Honoring Dr. Shalon Irving, A Champion for Health Equity

Illustration by Brett Ryder

Shalon MauRene Irving, PhD, MPH, MS, CHES, an epidemiologist with the Centers for Disease Control and Prevention (CDC) and lieutenant commander in the US Public Health Service Commissioned Corps, dedicated her life to understanding how structural racism, intersectionality, trauma, and violence influence health disparities over a lifetime. Indicative of her life’s work, Shalon’s bio on one of her social media pages says: “I see inequity wherever it exists, call it by name, and work to eliminate it. I vow to create a better earth!” She passed away unexpectedly on January 28, 2017, just three weeks after giving birth, calling national attention to one of the widest of all racial disparities in women’s health: disproportionately high rates of maternal mortality among Black women in the US.

During her career as a sociologist and public health leader, Shalon made valuable contributions to the fields of health equity and epidemiology, including her research on health disparities among racial and ethnic minorities, women’s health, elder abuse, and the consequences of intimate partner violence. Since Shalon’s untimely passing in 2017, her life and legacy have greatly contributed to the advancement of policies to prioritize the reduction of preventable maternal deaths in Black women, including ambitious and groundbreaking congressional legislation to address maternal health disparities.

In this essay, written by Shalon’s family, friends, colleagues, and supporters, we honor the lasting legacy of Shalon, a fierce champion for social justice and health equity, and we highlight the urgent need for widespread transformation of the US health care system to better respond to the needs and health priorities of women, and especially Black mothers.

A Devoted Daughter, Mother, And Friend

“Nana, I want to go to Heaven, so I can be with my Mommy.” —Soleil Irving

Shalon was exceptional in many ways. She was smart, kind, strong, and vibrant with a smile that electrified a room. She was a loyal, fiercely protective, and loving best friend to her mother, Wanda. Wanda cherished every moment she spent with her daughter, having already lost her two sons to illness and a tragic accident. It didn’t matter whether they were traveling together around the world or if they were miles apart, Shalon and Wanda were the closest of friends who talked every single day. If they weren’t talking, they were texting, spending time together on Google Hangout, or watching television (and falling asleep) together while on the telephone: “Momma, Momma. Wake up, wake up. Did you see that?” “No, I missed it.” Shalon was also Wanda’s strongest supporter when Wanda went back to school in her fifties to pursue her master’s degree.

Shalon was a blessing to her whole family, but most importantly to her daughter, Soleil. Shalon and those closest to her were all very proud and excited when she found out that she was expecting Soleil. Shalon wanted so badly to be a mother. She prayed for Soleil, and she was a natural nurturer.

Shalon’s friends and close colleagues often characterize her as the perfect embodiment of Black girl magic. She was a spiritually powerful and passionate Queen who exuded brilliance in every one of her endeavors. She always showed up. She showed up for her friends and colleagues, and she dedicated her life to showing up for those who needed a voice or a helping hand. At times, she was very quiet and pensive, but always loving. She was intuitive, intelligent, funny, and, her loved ones say, a real treat to be around.

Brilliant Sociologist And Public Health Scholar

Shalon made history at age twenty-five by becoming the first recipient of a dual PhD in sociology and gerontology at Purdue University, in West Lafayette, Indiana. Her published dissertation is titled More Than Sticks and Stones: The Long-Term Consequences of Reported Childhood Maltreatment. She received her master of public health degree at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, in 2009 and completed a postdoctoral fellowship in the Kellogg Community Health Scholars Program at Morgan State University, also in Baltimore. Ending health disparities was the cause for which she gave her last full measure of devotion. Her scholarly focus centered on elucidating underacknowledged public health problems, particularly health disparities that result from combined experiences of discrimination and oppression due to social factors such as race, class, and gender. This scholarly framework was first termed “intersectionality” in 1989 by Kimberlé Crenshaw.

