Derek M. Griffith, Ph.D. University of Michigan Michigan Premier Public Health Conference October 12, 2011 Promising Practices To Reduce Infant Mortality through Equity

Overview  Examine the pattern of disparities in infant mortality in Michigan  Explore the rationale behind the PRIME Intervention strategy  Outline some of our activities, objectives, outcomes and next steps

Infant Mortality Rates by Race: United States, * *Note: For years , “White” included persons stated to be “White,” “Cuban,” “Mexican,” or “Puerto Rican.” All others during that time period were referred to as “Nonwhite.”

Black-White Ratio of Infant Mortality, U.S.: * *Note: For years , “White” included persons stated to be “White,” “Cuban,” “Mexican,” or “Puerto Rican.” All others during that time period were referred to as “Nonwhite.” YEAR

Source: Michigan Resident Birth and Death Files, Division for Vital Records & Health Statistics, Michigan Department of Community Health Black and White Rates of Infant Mortality in Michigan:

Black-White Ratio of Infant Mortality in Michigan: Source: Michigan Resident Birth and Death Files, Division for Vital Records & Health Statistics, Michigan Department of Community Health

Black, Non-Hispanic Overall IMR= 14.1 Maternal Health/Prematurity 7.0 Maternal Care 1.9 Newborn Care 2.0 Infant Health 3.3 Data Source: 2008 Live Birth, Fetal Death and Death Cohort Matched Infant Death Files, Vital Records and Health Data Development Section, Michigan Department of Community Health Reference Overall IMR= 5.3 African American PPOR compared to the reference group, Michigan Overall Excess: 8.8 Maternal Health/Prematurity 2.1 Maternal Care 1.3 Newborn Care 1.0 Infant Health 0.9

American Indian Overall IMR= 12.2 Maternal Health/Prematurity 2.3 Maternal Care 3.2 Newborn Care 3.2 Infant Health 3.6 Data Source: 2008 Live Birth, Fetal Death and Death Cohort Matched Infant Death Files, Vital Records and Health Data Development Section, Michigan Department of Community Health Reference Overall IMR= 5.3 American Indian PPOR compared to the reference group, Michigan Overall Excess: 6.9 Maternal Health/Prematurity 2.1 Maternal Care 1.3 Newborn Care 1.0 Infant Health 0.9

PRIME Goals  Develop a training model and resources that promote understanding of practices that support institutional racism & help to eliminate racial disparities in infant mortality  Use state/local partnership network to codify effective efforts that undo racism & help to eliminate racial disparities in infant mortality  Establish a sustainable quality assurance process for these efforts within the BFMCH

PRIME Funding and Structure  Kellogg awarded one-year grant May 2010  Kellogg awarded 2 additional years December 2010  Steering Team Intervention Workgroup Evaluation Workgroup Local Learning Collaborative

PRIME Steering Team  Public Health Administration J. Chabut B. Pash  FMCH Bureau A. Carr B. Jegede C. Ogan B. Fink P. Dobynes-Dunbar C. Celestin L. Barnett B. Pash S. Bien  Epidemiology B. Coughlin  Minority Health Section S. Weir H. Nichol  University of Michigan D. Griffith J. Ober Allen T. Reischl  Local Public Health R. Canady Hammami  CBO E. Clement E. Kushman L. Abramson D. Peterson

Local Learning Collaborative  MI Department of Community Health  County/City Health Departments Berrien County Detroit Genesee County Ingham County Jackson County Kalamazoo County Kent County Oakland County Washtenaw County  Healthy Start Programs Detroit Genesee Grand Rapids Kalamazoo Native American (Sault Ste. Marie) Saginaw  Community-based Organizations ACCESS, Dearborn Dispute Resolution Center, Ann Arbor Grand Rapids African American Health Initiative MI Minority Health Coalition National Kidney Foundation

Promising Practices Overview

Conceptual Individual (risk factors) vs. Population Health approach Make explicit and plain what SDOH mean for how we think about racial disparities Incorporate social and cultural assets Unique social, cultural and historical roots of racial disparities - AA-White and AI- White

Individual Focus

Population Health Focus

Practical Develop and pilot resources and experiences that help staff incorporate SDOH in their day-to-day work Create tools that promote staff accountability and increase staff capacity to attend to SDOH Increase the capacity of staff and teams to assess and address their training needs in these areas

Technical Create separate but complementary plans to address AA-White and AI-White disparities in infant mortality Improve the quality of data available to inform statewide strategies to address AA- White and AI-White disparities in infant mortality Increase capacity for BFMCH for staff to use data to inform decisions, practices and policies

Organizational Revise strategic plans and other documents Decrease duplication of BFMCH and MDCH programs that affect infant mortality More effective utilization of inter-division expertise, resources and data and better quality improvement Increase capacity for BFMCH to support local efforts to address racial disparities in infant mortality

Contextual Conditions >20 year disparity in infant mortality in MI MI economic challenges Decreasing MDCH budget large percentage of MDCH staff are eligible for retirement Human Resources Leadership of MCH Bureau Director Co-Investigator and Evaluator from UMSPH Collaborators: NACCHO, local health officials, & MDCH directors & staff External training consultants, content experts, contractors & facilitators Opportunities for Inter- & Intra-departmental collaboration (i.e., HDRMH, DHS, Medicaid, etc.) OUTCOMES Short-Term Outcomes Increased Knowledge of Staff Tool kit & curriculum Change in BFMCH policies that may contribute to the racial disparity in IM Increased monitoring of SDOH in statewide health disparity report Increased continuous quality improvement and public sharing of measurable outcomes that reflect racial equity and health equity Increased BFMCH- local partnership efforts to reduce racial disparities in IM INPUTS ACTIVITIES OUTPUTS Recruit & hire project coordinator & leadership team to lead bureau efforts Project coordinator # of leadership team meetings Meeting minutes # of leaders involved in meetings and training activities Promising Practices To Reduce Infant Mortality through Equity Principal Investigator, Alethia Carr Revised, June 17, 2009 Documents Epidemiologic report to monitor IM disparities Green paper review of possible intervention strategies White paper of new policies & guidelines Distribution of Green and White papers to key people for feedback Long-Term Goal Reduction in the black/ white racial disparity in infant mortality in MI Review of bureau and non-health policies and practices Create tool kit and curriculum on social determinants of racial disparities Staff training # of meetings or discussions devoted to Bureau Review activity # of participants involved in meetings and training activities # of Employee Hours devoted to project activities Write and get expert feedback on reports, green paper, & white paper Evaluation Review of existing models and curricula Conduct self- assessment of MDCH social justice orientation

“The aim of research on health disparities is not to just accurately describe health differences or determine their cause, but to do so in a way that will be useful to making predictions, preventing greater health disparities, and improving human health.” (de Melo-Martin & Intemann, 2007)

Poverty Thresholds 2006 (Use landscape & legal printer options to print this table) Derek M. Griffith, Ph.D. University of Michigan School of Public Health