PRACTICES TO REDUCE INFANT MORTALITY

THROUGH EQUITY

Brenda Jegede, MPH, MSWDecember 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

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

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 8.18.5

7.6 7.97.4

8.07.4 7.5

7.1

United States Michigan

per 1,000 live births

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

2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-20100

5

10

15

20

25

NH White NH African American Hispanic NH Asian/Pacific Islander

NH American Indian/Alaska Native MI Average

Per 1,000 live births

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

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0

5

10

15

20

25

30

35

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Non-Hispanic, White Non-Hispanic, African AmericanState African American/White Disparity

Deaths per 1,000 live births

Disparity Ratio

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:

SafeAffordable

Housing

QualityEducation

Job Security

SocialConnection

& Safety

LivingWage

Access toTransporta-

tion

Availabilityof 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, 2009Michigan Behavioral Risk Factor Survey, 2008-2010

•PRIME - Activities & Findings3

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 fundingMay, 2010 & December, 2010

Steering TeamIntervention WorkgroupEvaluation WorkgroupLocal Learning CollaborativeNative American Ad Hoc Workgroup

PRIME Steering TeamMichigan Department of Community Health

Public Health Administration Bureau Family Maternal & Child Health

Division of Family & Community HealthWomen’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 HealthVanderbilt UniversityLocal Public Health (Ingham, Wayne)Community-Based Organizations

Inter-Tribal Council of MI Corner Health Center

Local Learning CollaborativeMI Department of Community HealthCounty/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 SuccessesPolicy/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/dchprimewww.michigan.gov/infantmortalitywww.michigan.gov/minorityhealth

BRENDA JEGEDE, M.P.H., M.S.W.JEGEDEB@MICHIGAN.GOV517-335-9483