Promising Practice: A Successful Infant Mortality Reduction Initiative Shannon Brownlee, MPH Daniel Kruger, Ph.D. CityMatCH Urban Maternal and Child Health Leadership Conference September 23, 2008

Our Problem Genesee County REACH 2010 Project 9/08

Genesee County REACH 2010 Project 3/08

REACH Partners FACED Flint Odyssey House/Health Awareness Center Genesee County Community Action Resource Department Genesee County Health Department U-M SPH/PRC Genesys Regional Medical Center Greater Flint Health Coalition Hurley Medical Center Mott Children’s Health Center PRIDE Priority Children U-M Flint Genesee County REACH 2010 Project 9/08

Our Community Action Plan  Derives from two points of view: –Bench –Trench Genesee County REACH 2010 Project 9/08

 Bench Racial disparities in infant mortality have persisted despite at least 2 decades of applied contributions from the clinical, scientific laboratory and legislative arenas to reduce racial disparities. –Two explanations:  No single intervention is likely to eliminate racial disparities in infant mortality  The period of pregnancy is simply too short to effectively address many risk factors important to infant health. Genesee County REACH 2010 Project 9/08

 Trench –If you always do what you’ve always done, you’ll always get what you’ve always gotten. If you want something you’ve never had, you have got to do something you’ve never done. Genesee County REACH 2010 Project 9/08

Thinking Outside of the Box A Different Approach to Address Infant Mortality “Trench” Community-based Partners “Bench” Genesee County REACH 2010 Project 9/08

Socio-Ecological Model Genesee County REACH 2010 Project 9/08

Addressing Infant Mortality in Genesee County: Our Model MATERNAL-INFANT HEALTH Fostering Community Mobilization Enhancing the Babycare System Reducing Racism

Fostering Community Mobilization

Community Dialogues  Priority setting and problem-solving regarding infant mortality –Two action groups organized –Black Men for Social Change –Women Taking Charge of Their Health Destiny  Provide needed assistance to mothers  Community empowerment & education  Health fairs Genesee County REACH 2010 Project 9/08

Community Media Campaign Radio spotsRadio spots TV commercialTV commercial Posters, fans, T-shirtsPosters, fans, T-shirts Billboards Genesee County REACH 2010 Project 9/08

Enhancing the Babycare System

 Provider seminars and community roundtables  Perinatal risk assessment tool  Perinatal morbidity and mortality reviews  Safe sleep campaign PRIDE Medical Services Committee Genesee County REACH 2010 Project 9/08

Maternal/Infant Health Advocates  Peer support  System navigation  Community “windshield” tours Genesee County REACH 2010 Project 9/08

University “Cultural Competence in Health Care” Course  Designed and offered at University of Michigan – Flint –Specialized training for client advocates –Enhance culturally competent practice –Improve patient-provider communication –Patients more likely to keep prenatal care appointments Genesee County REACH 2010 Project 9/08

Reducing Racism

Undoing Racism Workshops –2 ½ day facilitated event –24 workshops with over 880 participants –People’s Institute, New Orleans, Louisiana –Impact  Attitudes and beliefs towards culture and racism  Diffusion of impact  Follow-up working groups of community residents Genesee County REACH 2010 Project 9/08

African Culture Education Development Center  History and culture lectures  Middle Passage Experience  Post-Traumatic Slavery Disorder Curriculum Genesee County REACH 2010 Project 9/08

Healthy Eating Curriculum  Afrocentric  Peer Trainers  Harambee (“pulling together”) celebrations Genesee County REACH 2010 Project 9/08

SUCCESS!

Annual Infant Mortality Rates by Race Genesee County, MI Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.

Infant Mortality Disparity Ratio* Genesee County, Michigan *African American to White Disparity Ratios Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.

3-Year Moving Average Infant Death Rates Genesee County and Michigan

REACH Evaluation

Designed to assess: Process – Documentation of activities Outcomes – Changes in systems and individuals Impact – Changes in African American infant mortality rate and disparities with White infant mortality rate

REACH 2010 Logic Model

Vital StatisticsRacism and Health Disparities SurveyProcess Evaluation

Reduce/Undo Racism

Enhance Baby Care System

Mobilize Community

Facilitating Policy Change Graph Represents Institutional Policy Changes

REACH 2010 Evaluation Racism and Health Disparities Survey Asses experiences of racism, responses to experiences of racism, perceptions of the health care system, relationships with partners, health and birth outcomes. Telephone interviews were conducted by the Michigan Public Health Institute in April and May, 2007 Respondents included REACH Program participants, randomly selected community members aged in the REACH focus ZIP Codes in Genesee County, and randomly selected community members aged in demographically similar ZIP Codes in neighboring Saginaw County.

Descriptives of Survey Sample

Attitudes, Beliefs, and Knowledge regarding Racism

I believe that racism exists in our society today (Controlling for educational attainment)

Even today Blacks feel the effects of slavery and segregation (Controlling for educational attainment)

Experiences of racial discrimination

Beliefs regarding racism in healthcare

Blacks and Whites receive the same quality of health care (Controlling for educational attainment)

Blacks and Whites are treated with the same level of dignity and respect (Controlling for educational attainment)

Genesee County REACH Part 1: Perinatal Health Behaviors Vital Statistics Analyses Data Source: Michigan Department of Community Health’s vital statistics

Month of Pregnancy when African American Mothers entered Prenatal Care By County

Number of Prenatal Health Care Visits by African American Mothers By County

Kessner Index for adequacy of African American pre-natal care (lower scores indicate greater adequacy)

Genesee County REACH Part 2: Perinatal Health Outcomes Vital Statistics Analyses Data Source: Michigan Department of Community Health’s vital statistics

Percent of births that are premature among African American Infants

African American Infant Mortality Rate By County

Genesee County REACH Part 3: Socio-demographic trends Vital Statistics Analyses Data Sources: Michigan Department of Community Health’s vital statistics and U.S. Census’ American Community Survey

Socio-demographic trends in the Michigan Department of Community Health’s vital statistics and U.S. Census’ American Community Survey

Percent of Births to Women Aged 15-19

Percent of African American Births to Unmarried Women

Percent of African Americans with Income Below the Poverty Line

African American Mortality Rate, ages 5+

Socio-demographic trends American infant mortality rates would be difficult to explain by trends in the teen birth rate, percentage of births to unmarried women, educational attainment, household income, or poverty. No other age group of African Americans (assessed in 5 year age groups) exhibited a decline in mortality rates in 2004 and 2005 as African American infants did.

Conclusion The reduction in infant mortality rates in Genesee County, especially for African American infants, encourages the continuation and replication of activities in Genesee County’s REACH 2010 program. These activities continue as the Genesee County REACH partnership was selected to be a Center of Excellence in the Elimination of Disparities in the CDC’s REACH US program.

Shannon Brownlee, MPH Genesee County Health Department (810) Contact Us… Center of Excellence in Eliminating Disparities Daniel Kruger, PhD Prevention Research Center University of Michigan School of Public Health (734)