1. MICHIGAN Panel Presentation Region V Infant Mortality Summit, Chicago, IL March 21, 2013 Alethia Carr, RD, MBA Director, Bureau of Family, Maternal & Child Health Michigan Department of Community Health

2. Background - MICHIGAN Population demographics <9.9 M residents in 2011 81% white, 15% black, 0.9% Native American, 2.8% Asian/Pacific Islander 8.9% Unemployment, Dec. 2012 Ranks 38 th among states for IMR* Ranks 43 rd for African American IMR* Michigan’s 2010 Infant Mortality Rate (IMR) 7.1 ◦ African American IMR 14.1 ◦ American Indian IMR 10.5 ◦ Hispanic IMR 7.0 ◦ White IMR 5.5 2 *Source: Kaiser State Health Facts 2006-2008

3. Background - MICHIGAN Theoretical Framework is: ◦ Life Course Theory  Timeline, Timing, Environment, Equity ◦ Perinatal Period of Risk (PPOR)  Examines disparities Governor’s Dashboard has 2 health priorities Infant Mortality, Obesity 3

4. Background – MICHIGAN Governor Snyder’s Dashboard 4

5. The infant mortality rate among Black and American Indian infants is more than twice the state rate, 3 times higher than White infants and 3.7 times higher than Asian infants Michigan Infant Mortality Rate Race Specific

6. Trends of Infant Mortality by Race/Ethnicity and Disparities, MI 1970-2010 6 Source: Michigan Resident Birth and Death Files, MDCH Division for Vital Records & Health Statistics Prepared by: MDCH MCH Epidemiology Unit, 10/19/2012

7. Background – MICHIGAN Minority Health Bill passed in 2006 as PA 653 ◦ Mandates the SOM “develop and implement a structure to address racial and ethnic health disparities in this state” as part of the Public Health Code MDCH Organizational Structure support ◦ Section of Health Disparity Reduction / Minority Health Ambassador Initiative ◦ Overall health disparity data collection ◦ Epidemiology involvement ◦ Department wide Diversity Committee ◦ Health Equity Roadmap & Tool Kit created www.michigan.gov/minorityhealth www.michigan.gov/minorityhealth 7

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9. State of Michigan IM Reduction Plan 1. Implement Regional Perinatal System 2. Promote statewide adoption of policies to eliminate medically unnecessary deliveries before 39 weeks gestation 3. Promote adoption of progesterone protocol for high risk women 4. Promote safer infant sleeping practices to prevent accidental suffocation 5. Expand home-visiting programs to support vulnerable women and infants 6. Support better health status of women and girls 7. Reduce unintended pregnancies 8. Weave the social determinants of health into all targeted strategies to promote reduction of racial and ethnic disparities in infant mortality 9 http://www.michigan.gov/documents/mdch/MichiganIMReductionPlan_UPDATED_395151_7.pdf

10. Key Activities - MICHIGAN State IM Reduction Plan, 2012 Perinatal System of Care Recommendations, 2009 State Innovation Model Initiative (CMS funded) PRIME – Practices to Reduce IM through Equity (WKKF funded) AMCHP Life Course Metrics National Workgroup Participation NGA Learning Network Team Initiative CDC/AMCHP Maternal Mortality Initiative Participation AMCHP Preconception/Interconception Care Action Learning Collaborative Participant (ALC) Michigan Primary Care Transformation Grant (CMS funded) Member of Expert Panel on Improved Birth Outcomes (CMS sponsored) Partnership to End Disparity in IM (PEDIM) ALC (Round 2 participant) Strong Start for Mothers & Newborns Proposal Developed-not funded

11. Key Activities – MICHIGAN PRIME Project The Practices for Reducing Infant Mortality through Equity (PRIME) project is funded by a grant from W.K. Kellogg Foundation Goals include the reduction of racial disparities in infant mortality among Michigan’s ◦ African American population ◦ Native American population Focus is on institutional racism and social determinants of racial disparities No state level data sources contained sufficient information for Native American mothers and infants ◦ Michigan PRAMS randomly samples around 5-6 Native mothers each year ◦ Birth certificates contain limited information on social determinants www.michigan.gov/dchprime 11

12. Successes - MICHIGAN 2012 Infant Mortality Summit & Plan 2009 Perinatal Guideline Recommendations MOD Healthy Babies are Worth the Wait effort Partnership with Michigan Hospital Association co-sponsorship of MOD campaign Strong partnership with MOD – recent funding Excellent collaborative partnership with Michigan Medicaid – matching, funding, marriage Strong statewide stakeholder collaboration Kellogg Foundation partnership on Equity

13. Challenges – Michigan Disparities are geographically located Targeting efforts to greatest disparities Provider availability ◦ Rural specialty providers limited Changing hospital care system 13 Counties with High Infant Mortality Rates in Michigan Yellow highlights = High African American Infant Death Rates by County, 2007-2009 Blue highlights = High Caucasian Infant Death Rates by County, 2007-2009

14. Challenges - MICHIGAN Disparity continues and may be growing Identifying effective methods for weaving SDOH Metrics to demonstrate success Need to show ROI Funding shifts and uncertainties Keeping all the pieces moving and together

15. Wish List -MICHIGAN Insight to what’s working to improve the health of women BEFORE pregnancy and women with a history of poor pregnancy outcome Resources for continued investment in health equity skill development for public health staff Info about perinatal systems of care in large city communities (like Chicago, Indianapolis, Cleveland) Methods for assuring high risk/regular OB care in rural areas Great strategies for effective collaboration (not more meetings/better communication methods that lead to desired action)

16. Team Members - MICHIGAN Alethia Carr Debera Eggleston, MD Brenda Fink Elizabeth Hertel Carol Lowe Karla McCandless Holly Nickel 16