Maternal mortality, opioids, HIV: Lawmakers discuss Cobb's public health challenges

Feb. 1—ATLANTA — In the wake of a new, 800-page report from Cobb and Douglas Public Health, the agency's deputy director briefed Cobb lawmakers this week on some of the county's most pressing health challenges.

Cobb & Douglas Public Health's Lisa Crossman outlined four priorities of the authority — improving public health infrastructure, reducing maternal and infant mortality, addressing the opioid crisis and reducing HIV infection rates — at a meeting of the county's legislative delegation.

The priorities were developed based on needs identified in the community health assessment, prepared every five years by CDPH, as a sort of check-up on the state of the two counties.

Mothers and infants

The state of maternal and infant mortality in Cobb and Georgia took up the bulk of the discussion. While Crossman said "great strides" have been made in reducing mortality rates, there's more work to be done.

"Particularly our Black mothers are about two times more likely to die from postnatal issues than are their white counterparts," Crossman said. "So we really need to do something — that's ridiculous to me, that's ridiculous in Cobb County to have that happening."

A state Department of Public Health fact sheet reported that from 2015 to 2017, Georgia had 25.1 mothers die per 100,000 live births.

That rate puts the state on par with countries such as Grenada, Armenia and Azerbaijan, according to the World Bank.

Of those deaths, 87% were considered preventable, per the state DPH. Black women in Georgia were 2.3 times more likely to die from pregnancy-related causes than white women.

The leading causes of Georgia women dying in pregnancy in that period were cardiovascular issues, coronary issues, cardiomyopathy, hemorrhages, infection and cerebrovascular accidents, per the DPH.

State Rep. Sharon Cooper, R-east Cobb, chair of the House Public Health Committee, cautioned that people shouldn't overstate the problem, lest patients grow skeptical of medical care.

"I think there's a tendency to scare young mothers, especially Black mothers ... One death, as far as I'm concerned, is too many. But it's averaging out 120,000 births a year here in the state, somewhere in that area, of 30 (deaths)," Cooper said. "So I mean, I get concerned when it's so negative, that we scare pregnant women about going to the hospital to get care."

Graham Segrest of the state DPH said the state's top public health official, Dr. Kathleen Toomey, is making reducing maternal mortality a priority.

"I think you'll see that she's incredibly galvanized coming out of the pandemic to tackle this problem," Segrest said.

In 2020, infant mortality in Georgia was 6.3 per 1,000 births, down from 7.4 in 2016. In Cobb, the rate was 4.9 per 1,000, down from 6.7, according to CDPH. The rate of infant mortality was 3.0 per 1,000 for white infants and 7.8 for Black infants in Cobb.

"I am certainly not satisfied with our pace of change," said state Rep. Lisa Campbell, D-Kennesaw. "... I think one of the areas where we still have a huge opportunity in an existing system would be in our public education and our partnerships with our schools, and the communication. Certainly a lot of these mothers are very young, and that is an organizational infrastructure that exists."

Crossman said improving access to prenatal care and primary care in the postnatal phase were priorities.

In recent years, the state has extended postpartum medical care for low-income women enrolled in Medicaid. The state used to provide care for 60 days after giving birth. That was extended to six months in 2021, and to 12 months last year.

Crossman and legislators said many women don't realize they're eligible for coverage.

"That was a big step the Kemp administration's taken. I mean, from a state policy perspective, it doesn't seem that it could be easier," said state Sen. Ed Setzler, R-Acworth.

Setzler went on to ask how the program could be communicated better — "is it fundamentally one of engaging women to know what resources they have, or is it something different than that?"

Crossman said it's complicated. Part of the issue is communicating what resources are available. But there's also the issue of whether there's an OB/GYN provider nearby, and whether that provider accepts Medicaid, or serves uninsured residents.

In Cobb, grants and private funding has enabled DPH to serve as a payer of last resort for prenatal care, Crossman said.

Also, many women have trouble accessing resources because they work, or lack transport, she said.

Setzler remarked that having more clinics open during nontraditional hours might help. Crossman said some do, but that more need to.

HIV

Before the pandemic, Cobb was one of 50 counties in the U.S. identified with high HIV rates, Crossman said.

The community health assessment found that the rate of Cobb residents living with human immunodeficiency virus, or HIV, climbed by 19% from 2016 to 2020.

Crossman said her agency is trying to improve awareness of STDs and HIV, improve access to testing and improve access to treatment for uninsured residents.

Especially important is access to PrEP (pre-exposure prophylaxis), a daily medication that reduces one's likelihood of spreading or contracting HIV. The medication is available at all public health clinics, but not enough people take advantage of it, Crossman said.

Opioids

The opioid crisis worsened during the pandemic, Crossman said.

It was already bad before COVID-19. According to the state DPH, opioid deaths rose statewide by some 70% from 2010 to 2018.

Crossman said the issue is especially bad in parts of north Cobb, and especially affecting white men ages 30-50.

"We've been able to look at what are the reasons that the deaths are happening, and where are they happening in Cobb," Crossman said.

CDPH calls for increasing awareness, prevention and access to care to address the crisis. Crossman said the authority is trying to educate doctors, dentists and their patients on non-opioid pain relief.

State Sen. Kay Kirkpatrick, R-east Cobb, noted that the district attorney's office has received a grant for opioid fatality review.

The county is also set to receive money due to settlements from opioid lawsuits, Kirkpatrick said.

The legislature last year decriminalized test strips used to test for fentanyl, a synthetic opioid.

"The faucet has been turned down on prescribing opioids, which just means that people are at the mercy of buying stuff on the street," Kirkpatrick said. "Which is why we passed fentanyl test strips last year."

Crossman also noted that there is a statewide standing prescription for naloxone, which can reverse the effects of an overdose.

"Anybody can walk into a pharmacy and buy naloxone. It's not always covered by their insurance, or they may not have insurance. So it can be expensive," Crossman said, adding later that it runs $45-75.

CDPH is doing a pilot program by putting naloxone in places where overdoses are occurring more, such as bars, nightclubs and hotels.

Crossman said her agency, in partnership with the Cobb sheriff's office, Cobb Fire and EMS companies, has also applied for some of Cobb's COVID federal relief dollars, in order to purchase naloxone for first responders.

"One of the problems that we're having now is with the fentanyl and some of the others, one (naloxone dose) won't do it. It can take two or three. And our first responders often don't have that many with them," Cooper said.

State Rep. Devan Seabaugh, R-Marietta, thanked Crossman at the meeting's close.

"I just want to tell you how much and how grateful we are for public health in Cobb and your team for getting us through the pandemic," said state Rep. Devan Seabaugh, R-Marietta.

Added state Rep. Mary Frances Williams, D-Marietta, "I hope that at some point, the county will consider increasing its revenue that goes to public health. Some counties are doing more."

Responded Crossman, "I won't ever turn that down. Thank you. ... But I will say that last year, the Cobb County government folks did increase our allocation significantly."