Martha Miller is a 32-year-old, African American single mother living in a midsize city. She has three children from previous relationships. Her partner is Mick, a 38-year-old White man who lives with her, and who is unemployed. Although he is actively looking for a job, he has not worked in more than a year. Her oldest child is 8 years of age, she has a 4-year-old, and her youngest is 17 months. She works as a hotel housekeeper from 7:30 a.m. to 3:30 p.m. and at a fast-food restaurant from 6 p.m. to 11:30 p.m. She has limited time home with her children, only seeing them briefly after her first job, and then again in the morning before work. Her partner helps with the cooking and childcare. She is overweight with a body mass index of 32, has mild hypertension, and had a second A1c level of 6.4 for which you prescribed Metformin 500 mg twice a day during her last clinic visit 6 months ago. At that visit, she saw a dietitian for dietary counseling, and you spoke with her about developing a plan to get 150 minutes of exercise weekly.
She has not been back to see you despite repeated calls to her cell phone, a number that changes about every 8 to 10 months. She finally came into clinic last week, and you have determined that she is 20 weeks pregnant. You are concerned about the effectiveness of her medication, her very stressful life, and lack of follow-up as problems that can affect her health and that of her baby.
Select one of the options below and discuss the ways in which this condition/social problem might increase her health risks?
1.The effects of income inequality on her health and ability to be an active participant in her care.
2.Racial discrimination she may experience related to her romantic relationship.
3.Health disparities she may experience related to her pregnancy, such as the risk for preterm labor and the high rate of infant mortality in low-income women.