1. 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

3. Our Problem Genesee County REACH 2010 Project 9/08

4. Genesee County REACH 2010 Project 3/08

5. 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

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

7.  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

8.  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

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

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

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

12. Fostering Community Mobilization

13. 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

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

15. Enhancing the Babycare System

16.  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

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

18. 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

19. Reducing Racism

20. 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

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

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

23. SUCCESS!

24. Annual Infant Mortality Rates by Race Genesee County, MI 1999-2006 Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.

25. Infant Mortality Disparity Ratio* Genesee County, Michigan 1999-2006 *African American to White Disparity Ratios Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.

26. 3-Year Moving Average Infant Death Rates Genesee County and Michigan 1997-2006

27. REACH Evaluation

28. 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

29. REACH 2010 Logic Model

30. Vital StatisticsRacism and Health Disparities SurveyProcess Evaluation

31. Reduce/Undo Racism

32. Enhance Baby Care System

33. Mobilize Community

34. Facilitating Policy Change Graph Represents Institutional Policy Changes

35. 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 18-45 in the REACH focus ZIP Codes in Genesee County, and randomly selected community members aged 18-45 in demographically similar ZIP Codes in neighboring Saginaw County.

36. Descriptives of Survey Sample

38. Attitudes, Beliefs, and Knowledge regarding Racism

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

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

41. Experiences of racial discrimination

42. Beliefs regarding racism in healthcare

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

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

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

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

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

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

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

50. Percent of births that are premature among African American Infants

51. African American Infant Mortality Rate By County

52. 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

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

54. Percent of Births to Women Aged 15-19

55. Percent of African American Births to Unmarried Women

56. Percent of African Americans with Income Below the Poverty Line

57. African American Mortality Rate, ages 5+

58. 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.

59. 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.

60. Shannon Brownlee, MPH Genesee County Health Department (810) 341-7661 sbrownlee@gchd.us@gchd.us Contact Us… Center of Excellence in Eliminating Disparities Daniel Kruger, PhD Prevention Research Center University of Michigan School of Public Health (734) 936-4927 djk2012@gmail.com www.gchd.us