ACT NOW: Is Grief Normative or a Diagnosable Condition?

Open for comment until 11:59 p.m. Eastern Time on Friday June 2, 2023

One of the most hotly debated topics in bereavement care is whether all grief is normative or a diagnosable condition. For the first time, the federal government is beginning to examine scientific evidence on when grief is normative and when, if ever, does it limit daily life and function.

As part of the FY23 U.S. budget process, Congress passed a $1 million appropriation directing the Agency for Healthcare Research and Quality, a federal health agency, to conduct an evidence-based review of grief and bereavement literature to determine the feasibility of developing consensus-based standards for high-quality bereavement and grief care. AHRQ is accepting comments from the public on this issue until 11:59 p.m. Eastern Time, Friday, June 2, 2023. To learn more, visit AHRQ’s website and follow the directions on how to submit a comment.

Further, a technical panel of experts will be convened to help guide and inform federal efforts. Evermore has the distinct opportunity to nominate experts for the technical panel. If you are interested in being nominated, submit a nomination here (the nomination period has now closed). Nominations will be accepted until 12:00 p.m. Eastern Time, Friday, May 19, 2023. Submitting a nomination application does not ensure that Evermore will advance your application to federal leaders. In addition, if accepted, Evermore will not cover expenses related to your service as part of this effort.

As concurrent mortality epidemics touch every neighborhood in America, now, more than ever, our nation must invest in grief and bereavement leaders, programs, and science. This effort will advance our nation toward Evermore’s vision of a world where all bereaved people experience a healthy, prosperous, and equitable future. We are more committed than ever to serving bereaved children and families and the tireless frontline providers who have been on the frontier for decades.

“I Want to Listen to Your Absence”

“Letter to My Father”

“LESS HEAVY THINGS”

“He Checks His Luggage”

“Nevertheless, It Moves”

 

Five Important Questions About FMLA and Bereavement Leave

By Prerna Shah

When a loved one dies, many family members seek bereavement leave to attend to family affairs, their grief, and sort through the many changes that invisibly unfold behind closed doors. It may be surprising to learn that most employees have no legal right to take leave, except in five states in America (learn more about state bereavement laws here).

The Family Medical Leave Act, also known as FMLA, provides job and benefits protection for 56 percent of the United States workforce; however, bereavement is not an eligible condition for job or wage protection. Many may be surprised to learn that newly bereaved families have no legal right to take leave to cope with the death of a loved one. 

So, what is a newly bereaved family member to do? 

In honor of National Employee Benefits Day, Evermore sat down with Jeff Nowak, an FMLA expert, who provides legal strategies and solutions for employers of all sizes across the globe, for an in-depth conversation on all aspects of FMLA.

1) What is the FMLA?

FMLA is a federal law that provides up to 12 weeks of leave to an eligible employee in a 12-month period. There are a number of reasons why you may be eligible for FMLA job protection, including 

  • An employee’s own serious health condition, 
  • the employee has to care for a family member with a serious health condition, or 
  • due to pregnancy, 
  • bonding time after childbirth or adoption, or placement into foster care, and
  • a qualifying need due to the active duty of a spouse, child, or parent.

While FMLA generally covers all public-sector employers, it also extends coverage to private employers that have 50 or more employees in a 75-mile radius. In general, to be eligible, an employee must have worked for at least 1,250 hours over the previous 12 months. 

 

2) Does FMLA offer bereavement leave? 

No, generally, FMLA does not specifically provide bereavement leave; however, Department of Labor statements and legislative history indicate a miscarriage is classified as a “serious health condition.” As a result, both miscarriage and stillbirth — two conditions before independent life begins — should be eligible for FMLA bereavement leave if the birthing person is unable to work because of her own “serious health condition” (e.g., physical recovery from miscarriage and/or labor and delivery, emotional distress). Paternal coverage may be extended if the spouse is caring for a loved one with a serious health condition.

For most bereaved families, however, bereavement is not an eligible event for FMLA job or wage protection.

Novak shares, “Oftentimes, employers have their own bereavement leave policies. Generally, these policies cover one to three days of bereavement leave, but that is not enough for most people. FMLA can be invoked to cover bereavement leave if the employee has a serious health condition like depression or anxiety, but you would need to invoke the ‘serious health condition.’

 

3) How can you best communicate with your employer after a loss?

Communication is key. 