During her time as an epidemiologist with the CDC’s Division of Violence Prevention, Shalon used her voice to fight for health equity by exposing hidden gaps in public health. She intuitively saw structures, systems of relationships, and social dimensions of public health problems that went unnoticed by many others. She used her unique vision to call attention to situations unseen, to life experiences undescribed, and to struggles unwitnessed. Notably, her scholarship on housing, food insecurity, and hypertension; violence-related trauma among Black youth and young adults; child maltreatment; intimate partner violence; and elder abuse helped shed light on these complex issues in nuanced and thoughtful ways.

Fierce Champion For Black Girls And Women

There is no mistaking the difference Shalon made in helping to shape a more equitable future for Black girls and women. She saw their value and vulnerabilities, and she was determined to address unmet needs to help level the playing field. Her consulting firm, Inclusivity Standard, was developed to empower girls from disadvantaged backgrounds to prepare for college and to enable businesses and schools to embrace inclusivity.

During her time working as a fellow with Sisters Together and Reaching, Inc., known as STAR, Shalon used her training as a certified health education specialist to engage with teenage girls living with HIV in Baltimore to better understand their sexual and emotional health and their relationships with adults, especially their mothers or female guardians. She was compassionate and relatable in her interactions, worked to help teenagers reengage with their birth mothers, and helped identify stable housing for young women who were pregnant. She championed those who didn’t have a voice and promoted the use of community-based participatory approaches, such as Photovoice, to document social determinants of health disparities for young Black women.

A Life Cut Short

“In this short life that only lasts an hour/How much—how little—is within our power?” —Emily Dickinson

Shalon suffered a sudden cardiac arrest at home on the night of January 24, 2017, just twenty-one days after giving birth to her daughter and only six short hours after returning home from yet another visit to her medical providers, during which she was in distress and pleaded with them to help her. On this visit, her concerns were dismissed, as they had been several times. It didn’t matter that Shalon had a dual PhD. It didn’t matter that she had an MPH from the top-ranked school of public health in the world. It made no difference that she was a lieutenant commander in the US Public Health Service, was an officer in the world-renowned Epidemic Intelligence Service, was a highly respected epidemiologist at the CDC, and was president of her own consulting firm. She was still a Black woman.

Let’s be abundantly clear: The medical community is failing Black mothers in the US. For decades Black women have been dismissed, ignored, and disregarded, or at the very least, they have not been taken seriously in their interactions with the health care system. It’s not uncommon for Black women to report experiences of racism and discrimination by medical providers. This racism may be blatantly overt or covertly subtle, but make no mistake—it exists. The three short weeks that followed her daughter’s birth should have been filled with joy, happiness, and improving health status for Shalon. Instead, her general health declined, and she suffered from dangerously high blood pressure. Her legs swelled. She had decreased urine output in the last week of her life, and she gained nine pounds in ten days. She had severe headaches. She expressed to her doctors that something was very wrong. Despite frequent visits to her providers, her complaints were not adequately addressed and were routinely dismissed with, “It’s to be expected. You just had a baby. Give it time.”

Our health care system failed Shalon—a brilliant scholar who dedicated her life’s work to the mission of public health.

With her education and professional training, Shalon could articulate her concerns very clearly. Yet her concerns and cries for help were minimized and dismissed. Journalists’ inquiries into her story later confirmed a string of missed opportunities to take her case more seriously. What could explain this? We believe it was due to the covert bias of her providers. This bias, fueled by structural racism, is the root cause of disparities in health care. This bias caused Shalon to be one of the statistics for maternal health deaths in 2017. Ultimately, her death was attributed to complications from postpartum high blood pressure. As a result, Wanda lost her best friend, Soleil lost her mother and all of the relationship possibilities that could have existed between the two of them, and the world lost a fierce champion for health equity. Our health care system failed Shalon—a brilliant scholar who dedicated her life’s work to the mission of public health. Most egregious is that what happened to Shalon is happening to Black women across the US at alarming rates. According to CDC data, in 2019 the maternal mortality rate was 44.0 per 100,000 live births for non-Hispanic Black mothers compared with 17.9 per 100,000 live births for non-Hispanic White mothers. Multiple factors contribute to preventable maternal deaths, including inequities in health care access and quality of care, underlying chronic conditions, structural racism, and bias. To allow the systems that permit these inequities to persist unchecked is unconscionable.

