1. 1 Social Justice in Maternal and Child Health Practice ~ the View from a FIMR Project Mary Ostrem, DrPH Boston Public Health Commission January 20, 2005

2. 2 Orientation to This Presentation Goal A common framework BPHC Social Justice Work The Boston FIMR as a Case in Point

3. 3 Boston: the Disparities Scene INDICATORBLACKWHITE__ Asthma Hospitalization Rate (< 5 y/o)* 10.7 2.9 Very Low Birthweight 3.6% 1.2% Overweight 64.0% 44.3% Overall Mortality** 1,054.9 892.6 Diabetes Mortality** 48.3 23.4 Lack of Health Insurance 12.8% 6.3% Heart Disease Mortality** 220.7 205.4 High Blood Pressure 30.0% 17.0% HIV/AIDS Mortality** 33.2 8.1 Homicide** 27.0 3.4 Infant Mortality* 12.4 4.6 Hospitalization Rate (all ages)*163.0 107.5 Prostate Cancer Mortality** 68.7 30.0 Smoking During Pregnancy 6.3% 5.1% Teen Birth Rate*** 14.1 6.0 *Per 1,000 **Per 100, 000 ***Per 1,000 15-17 year-old females

4. 4 How Did Social Justice Gain Prominence? Inadequacy of biological, genetic, individual behavioral explanations for disparities Clear evidence of socioconomic and systemic impact Consistency with historic public health principles

5. 5 One Angle on Social Justice: The Health Impact of Racism Socioeconomic status and environmental conditions Exposure to stressors Access to health care services Treatment by the health care system Health-related behavior

6. 6 BPHC Action Programs –Existing and new –Mayoral priority initiatives Task Force Hospital Working Group Policies –Priority in mission –Integrated into collaborations –Modeled through training and internal activities

7. 7 Programs Boston Fetal and Infant Mortality Review Boston Healthy Start Initiative Cherishing Our Hearts & Souls Coalition REACH 2010 Breast and Cervical Cancer REACH 2010 Boston Elders REACH 2010 Metro Boston Haitian HIV/AIDS Coalition Steps to Cultural Competence

8. 8 Programs Sister Talk II local TV series State Legislature hearings Advocacy for and staffing of new State Commission on Disparities Communication and support –Conferences –Community meetings –Summit and action plan –Funding Upcoming projects: increasing workforce diversity, monitoring to ensure equitable health practices, and support of grassroots efforts

9. 9 Mayoral Priority Initiatives The Mayor’s Hospital Working Group The Mayor’s Blue Ribbon Task Force on Eliminating Racial & Ethnic Health Disparities

10. 10 Policies Mission priority Staff training –“Undoing racism” –Discrimination and harassment Cultural competency assessment and development Grants office role

11. 11 Elimination of Disparities in Maternal and Child Health The Health of Women and Infants Working Group –Women’s Health Demonstration Project –BHSI and Healthy Baby/Healthy Child –Cultural Competence –FIMR –Adolescent Health Common Thread: Surveillance of women’s health Common Tool: Women’s Health Questionnaire Common Approach: Collaboration

12. 12 FIMR Partners 4 Boston Public Health Commission –Healthy Baby/Healthy Child –Executive Office –Research Office Massachusetts for SIDS March of Dimes Health of Women and Infants Working Group

13. 13 A New Model Why? –IMR findings –Learning from collaboratives and programs Key Elements –Bereavement support –Women’s health assessment –Data analysis for public health programming and policy 6

14. 14 Women’s Health Focus Economic, social, other aspects of health Preconceptional/interconceptional but not solely reproductive focus Attention to relationship with health system, barriers Women’s perceptions for data

15. 15 Conclusions Social justice and the Boston FIMR Findings and impact Expectations