According to Novak, “It’s so critical that the employee simply communicates upfront. Be candid with your employer. I’m hurting right now. This is a really difficult time for me, I can’t keep my attention on my work when I’m dealing with this loss in my life.”

“Some of us are fearful of that, right? We’re fearful of what the employer may do. We are in fear of losing our job as a result. But it’s important to characterize what you’re dealing with; if you need to start using words like, “My mental health is at issue here, or I just need to leave for my own mental health.” I tell employers that that line alone triggers an FMLA obligation. Now we potentially are in an FMLA-protected situation.”

Novak suggests that it’s beneficial to involve the HR team: “It’s important to be in full communication with the HR team. Look at your FMLA policy and find out, who does your employer want you to communicate with?”

Candid and open communication with the employer can make a difference; however, only share what you feel comfortable with. When the employer understands that coping is inducing mental distress, that’s when FMLA may be triggered, and this affords the employee job-protected leave. 

 

4) What compensation is offered through the FMLA?

Leave associated with FMLA is unpaid. 

When someone close to us dies, families often incur unexpected costs like funeral expenses, moving property or estate titles, among others. Novak shares, “By its very nature, federal FMLA is unpaid. And that remains (so) today. And I would say for the foreseeable future, federal FMLA is going to be unpaid.

Nowak adds, “As a result of Congress being unable or unwilling to pass a paid leave law at the federal level, we’ve seen quite a bit of growth at the state and local level when it comes to paid FMLA leave.” 

If you are able to take bereavement leave, it’s important to keep in mind that employers have no legal obligation to pay the employer during their leave. 

Nowak notes that while a handful of states have passed their own FMLA laws, others have passed paid FMLA laws and others have provisions for paid sick leave (learn more about state bereavement laws here). 

Nowak says, “It’s likely that we may see a paid leave law that involves contributions from either the employer or the employee or both sharing (contributions) that provide the funding for paid leave.” 

 

5) Where can I find out more information?

For more in-depth coverage of our session with Jeff Nowak, you can head to our YouTube channel, and don’t forget to subscribe while you are checking our videos. We regularly update our channel with resources from experts working in the area of grief and bereavement, and our In the Know sessions are very popular and informative. 

On our website, you will also find many relevant and expert-led resources on FMLA – miscarriage and stillbirth, state laws and legislation related to bereavement leave, U.S. military bereavement leave guidance, general information on grief, how community leaders can help, our national grief support directory, books on grief for adults and children, our most recent achievements in advancing in bereavement care, and more. 

Please also help spread the word about FMLA and bereavement leave, have these conversations with your colleagues and coworkers on this National Employee Benefits Day. 

A Year in Review 2022: Advancements in Bereavement Care

In 2022, our community of supporters has grown by more than 50 percent for the second consecutive year. Our movement consists of people from every corner of America – from truck drivers to professors to homeschoolers and executives. We unite in solidarity to create a more compassionate world for those who will follow us. What do we do with the pain of loss? We create change.

We’ve done that in 2022, and we are on the cusp of much more. This year has been the most consequential yet in the advancement of bereavement policy, and we could not have made it this far without you. As we reflect on 2022 and look towards 2023, there are some bright spots we want to share with you:  