How do we eradicate disparities in maternal mortality? It is long past time that leaders in all sectors take steps to transform the health care system status quo. The first step must be acknowledging the failure in the inherent design of the health care system itself: a complex system that is primarily funded by the treatment of illness (versus disease prevention) and is also incredibly difficult to navigate, with major gaps in continuity of care and little accommodation of patients’ diverse demands and needs. The next step requires taking responsibility and owning that failure. The most important step is actively taking the necessary actions to right the wrongs created by that failure. We must confront the racism and differential treatment that exist in health care. We must trust Black women and the Black scholars, researchers, and clinicians who champion evidence-based solutions.

Lasting Legacy In Health Policy And Public Health

“We are confronted with the fierce urgency of now. …This is a time for vigorous and positive action.” —Rev. Dr. Martin Luther King Jr.

The nature of Shalon’s untimely and tragic death galvanized public health leaders, policy makers, health providers, researchers, educators, and media personnel to collectively illuminate the urgency of addressing Black maternal mortality. The tragic truth of her death is that if this can happen to Shalon, it can happen to anyone. She was a highly educated and well-respected public health expert with excellent health insurance and a strong social support system who lived in one of the wealthiest countries in the world. As a consequence, her life and passing inspired unprecedented national attention and the allocation of new resources devoted to research and practice reform around Black maternal health, the creation of national policies aimed at reducing maternal disparities, the development of curricular content and execution of academic forums attempting to distill the fundamental root causes of disparities in Black maternal mortality, and the publication of high-profile news stories that delve into her life.

Inspired by the tragic death of her friend Shalon, Rep. Lauren Underwood (D-IL) cofounded—and cochairs with Rep. Alma Adams (D-NC)—the Black Maternal Health Caucus of the House of Representatives to elevate the Black maternal health crisis and advance policy solutions to improve maternal health outcomes. Congresswoman Underwood and other members of the Black Maternal Health Caucus introduced the Black Maternal Health Momnibus Act of 2021 to address inequities in housing, nutrition, and transportation, as well as racial bias, in the treatment of pregnant women; improve data collection; and bolster maternal mental health resources.

The legislation, which comprises twelve separate bills, recognizes that comprehensive solutions are needed to address the multifaceted and multidimensional causes of poor maternal health outcomes and maternal health disparities. It emphasizes the significance of leadership of community organizations and people of color in those solutions, and it would establish new grant programs for community-based organizations and public health departments to address unique social determinants of health needs in their communities, such as housing, transportation, and nutrition. The legislation would also provide new grant funding to community-based organizations working to improve maternal health outcomes and promote equity through support for pregnant and postpartum people with maternal mental health conditions and substance use disorders.

Critically, the Momnibus legislation would provide new funding to study and implement trainings on bias, racism, and discrimination for all employees in maternity care settings, as well as new funding to establish respectful maternity care compliance programs in hospitals. The legislation would invest in diversifying and growing the maternal health workforce, including nurses, physician assistants, doulas, and other perinatal health workers who can provide culturally congruent care to women of color. The Momnibus Act would also improve data collection and quality measures to better understand maternal mortality and morbidity.

In November 2021 one bill within the Momnibus Act—the Protecting Moms Who Served Act of 2021, which addresses maternal health among veterans—was signed into law by President Joe Biden. In addition, all eligible provisions of the Momnibus Act were included in the House’s draft of the Build Back Better Act, totaling approximately $1 billion in new funding, predominantly for Black mothers. Alongside the Build Back Better Act’s requirement for state Medicaid programs to provide twelve months of continuous coverage for postpartum women, these policies would represent our country’s largest-ever investment in maternal health.

