Journal of Health Care for the Poor and Underserved

As the summer of 2021 simmers on, JHCPU again publishes a large collection of papers delving into the complex sea of health inequities. In this Note, to stand in for the large array of topics the issue covers, I highlight a small selection, two papers concerning violence, two on COVID-19, and two concerning sub-Saharan African nations.

Violence courses through American society unabated, rising exponentially over time. Much of this is gun violence, and virtually all of it inflicts both physical and mental trauma. The first highlighted paper on violence is by Corbin et al., who worked with 88 survivors of violent assault (gunshot, stabbing, or assault) who had presented to emergency rooms within the previous month, administering clinical scales for PTSD (PCL-5), depression (PHQ-8), and sleep (PROMIS®) to evaluate the mental health sequelae of violence. They report, "High proportions of participants met criteria for prospective PTSD (59.1%), major depression (44.3%) or disordered sleep (34.1%), with 27.3% meeting criteria for all three conditions." The authors conclude that survivors of violence should routinely be assessed for these conditions and referred for treatment as needed. This work serves as a powerful reminder of the seen and unseen damage inflicted by violence.

Maternal morbidity as a term of art in public health refers to death due to complications from pregnancy or childbirth and does not encompass deaths due to "accidental or incidental" causes, specifically homicide, suicide, substance overdose, and motor vehicle accidents. As Bright et al. report, such traumatic causes of maternal death (death during pregnancy and a brief neonatal period) are far more common than medical causes of maternal death. Furthermore, pregnancy appears to be a time of increased vulnerability to violence; the authors note that in the U.S. in 2015, "4% of all deaths of women of reproductive age were attributed to homicide, but between 8% and 13% of maternal deaths were attributed to homicide." An underlying implication, on my reading, is advice something like this: "If you want to talk about major causes of maternal mortality, then talk about guns, drugs, and cars." The authors argue for three practical steps to reduce these traumatic causes of maternal death.

COVID-19 continues its battle with the world population over 20 months since its inception. I highlight two of a number of papers in this issue concerning the pandemic. The first concerns Centers for Independent Living, federally-funded, community-based organizations designed and operated by people with disabilities. Centers for Independent Living initiatives include individual and systems advocacy, peer support, information and referral, independent living skills training, and transition services. Kennedy and colleagues surveyed 144 Center for Independent Living administrators and staff concerning what is needed by people with disabilities during the COVID-19 [End Page ix] pandemic. The strongest outcome recalls a refrain so often heard during crises: This emergency has laid bare the already over-burdened lives of a group of people most at risk, in this case people with disabilities. What the people with disabilities need during the pandemic is what they have always needed, but more so: health and safety, long-term supportive services, and reduction of social isolation and economic insecurity.

Hernandez Caceres and colleagues analyzed the time series of daily cases in the World Health Organization African Region (WHOAR) from February 26th to December 29th, 2020. They provide an overview of the first wave (peaking around July 20th, 2020) and the second wave (either ongoing or having given way to a third wave) across WHOAR. The authors also provide basic reproduction numbers for the virus in WHOAR. Editor's note: By July 2021, both the number of confirmed cases and the number of COVID-19 deaths in sub-Saharan Africa have exceeded the predictions for August 2021 made by these models.

The Literature Review by Abasse et al. might better be classified as a policy brief. It concerns the health system and the health status of the citizens of a particular sub-Saharan country—Comoro Islands—in systematic comparison with those of its neighbors, Mauritius and Seychelles. The Comoros, which was colonized by the French...