  • We are winning mindshare among our nation’s most esteemed federal health leaders. In an event hosted by the Centers for Disease Control & Prevention (CDC), our founder and executive director Joyal Mulheron, had the distinguished opportunity to provide a private briefing to key U.S. Department of Health & Human Services agencies on bereavement policy, research, and statistics. As an emerging social and health concern, it is imperative that government leaders understand the complexity of bereavement policy and its impact as it crafts and prioritizes its response. 
  • With Evermore’s support, Congress is directing the federal government to establish credentialing standards for grief therapists. Supporting bereaved people requires specialized training, which is not currently required for mental health practitioners. We are thrilled that Congress has directed federal health leaders to create universal eligibility standards to bring consistent and quality care to all grieving people.
  • For the first time, Congress is encouraging CDC to collect bereavement data because of Evermore’s advocacy. Adding bereavement exposure to CDC data collection provides key demographic data and trends by race, geography, chronic disease risk factors, identity, and age, for example. A recurring data set of this magnitude will facilitate a better understanding of the scope of the problems connected to bereavement, and it will inform future policymaking and program priorities and investments.
  • With Evermore’s support, Congress is directing federal health leaders to write the nation’s first report on grief and bereavement. COVID-19 and the nation’s concurrent mortality epidemics have impacted millions of Americans, yet grief and bereavement are not prioritized in our nation’s health policies, programs, or funding initiatives. This report will provide a holistic evaluation of the scope of the issue, the populations impacted, and the interventions offered to support grieving children and families. 
  • We are fighting for consumer rights, protections, and price transparency in the funeral industry. In almost every state in the nation, funeral homes are not required to publicly share their prices before a bereaved family walks through their doors, thereby leaving newly bereaved families vulnerable to price gouging and spending on services they don’t need or want. Evermore is preparing comments to submit to the Federal Trade Commission (FTC) on why funeral homes should be required to share pricing information publicly. This proposed amendment may substantially protect bereaved families during times of loss and crisis. 
  • Evermore releases America’s Forgotten Orphans, a free 58-page report, to bring childhood bereavement to the attention of federal lawmakers and agencies. In collaboration with Penn State and the University of Southern California, we identified a 22-year trend in increasing childhood bereavement across every state in the nation and among every racial and ethnic population. Childhood bereavement, and bereavement generally, have been a long-standing public health and social concern hiding in plain sight. 
  • Evermore releases free fact sheets and tools to calculate childhood bereavement in your own jurisdiction. We’ve developed 51 state fact sheets that help state and local lawmakers assess and better understand childhood bereavement in their jurisdictions. In addition, we’ve provided tools allowing local champions to calculate the prevalence of childhood bereavement in their school or Congressional districts. 
  • We are bringing the nation’s experts in grief and bereavement to you. This year we launched In the Know, a monthly video series featuring some of the nation’s experts in grief and bereavement, including luminaries like Megan Devine, one of our nation’s most respected grief leaders, and Dr. Toni Miles, who helped pioneer bereavement epidemiology. 
  • Evermore’s national grief directory continues to be a top resource for grieving children and families. Our comprehensive grief directory features more than 300 nonprofit resources across every state in the nation and continues to grow.
  • Our weekly newsletter keeps our community connected, learning, and engaged. This year we launched a weekly newsletter to provide insights on bereavement science, policy, and community action. Our readership continues to grow as our stories and information aim to transform our nation’s systems toward supporting the lives of bereaved children and families. 

 

We are not sitting on the sidelines and hoping change will come. We are actively working to advance these critical developments with respect and credibility each day. As we close out 2022, we want to thank you for making our work possible. Unlike other health and social concerns, bereavement policy and law are not funding priorities for any philanthropist or foundation we can find. Instead, people like you solely fund our movement.

 

We will continue our work building a healthy, prosperous, and equitable future for all bereaved people in 2023. If you would like to support our work in the coming year, you can make a donation here.

 

We wish you and yours a warm, healthy, and restorative 2023!

Few Universities Offer Leave Policies and Grief Support for Bereaved Students

It was the beginning of her junior year at the University of South Carolina (UofSC) when Mairead Peters’ cousin unexpectedly passed away. Not only was Peters just getting settled into her new class schedule, she was now forced to navigate the school year while wading through the shock and pain of her grief. 

The following semester, Peters also experienced the death of her father. 

Despite losing two loved ones in such a short period of time, Peters decided to continue her studies, hoping college could serve as a distraction to the grief she now carried. To help her through this journey, Peters sought resources at her university, but found none were available. 

“I had to be my own advocate and try to search for other people like me,” says Peters. “There weren’t really any groups offered at my college, and so I just had to rely on my own friends and support group, which I was fortunate enough to have. But a lot of people don’t have that. I went to a big school, and the fact that they didn’t have some type of support group already in place was pretty shocking to me.”

Peters is not alone in her experience, as recent research indicates that 25 and 30 percent of college students, if not more, experience the death of a family member or close friend in a given year. In the span of two years, that percentage rises to 40, according to several 2020 studies conducted by Dr. Chye Hong Liew and Dr. Heather L. Servaty-Seib of Purdue University West Lafayette. 

After experiencing the death of someone close to them, students must not only navigate their grief, but also  continue on with their studies if they decide to remain in school, in which case, according to Dr. Liew and Dr. Servaty-Seib’s work, students become more at risk of poor academic performance, lower semester GPAs, and possibly withdrawing from enrollment compared to students who have not experienced a loss. Even so, few college campuses in the United States have instituted adequate bereavement-leave policies to protect grieving students and their academic success. Unlike working adults, students attending a college or university are not able to take time away from school — often because they will miss lectures, labs, or exams. Without specific policies in place, professors are provided the ultimate discretion in the treatment of absences, even for students who are recently bereaved. 

