Elizabeth Howell

This month, we are highlighting Elizabeth Howell, MD, MPP, the Chair of the Department of Obstetrics & Gynecology, and Harrison McCrea Dickson, M.D. President's Distinguished Professor at the Perelman School of Medicine. 

Not only does April mark National Minority Health Month, which focuses on reducing health disparities, but this week is Black Maternal Health Week.  

For decades, Dr. Howell has been focused on improving the quality of care for mothers and their babies, shrinking health disparities for marginalized groups, and advancing women’s health. 

We spoke to Dr. Howell about her passion for this work, the future of maternal health, and her connection to the College. 

 

How long have you been a Fellow of the College, and what drew you to seek Fellowship?

I have been a Fellow for four years.  I was encouraged by Dr. Erica Thaler, the current Board Chair, to seek Fellowship at the College.  At that time, I was new to Philadelphia as I had recently moved from New York City to become Chair of Obstetrics and Gynecology at Penn. 

I was drawn to The College of Physicians of Philadelphia because of its history and mission.  It was an honor to join the oldest private medical society in the United States, and its goals to advance science and public health deeply resonated with me. 
 

What inspired you to focus your career on maternal health and addressing disparities in care, and what keeps you motivated in this work?

My passion for ensuring that all women have the best chance at a healthy pregnancy and delivery is deeply rooted in my upbringing. My father lost his mother at a very young age, and early on, I came to understand that mothers are the foundation of families and communities. My father was a civil rights attorney, and both my parents advocated for social justice. It is therefore not surprising that I grew into someone who is deeply committed to improving maternal health and ensuring better outcomes for all mothers and babies. 

For over two decades, I focused my research on the contributions of quality of care to disparities in maternal and infant health outcomes. When I became a medical student and was faced with the realities of the NICU and the disproportionate representation of Black infants, I delved into data on infant mortality. Later, when I became an OBGYN resident, I learned about the many access and quality of care challenges that many pregnant Black women faced. I began to think about ways the health care system and providers could intervene in remedying this situation. I went on to get fellowship training and became an OBGYN health services researcher. I was very focused on maternal morbidity and mortality. Initially, we did not have a great metric for maternal mortality because it occurs relatively infrequently (18.6 maternal deaths per 100,000 live births in 2023). However, the CDC introduced its first metric for severe maternal morbidity and defined it at that time as having a life- threatening diagnosis or undergoing a life-saving procedure during a delivery hospitalization. The metric utilized diagnosis and procedure codes, and health service researchers were then able to investigate its occurrence in population studies. 

Over the next decade, my team examined severe maternal morbidity and hospital quality.  Using national data sets, we demonstrated that Black women delivered in a specific set of hospitals and those hospitals had worse outcomes for both Black and white moms, regardless of patient risk factors. We found that three-quarters of all Black women in the US delivered in a specific set of hospitals, while less than one-fifth of white women delivered in those same hospitals. Using New York City data, we found that a woman’s risk of having a life-threatening complication in one hospital could be six times higher than in another hospital. Black and Latina mothers were more likely to deliver in hospitals with worse outcomes. In fact, differences in delivery hospitals explained nearly one-half of the Black-white disparity in severe maternal morbidity in New York City hospitals.   

I spent twenty years at the Icahn School of Medicine at Mount Sinai and was the founding Director of the Blavatnik Family Women’s Health Research Institute. I have always been passionate about advancing science in women’s health and was thrilled to have the opportunity to continue that work in Philadelphia. I moved to Philadelphia five years ago, excited to use many of the lessons I learned over the years to tackle maternal mortality and morbidity in Philadelphia, a city where maternal mortality rates are high and significant racial and ethnic disparities exist. Over the last five years, I have worked with my colleagues at Penn Medicine to improve the quality of care for all pregnant women, narrow disparities, and advance women’s health. 

I continue to be motivated to do this work because maternal mortality remains high in the United States and significant disparities (across race and ethnicity, geography, income, and other dimensions) exist. I continue to believe that all women should have access to high-quality pregnancy, delivery, and postpartum care. I feel fortunate to lead the Department of Obstetrics and Gynecology at Penn, work with amazing colleagues, and continue to address this public health crisis. 

 

As we spotlight National Minority Health Month, what do you hope healthcare professionals and the public take away from this observance?

I hope healthcare professionals remember the contributions of the many minority healthcare professionals to promoting health and wellness.  There are so many important contributions that are not widely recognized, and there is a dire need for future leadership from this community and many others if we are to narrow health disparities and optimize health and wellness for all. 

 

From your experience, what are some of the most effective strategies for improving outcomes for underserved communities? 

At Penn Medicine, we have a multipronged strategy to improve maternal health outcomes for underserved communities. 

We implemented data dashboards with quality metrics stratified by race and ethnicity so that we understand outcomes for all our patients. We also stratify obstetric and gynecologic complication rates by race and ethnicity and then design quality improvement strategies to improve care for all our patients. 

We have built a large maternal health equity research portfolio funded by the NIH, industry, and foundations. We are home to the inaugural March of Dimes Research Center for Advancing Maternal Health Equity. Our current portfolio ranges from basic science and translational research to clinical, health services, and policy research. We conduct research across the pregnancy continuum from preconception to pregnancy, delivery, and the postpartum period. We have collaborations with institutions across the US. 

We started a Women’s Health Center for Clinical Innovation – a center that currently includes 21 programs that leverage technology to improve outcomes, access, and equity across our six clinical divisions.

We have a very strong community engagement component. We partner with community organizations and have a departmental community advisory board. We have strong links with the Philadelphia Department of Health, and faculty serve on the city and state maternal mortality review boards.  

  

What advice would you give to students, residents, or early-career physicians who want to make an impact on minority health or health equity?  

We need more healthcare professionals committed to improving the health and wellness of underserved populations. We need physicians who are well-trained clinically and in research to tackle some of the most glaring and difficult issues facing our field.  We need to leverage technology and artificial intelligence to advance health and narrow disparities.   

  

What changes or innovations in maternal health are you most hopeful about in the next 5–10 years? 

The majority of maternal deaths occur postpartum in the United States, and there is a commitment to advancing new postpartum care models (e.g., use of patient navigators, doulas, community health workers; extending care to the home; new education platforms about warning signs; cardiovascular screening and identification). There is a lot of research, program innovation, and potential for technology to advance maternal health during this period. 

 

What is your favorite part of the College, and is there a particular Museum or Library object that resonates with you personally? 

I discovered my favorite part of the College when I was inducted and signed the Records of the College of Physicians By-Laws and Signatures. The register records the signatures of members dating back to the organization’s founding. It was a memorable moment, and I stood in awe of this historic book and the many physicians who signed it before me. 

 

What do you wish more people knew about the College and the resources it offers? 

The College offers an incredible network of healthcare professionals, outstanding seminars and activities, and meaningful opportunities for advocacy. It also includes a remarkable Library, Museum, and many additional resources.