Shalon’s story was also one of the influences for calls for other systemic changes regarding funding allocation and research priorities in federal and state institutions. Recently, the National Institutes of Health, CDC, and Health Resources and Services Administration have increased funding to support much-needed research on the constellation of factors influencing Black maternal mortality. In addition, several states have sought, and the Centers for Medicare and Medicaid Services (CMS) has granted, Section 1115 waivers to allow continuous postpartum Medicaid coverage of up to one year, extending the sixty-day coverage period required by statute. The American Rescue Plan Act of 2021 further enabled states to use state plan amendments in addition to Section 1115 waivers to accomplish some of these objectives. In 2020 the Surgeon General released a Call to Action to Improve Maternal Health.

Shalon’s story has had an enduring effect on the ways in which public health and medical educators characterize Black maternal health.

Shalon’s story has had an enduring effect on the ways in which public health and medical educators characterize Black maternal health. The Commissioned Corps of the US Public Health Service and the Epidemic Intelligence Service at the CDC have established awards to honor Shalon’s lifelong commitment to advancing health equity. Her friends, family members, and colleagues who were members of the Epidemic Intelligence Service instituted the Shalon M. Irving Health Equity Award to ensure that her dedication and passion for addressing structural inequity live on in future generations of public health professionals. In addition, educators have included the details of her pregnancy and subsequent death as a case study when examining the broader systemic failures in the delivery of health care for pregnant Black women in the US, including in the 2019 Johns Hopkins Bloomberg School of Public Health’s “Fierce Urgency of Now” symposium, which memorialized Shalon as a scholar, health equity leader, daughter, and friend; academic grand rounds held at schools of medicine and public health around the nation; and scholarly pieces from the Harvard School of Public Health and the Robert Wood Johnson Foundation.

These efforts have been aided by high-profile news coverage about the circumstances surrounding Shalon’s death, as well as features in documentaries about maternal mortality in Black women, including the forthcoming “Listen to Me” documentary. Her story was covered extensively in articles published by ProPublica and NPR and served as a lens through which a mainstream audience came to a deeper understanding of the unique struggles confronting Black pregnant women. Her story was also featured in CBS News, Chicago Magazine, USA Today, and Time Magazine.

In the nonprofit sector, Shalon’s mother joined forces with several of her friends and CDC colleagues to found Dr. Shalon’s Maternal Action Project. This organization is devoted to eliminating preventable deaths in Black mothers by engaging stakeholders along every part of the public health and health care spectrum. Organization leaders also actively work with legislators to promote accountability measures and bills focused on improvements in the postpartum period. The organization is also working on a feature-length documentary film about the lessons learned and legacy of Shalon.

Dr. Shalon’s Maternal Action Project is also spearheading a community-based project designed to redefine quality of medical care for Black women and has created an anonymous peer support app, Believe Her, to provide a platform for Black mothers to share their experiences, benefit from peer-to-peer support, and develop and promote evidence-based strategies that improve health outcomes for Black birthing people and families. Believe Her was officially launched at the 2021 Black Maternal Health Conference and is part of a growing movement in advocacy and technology by Black women to support Black mothers, challenge structural racism, and save lives.

For Soleil

Shalon’s life and passing fundamentally shifted public and policy discourse on maternal health disparities and the pressing need to acknowledge and address systemic racism as a root cause of racial disparities in maternal health outcomes. Although her death underlines how racism erodes the protective benefits that educational attainment and higher socioeconomic typically confer for birthing people, the collective efforts of loved ones, colleagues, and policy makers are a testament to the impact of her steadfast commitment to health equity and social justice.

It is our hope that Shalon will be remembered not only for how she left this life but also, and more important, for the luminance, warmth, and clarity that she blessed us with in her short time on this earth. Shalon’s light—her brilliance—made the world a warmer and brighter place. It burns on in the minds and hearts of those whom she touched and through her scholarly works. May it always be instilled in Soleil that she had a sound foundation from conception to delivery, knowing that as she arrives into her youth and eventually her womanhood, she can be whatever she desires to be. May she always know that she has a legendary mother and a loving, devoted grandmother who, in the urgency of now, would encourage her to advocate for those who cannot advocate for themselves. Asè.