“Students who are believed and supported in their grief will be more engaged both while they are students and when they transition to alumni,” Dr. Servaty-Seib wrote in an email. “If we are truly committed to our students’ academic, professional, and holistic growth and development, we must create structures that facilitate rather than hinder their success.”

Purdue University has been addressing the needs of grieving students since 2011, when a bereavement policy — only the second in the country at the time — was enacted by the university faculty senate. The Grief Absence Policy for Students (GAPS) protects university students and their ability to make up coursework after experiencing the death of a loved one or friend.

The Purdue policy outlines qualifying requirements about the relation of the student to the deceased, the number of leave days allowed, and the additional absences afforded to students for travel considerations. Students can also petition for leave for the death of a family member or friend in the event that their situation is not explicitly covered by the policy. 

When a student wants to request leave under GAPS, they first fill out an online form through the Office of the Dean of Students (ODOS) to report the death. After completing a report, the student’s instructors are notified of their absence. Upon receipt of either an obituary or a card from the memorial service following the student’s leave, the ODOS counselor sends an official notification to the instructors. 

“At a minimum, students should receive the same assurance that employees have in terms of their ability to take days away for bereavement leave,” Dr. Servaty-Seib wrote. “Here at Purdue, our advocacy did begin with looking at the standard bereavement policy for employees.”

Drawing from the Purdue Paid Bereavement Leave policy for employees and the student bereavement policy at Ball State University — the only other known policy at the time — the Purdue Student Government (PSG) began drafting a resolution for a bereavement policy for students in 2010. 

Before meeting with members of the faculty senate, Brad Krites, then president of PSG, leveraged his relationships with the Purdue student newspaper, The Exponent, to call for the publication of articles that featured grieving students who had fallen through the cracks created by the absence of a bereavement policy. The paper also published editorials championing support for the proposal. 

After approval of the resolution by the university student senate, Krites introduced the proposal before the faculty senate. One month later, in March 2011, the resolution was overwhelmingly approved by the university faculty senate. 

According to Dr. Servaty-Seib, the policy was a success, largely because it addressed the faculty concerns about consistency in applying the policy, validation of the death information submitted by students, and assurance that the process wouldn’t require more of their time. 

Although the policy has been in place for 11 years now, research conducted by Hannah Darr, a student of Dr. Servaty-Seib revealed that only 11 percent of students were aware of the policy and knew how to use it, while 26 percent had never heard about the policy. 

Students who were aware of the policy said they learned about it through faculty members and orientation programs. Students who were eligible to utilize the policy but didn’t said this was either due to lack of awareness or concerns about compromising their academic standing. 

The study also found that Black and brown students were even less likely to know about, and less likely to utilize, the Purdue student bereavement policy, despite experiencing a much greater number of deaths while in college. 

Dr. Servaty-Seib offers that Black and brown students may feel less comfortable communicating about their losses with campus faculty and staff based on prior, unfavorable campus experiences. 

“They may not want to share their business for fear it will come back around and be used against them,” Dr. Servaty-Seib wrote. “These students may not trust that faculty will offer them the ability to make up work, or if they do allow it, will see them as asking for extra assistance rather than it being their right.”

Sydney Rains, vice president of the student body association and a senior at Gonzaga University (GU), is working to fill this bereavement policy gap at her university. Rains began to push for  a similar bill after her own experience with the death of a loved one that irrevocably altered the final months of her junior year.

Rains and her father share a tattoo.

In an interview with GU’s student newspaper, The Gonzaga Bulletin, Rains explains that after she experienced the death of her father, she felt a lack of care and support from her university.   

“The experience I had coming back to school was much different than what I expected it to be at a small, intimate institution that is very much looked up to in their mental health aspects,” Rains told The Bulletin. “I think that, at a school where we talk so much about caring for the whole person, it’s essential to live up to that promise by providing structure and support for students during times of tremendous loss.”

Less than two weeks after the death of her father, Rains returned to class, working feverishly to complete assignments she had missed during her absence.

Rains with her father during a track event.

