as federal, state, and local governments. Prior to co-founding CommonHealth ACTION in 2004, Natalie was in executive leadership at the National Association of County and City Health Officials in Washington, DC, where she managed the National Turning Point Initiative.

A graduate of the University of Maryland with a degree in Government and Politics, Natalie conducted federal health policy analyses at the National Health Policy Forum and was on staff at the National Institutes of Health. She has been selected for numerous national fellowships including the Emerging Leaders in Public Health Fellowship (Jointly hosted by the University of North Carolina's Schools of Business and Public Health) and New York University's Robert F. Wagner School of Public Service Lead the Way Fellowship for visionary and entrepreneurial leaders in the nonprofit sector. In 2012, Natalie was selected to the Council of Innovation Advisors for ConvergeUS, a national initiative focused on technology-based social innovation between the technology sector and the nation's nonprofits. In addition, she co-authored a chapter featuring the Joint Center for Political and Economic Studies' PLACE MATTERS Initiative in the second edition of Tackling Health Inequities through Public Health Practice (2010).

Committed to the health and well-being of all people, Natalie views health as the product of complex interactions amongst systems and factors such as education, employment, environmental conditions, access to technology, housing, transportation, and healthcare. Throughout her career, she has sought to understand the root causes of ill-health including the delicate balance amongst genetics, personal health behaviors, and the systems and institutions that provide the contexts within which we live our lives and make our decisions. That understanding guides her work with corporate, academic, elected, and community leaders whose decisions produce health. For the past decade through curriculum development, education, and publications, she has focused on the roles that systemic privilege and oppression play in the production of the public's health, particularly health inequities'this includes serving as the primary architect for CommonHealth ACTION's nationally-recognized Equity, Diversity, and Inclusion Training Institute.

Since 2016, Natalie has served as co-Director of the Culture of Health Leaders National Program Center, funded by the Robert Wood Johnson Foundation; she directs the Kaiser Permanente Institute for Equitable Leadership in Baltimore; she is a member of the Institute for Healthcare Improvement's Equity Advisory Group; she serves on the Ventures Advisory Group for ReThink Health; and she is a member of the NationSwell Council.

'As an advisor to corporate leaders, communities aspiring to change, and everyone in between - I guide people and organizations to common language, plans, and solutions necessary to make the world a healthy and equitable place. As a strategist, I focus on strengthening the connective tissue that forms relationships and organizations. As a facilitator, I cultivate spaces of constructive discomfort where people exchange ideas that create change. As a writer, I use what I know to say what needs to be said and as a leader, I know that world-changing is serious business but then again, what better way is there for me to spend my time?'

Published: March 15, 2018

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