Beyond Infant Mortality: What’s Poverty and Race Got To Do With It? Just about everything when it comes to staying healthy in Memphis. NNIP Spring 2010

Phyllis G. Betts, Director Contact Center for Community Building and Neighborhood Action and InfoWorks Memphis School of Urban Affairs and Public Policy The University of Memphis

Key Sources Populations of Color in Tennessee: Health Status Report. Tennessee Department of Health Office of Policy, Planning, and Assessment and Office of Minority Health. Kenneth Robinson, et. al Populations of Color in Tennessee: Health Status Report. Tennessee Department of Health Office of Policy, Planning, and Assessment and Office of Minority Health. Kenneth Robinson, et. al Center for Community Building and Neighborhood Action: analysis of birth and infant mortality and other indicators for Memphis and Shelby County. Ongoing.Center for Community Building and Neighborhood Action: analysis of birth and infant mortality and other indicators for Memphis and Shelby County. Ongoing.

Infant Mortality Initiative Commercial Appeal feature followed by BabylandCommercial Appeal feature followed by Babyland Shelby County SummitShelby County Summit TN Office for Children’s Coordinated CareTN Office for Children’s Coordinated Care Infant Morality “Core Group”Infant Morality “Core Group” Established Shelby County Office for Early Childhood and YouthEstablished Shelby County Office for Early Childhood and Youth Early Success CoalitionEarly Success Coalition Voices for Memphis’ ChildrenVoices for Memphis’ Children

Infant Mortality: Canary in the Coal Mine 14 per baseline14 per baseline African American twice as high as white birthsAfrican American twice as high as white births Drivers: Pre-maturity and low birth weightDrivers: Pre-maturity and low birth weight 30% African American teens give birth by age 17 (city of Memphis)30% African American teens give birth by age 17 (city of Memphis) NICU progress at The MedNICU progress at The Med Individual education and social support: Blues Project, Moses Model, Centering PregnancyIndividual education and social support: Blues Project, Moses Model, Centering Pregnancy Social Marketing w/ Community VoiceSocial Marketing w/ Community Voice FIMR: Community Action TeamFIMR: Community Action Team

Deaths Per 1000 Live Births, Top Ten Leading Causes of Death Shelby County, TN, 2006 Source: Death Certificate Data (Tennessee Resident Data),Tennessee Department of Health accessed 5/11/2010

Early Success Coalition Nurse Family Partnership and support for building infrastructure (HHS)Nurse Family Partnership and support for building infrastructure (HHS) LeBonheur (Methodist) Children’s Hospital and Shelby County Office for Early Childhood and YouthLeBonheur (Methodist) Children’s Hospital and Shelby County Office for Early Childhood and Youth 65 provider partners65 provider partners Linked with Site Based Services CollaborativeLinked with Site Based Services Collaborative Data Partners: CBANA-InfoWorks and UTHSC Preventive Medicine/CANDLEData Partners: CBANA-InfoWorks and UTHSC Preventive Medicine/CANDLE National Mathematica evaluationNational Mathematica evaluation Collaborative planning and grantwritingCollaborative planning and grantwriting Advocacy: Voices for Memphis’ ChildrenAdvocacy: Voices for Memphis’ Children

Getting Organized Early Success Coalition Voices for Memphis’ Children Shelby County Early Childhood and Youth Provider Partners

Early Success Focus Areas Infant Mortality InitiativeInfant Mortality Initiative Home VisitationHome Visitation Parenting SupportParenting Support Headstart-PreK-Child CareHeadstart-PreK-Child Care Early InterventionEarly Intervention JustCare Family Network and JustCare 180JustCare Family Network and JustCare 180 Children’s Exposure to ViolenceChildren’s Exposure to Violence →Community Risks and Assets: CBANA-InfoWorks →Policy Advocacy: Poverty as a Risk Factor

Voices “Five Hopes” HealthHealth Behavioral HealthBehavioral Health EducationEducation Juvenile JusticeJuvenile Justice Social Equity: Unnatural CausesSocial Equity: Unnatural Causes

Poverty as a Risk Factor: Kids Heightened probability outcomes: Infant mortality/prematurity/low birth weight and related diagnosisInfant mortality/prematurity/low birth weight and related diagnosis Child obesity and diabetesChild obesity and diabetes Lead poisoning/other heavy metal toxinsLead poisoning/other heavy metal toxins Asthma/other respiratory diagnosis (second hand smoke)Asthma/other respiratory diagnosis (second hand smoke) Nutrition-related developmental and cognitive diagnosesNutrition-related developmental and cognitive diagnoses Stimulation-related developmental shortfallsStimulation-related developmental shortfalls Injuries from abuse, neglect, and neighborhood violenceInjuries from abuse, neglect, and neighborhood violence HomicideHomicide

28% Below Poverty Dire Poverty 15% Moderate and Higher Income 48% Low Income 24% Child Poverty in Shelby County

Reaching Families Where They Live

Early Impact of Disparities Framework Broaden focus to include Zone 2Broaden focus to include Zone 2 Asset MappingAsset Mapping Transformation Institute: wrap-around system of careTransformation Institute: wrap-around system of care Link with Site-Based Resident Services Collaborative: Reaching Families Where They LiveLink with Site-Based Resident Services Collaborative: Reaching Families Where They Live Toward a risk, assets, and segmentation model to drive action: Fragile Families frameworkToward a risk, assets, and segmentation model to drive action: Fragile Families framework

The Bigger Picture: Social Determinants Why are poverty and low educational attainment predictive of “unhealthy lifestyles”?Why are poverty and low educational attainment predictive of “unhealthy lifestyles”? Hint: “ignorance” is an insufficient answerHint: “ignorance” is an insufficient answer Aggravating factor: hardshipAggravating factor: hardship Mediating factor: stress → depressionMediating factor: stress → depression Mitigating factor: social supportMitigating factor: social support Theory of change: stronger families in stronger communitiesTheory of change: stronger families in stronger communities –Confronting poverty

Emerging Evidence: Stress Cortisol, adrenalin, and inflammationCortisol, adrenalin, and inflammation Biological markers vs. self-reportsBiological markers vs. self-reports Depression, self-medication, and immobilization vs. sense of efficacy and proactive self-careDepression, self-medication, and immobilization vs. sense of efficacy and proactive self-care Apparently self-destructive behavior is not just about poor self-esteemApparently self-destructive behavior is not just about poor self-esteem

Primary Social Support Systems FamilyFamily NeighborhoodNeighborhood SchoolsSchools WorkWork Housing as a PlatformHousing as a Platform

1-Year Clinic Visit Data Outcome Measures

Reaching Families Where They Live: Peacemaking Circles at Autumn Ridge