“That point was when I was really starting to feel the drive to pursue a bereavement policy because my experience was just so exhausting,” Rains told The Bulletin. “It’s heartbreaking to think of other students having to go through the same situation that I did.”

After numerous meetings and conversations with university provosts, deans, and other decision-makers, Rains was able to gain enough support to back a resolution she intends to write and propose to the student body senate. 

Her resolution calls for the university to develop a bereavement policy that covers absences and academic deadlines after the death of a loved one. Gonzaga’s administration operates on a shared governance system, comprised of an academic council and faculty senate. After her proposal to the student body senate, Rains plans to consult the faculty senate to get more feedback. The final step will be to present the proposed policy to the academic council, where members will vote to determine if such a policy will be developed.

Although these two universities are working toward student bereavement equity, Dr. Servaty-Seib says every institution should consider its own culture and general approach to bereavement when exploring the implementation of such a policy. 

In an article published in the Journal of College Student Development, Dr. Servaty-Seib and Dr. Liew advise colleges and universities seeking their own student bereavement policy to look to existing faculty and staff policies for guidance, engage with key faculty leaders and administrators, use the media to generate awareness, and perhaps most importantly, involve students and their stories. 

“The most compelling and convincing voice for a student-focused policy like a student bereavement policy may be a student,” writes Dr. Servaty-Seib. “If grieving students are open to sharing their stories and challenges, consider including them in the process. Their words can be powerful, and they may appreciate the opportunity to make a difference through advocating for future grieving students.”

The Bereavement Benefit Most Women Don’t Know About (But Should!)

As many as half of all pregnancies end in miscarriage. Even though 87 percent of women have experienced a miscarriage while employed, an alarming number of women aren’t aware that the Family Medical Leave Act (FMLA) allows for time off from work after a miscarriage and stillbirth. 

These were the findings from a survey conducted by InHerSight in partnership with Evermore. InHerSight uses data to help women find employers and companies that support women’s goals and needs. This survey, conducted earlier this year, included 1,300 women, with the goal of assessing their awareness of their right to time off work under FMLA after experiencing a miscarriage or stillbirth. 

Survey results were striking, with 77 percent of respondents indicating they were unaware they had access to this protection. Sixty-six percent of these women reported that they hadn’t been informed by their employer of their legal rights regarding leave under FMLA, which guarantees up to 12 weeks of unpaid leave if the employee is unable to work because of his or her own “serious health condition.”

While miscarriage and stillbirth are not specifically included in the definition of “serious health condition” in FMLA, Department of Labor statements and other legislative documents indicate miscarriage is covered by the policy. A woman whose pregnancy ends in miscarriage should be able to use FMLA leave if she’s unable to work due to physical recovery or emotional distress.


Even so, 91 percent of women who have experienced a miscarriage or stillbirth while employed reported taking no days off work to recover. Ninety-eight percent of the women surveyed reported not filing for leave under FMLA after experiencing a miscarriage or stillbirth.
[Read more about InHerSight’s findings here.]

“Knowing federal leave benefits should not be the responsibility of a newly grieving woman or family. Employers have a tremendous opportunity to provide a supportive workplace environment by ensuring that women are aware of their rights.”

As Evermore seeks to learn more about the realities of bereavement in the United States, and the impact of those realities, partners like InHerSight play a crucial role in gathering data and identifying areas in need of policy change and community support. Evermore partnered with InHerSight for this survey because of the company’s dedication to women employees and their benefits and well-being in the workplace. 

“Partners like InHerSight are critical in facilitating transformational social policy,” Mulheron says. “Bereavement is ubiquitous. Understanding the impact, collecting data on the family’s perspective, and then shining a spotlight on those experiences requires leadership. We are grateful to InHerSight and others who are advancing bereavement care in America.”

The findings from this survey indicate how important it is for workplaces to provide effective education and communication that cultivates a supportive environment for employees experiencing bereavement. At Evermore, we believe it is crucial that employers take greater initiative to inform their employees of the benefits and protections available to them. 

Benefits should be communicated through employee handbooks, during onboarding and orientation trainings, and throughout the duration of a worker’s employment. When the time comes for employees to exercise their benefits, employers should be prepared to guide them through the process and direct them to human resources (HR) for further assistance. 

Employers must also work hard to create a culture in which people can bring personal and emotionally challenging issues to their directors, managers, and HR personnel. To further support an inclusive workplace culture, Evermore also recommends that employers institute five days of paid bereavement leave for all employees. 

