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.
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.
“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.