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PRACTICES TO REDUCE INFANT MORTALITY THROUGH EQUITY
Brenda Jegede, MPH, MSW
December 9, 2013
Michigan Family Impact Seminar
• Why PRIME? 1
• Understanding Racial Differences in Infant Mortality 2
• PRIME Activities & Findings 3
Overview
Michigan vs. US rates of infant
mortality 2000-2010
3
6.9 6.8 7.0 6.8 6.8 6.9 6.7 6.8 6.5 6.3 6.2
8.2 8.0 8.1 8.5
7.6 7.9
7.4 8.0
7.4 7.5 7.1
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
per 1,000 live births
United States Michigan
Source: Centers for Disease Control and Prevention, National Center for Health Statistics MI Resident Live Birth and Death Files, Division for Vital Records and Health Statistics
Michigan’s Infant Mortality Rate has declined significantly from 2000 to 2010.
2010 Infant Mortality Rate: 7.1 The lowest ever reported in Michigan
Average Infant Mortality Rate by race/ethnicity, MI 2000-2010
4
0
5
10
15
20
25
2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010
Per 1,000 live births
NH White NH African American Hispanic
NH Asian/Pacific Islander NH American Indian/Alaska Native MI Average
Source: MI Resident Live Birth and Death Files, Division for Vital Records and Health Statistics
Trends of infant mortality by race/ethnicity and disparities, MI 1970-2010
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
0
5
10
15
20
25
30
35
Disparity Ratio Deaths per
1,000 live births
Non-Hispanic, White Non-Hispanic, African American State African American/White Disparity
Healthy People 2020 Goal
Source: Michigan Resident Birth and Death Files, MDCH Division for Vital Records & Health Statistics Prepared by: MDCH MCH Epidemiology Unit, 10/19/2012
5
Top 11 MI Counties with Racial
Disparities in Infant Mortality: 2009
6
• Understanding Racial Disparities in Infant Mortality 2
Unnatural Causes – When the Bough Breaks
• Why do African American women have babies that are born too small, at twice the rate of white American women?
– Socioeconomic differences?
– Is there something in the DNA of African American women?
California Newsreel 2008
Life Course Theory points to broad social, economic and environmental factors as underlying causes of persistent inequalities in health for a wide range of diseases and conditions across population groups
Social Determinants of Health
The economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole.
They include, but are not limited to:
Safe Affordable
Housing
Quality Education
Job Security
Social Connection
& Safety
Living Wage
Access to Transporta-
tion
Availability of Food
Dennis Raphael, Social Determinants of Health; Toronto: Scholars Press, 2004
Health equity, as defined by Health People 2020, is the "attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities".
Health Equity
If health equity were achieved and all infants born in Michigan had the same chance of surviving beyond their first
birthday, 235 babies who died in 2009 would be alive today – more than enough
to fill a jumbo jet
Unequal Treatment
• Across virtually every therapeutic intervention, ranging from high technology procedures to the most elementary forms of diagnostic and treatment interventions, minorities receive fewer procedures and poorer quality medical care than whites
• Differences persist even after differences in health insurance, SES, stage /severity of disease, co-morbidity, and the type of medical facility are controlled
• Differences persist in contexts such as Medicare and the VA Health System, where differences in economic status and insurance coverage are minimized
Institute of Medicine, 2003
Other Reports
• CDC Health Disparities and Inequities Report 2011
• HHS Action Plan to Reduce Racial & Ethnic Disparities – April, 2011
• RWJF – Place & Heath: Why Conditions Where We live, Work & Play Matter – May, 2011
Cost of Inequities
• In the U.S. it is estimated that between 2003-2006 the combined cost of racial and ethnic health disparities and premature death was $1.24 trillion
• Approximately 54,300 days of adult productivity are lost each year in Michigan due to disparities in physical and mental health
The Economic Burden of Health Inequalities in the United States, Joint Center, 2009 Michigan Behavioral Risk Factor Survey, 2008-2010
• PRIME - Activities & Findings 3
Create a comprehensive strategy and practice model in state public health that will reduce racial disparities/inequities in infant mortality. Targets African Americans and Native Americans
Use state/local partnership network to codify effective efforts that undo racism and help to eliminate racial disparities in infant mortality
Establish a sustainable quality improvement process for these efforts within the Bureau of Family, Maternal & Child Health
PRIME Objectives
PRIME
W.K. Kellogg awarded 3 ½ years of funding May, 2010 & December, 2010
Steering Team Intervention Workgroup Evaluation Workgroup Local Learning Collaborative Native American Ad Hoc Workgroup
PRIME Steering Team Michigan Department of Community Health
Public Health Administration Bureau Family Maternal & Child Health
Division of Family & Community Health Women’s Infants & Children (WIC) Children’s Special Health Care Services
Health Disparities & Minority Health Section Lifecourse Epidemiology and Genomics Division
University of Michigan, School of Public Health Vanderbilt University Local Public Health (Ingham, Wayne) Community-Based Organizations
Inter-Tribal Council of MI Corner Health Center
Local Learning Collaborative MI Department of Community Health
County/City Health Departments
Berrien County
Detroit
Genesee County
Ingham County
Jackson County
Kalamazoo County
Kent County
Oakland County
Washtenaw County
Wayne County
Healthy Start Programs
Detroit
Genesee
Grand Rapids
Kalamazoo
Ingham
ITCM Native American
(Sault Ste. Marie)
Saginaw
Community-based Organizations
ACCESS
Dispute Resolution Center
Grand Rapids African American
Health Initiative
MI Minority Health Coalition
National Kidney Foundation
PRIME Activities
• Training & Evaluation
–Undoing Racism
–Health Equity & Social Justice
–Health Equity Learning Labs
• Native American PRAMS
• Reports
–Health Equity Status Report
• MI Policy Review
MDCH Successes Policy/Program Changes
• DFCH Training with Local Providers
• Local MCH/Health Disparities
• Nurse Family Partnership Outreach Plans
• Native American PRAMS
• WIC Health Equity Plans & Local Provider Training
What we are learning…
“Learning Labs” are needed
Important to Collect Racial & Ethnic Data
Staff Competencies
Improved
European Americans
Demonstrated the Ability to Catch up in their Learning
Important to Address Root
Causes
Connecting with Local Community
is Imperative
Lack of guidelines for State Health
Department
Reducing Infant Mortality….
• Prevention
• Population Health Factors – SDOH
• Home Visiting Programs
• Partnerships with local communities
• Trying something different
MDCH Website - Resources
www.michigan.gov/dchprime www.michigan.gov/infantmortality www.michigan.gov/minorityhealth
BRENDA JEGEDE, M.P.H., M.S.W. [email protected] 517-335-9483