“According to the Department of Labor, only 56 percent of America’s workforce qualifies for FMLA benefits,” Mulheron says. “That leaves millions of women working in the gig economy, in small employers, or as solopreneurs who have no benefit at all.” 

In 2021, Senator Tammy Duckworth (D-IL) and Congresswoman Ayanna Pressley (D-MA) introduced legislation that aims to raise awareness about pregnancy loss and provide paid leave benefits for workers experiencing the pain of a miscarriage or stillbirth. The Support Through Loss Act supports bereaved workers by increasing access to workplace supports and access to resources and adequate care. 

“Pregnancy loss should be met with care, compassion, and support. It is a common experience, but many struggle in silence due to the lack of awareness and cultural stigma,” says Pressley in a press release detailing the legislation. “Our bill sends a message to families that they are not alone.”

It is also imperative that employees know how to advocate for themselves in order to access the benefits available to them. If you are unaware of the benefits at your workplace, ask your manager or an HR representative to guide you through company policy. Evermore encourages readers to communicate their knowledge with coworkers, improve awareness in the workplace, and work together to create a workplace where benefits are a continuous topic of conversation.

Toni Miles’ Ground-Breaking Research in Bereavement Prevalence

Earlier this month, Evermore hosted a conversation with Toni Miles, M.D., Ph.D., a grief and bereavement researcher in Georgia and Morehouse School of Medicine adjunct professor, to discuss the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) — a health-related survey of adults that measures certain behaviors, such as seatbelt use, smoking, and substance use. [Watch the full conversation here.]

While the BRFSS asks a number of questions about physical and mental health, one thing it doesn’t measure is adult experiences with the death of loved ones and family members. “We count dead people, but we do not count the people who are left behind,” says Miles. “We can’t see bereavement because we don’t count it.”

In a quest to discover the population health effects of death in her home state, Miles conducted a field study in 2019 that piloted three bereavement exposure questions in Georgia’s BRFSS. 

As part of her study, Miles asked participants if: 1) they had experienced a death event in the past two years, 2) how many deaths they had experienced, and 3) their relationship to the individual who was lost. The data she collected was striking. [/vc_column_text][vc_video link=”https:///www.youtube.com/watch?v=vRi8AUTzTyo”][vc_column_text]Miles’ work found that, pre-COVID, 45 percent of Georgia adults surveyed had experienced death in the previous two years — with 400,000 people experiencing two or more deaths in that time period. Extrapolating these findings to the overall state population, Miles estimates that 3.7 million adults, out of Georgia’s 8.1 million residents, were recently bereaved.   

The survey also revealed a disproportionate burden on African Americans in Georgia, with 58 percent of respondents reporting the death of a loved one. 

The survivors of these death events are, themselves, at risk for poor physical health outcomes, premature death, and other adverse consequences that can alter their life course. Miles’ work found that Georgia adults experiencing a family death were at a higher risk of mental health problems, an undermined capacity to work, and binge drinking. 

Distinguished researcher and bereavement expert Dr. Toni Miles

“We always talk anecdotally about how bereavement makes people sick — so and so died of a broken heart — but you don’t have the data to make that connection,” says Miles. “BRFSS allows us to make that connection.”

Evermore hopes that more states will add these three bereavement exposure questions to their BRFSS population research because collecting data on bereaved residents could help Americans understand the associated impacts of bereavement and inform and bolster policy on bereavement care.

In 2021, Evermore leveraged Miles’ work, using the U.S. budget process as a catalyst to advance bereavement epidemiology in the BRFSS (read Evermore’s testimony to the Senate Health Appropriations Subcommittee here). Evermore created this avenue by successfully advocating for appropriations language to the U.S. budget that works to standardize the CDC’s measurement of the three bereavement exposure questions. However, implementation of these provisions is not guaranteed. 

This is why it is crucial for Americans to voice their position on this issue. Anyone can contact the BRFSS coordinator in their state to advocate for the inclusion of these three questions in future iterations of their state’s survey. If more states begin to adopt and ask these questions, the CDC is more likely to implement them nationwide. 

We encourage readers to identify their local coordinator, call them, and explain why these questions are crucial to bereavement care. This is a universal issue — one that disproportionately impacts communities of color — and now is the time for action.