Date post: | 02-Jan-2016 |
Category: |
Documents |
Upload: | randall-peck |
View: | 23 times |
Download: | 2 times |
Derek M. Griffith, Ph.D.
University of Michigan
Michigan Premier Public Health Conference
October 12, 2011
Promising Practices To Reduce Infant Mortality
through Equity
Overview
Examine the pattern of disparities in infant mortality in Michigan
Explore the rationale behind the PRIME Intervention strategy
Outline some of our activities, objectives, outcomes and next steps
Infant Mortality Rates by Race: United States, 1915-1997*
0
20
40
60
80
100
120
140
160
180
200
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
1997
Year
Infa
nt
de
ath
s p
er
1,0
00
liv
e b
irth
s
Blacks
Whites
*Note: For years 1915-1960, “White” included persons stated to be “White,” “Cuban,” “Mexican,” or “Puerto Rican.” All others during that time period were referred to as “Nonwhite.”
Black-White Ratio of Infant Mortality, U.S.: 1915-1997*
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
1997
Rat
io o
f Inf
ant d
eath
s pe
r 1,
000
live
birt
hs
B/ W Ratio
*Note: For years 1915-1960, “White” included persons stated to be “White,” “Cuban,” “Mexican,” or “Puerto Rican.” All others during that time period were
referred to as “Nonwhite.”
YEAR
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
5
10
15
20
25
30
35
White
Black
Year
Infa
nt
De
ath
s p
er
1,0
00
Liv
e B
irth
s
Source: 1970 - 2009 Michigan Resident Birth and Death Files, Division for Vital Records & Health Statistics, Michigan Department of Community Health
Black and White Rates of Infant Mortality in Michigan: 1970-2009
Black-White Ratio of Infant Mortality in Michigan:1970-2009
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
0.5
1
1.5
2
2.5
3
3.5
B/W Ratio
Year
Ra
tio
of
Infa
nt
De
ath
s p
er
1,0
00
Liv
e B
irth
s
Source: 1970 - 2009 Michigan Resident Birth and Death Files, Division for Vital Records & Health Statistics, Michigan Department of Community Health
Black, Non-Hispanic
Overall IMR= 14.1
Maternal Health/Prematurity
7.0
Maternal Care
1.9
Newborn Care
2.0
Infant Health
3.3
Data Source: 2008 Live Birth, Fetal Death and Death Cohort Matched Infant Death Files, Vital Records and Health Data Development Section, Michigan Department of Community Health
Reference
Overall IMR= 5.3
African American PPOR compared to the reference group, Michigan 2006-08
Overall Excess: 8.8
Maternal Health/Prematurity
2.1
Maternal Care
1.3
Newborn Care
1.0
Infant Health
0.9
American Indian
Overall IMR= 12.2
Maternal Health/Prematurity
2.3
Maternal Care
3.2
Newborn Care
3.2
Infant Health
3.6
Data Source: 2008 Live Birth, Fetal Death and Death Cohort Matched Infant Death Files, Vital Records and Health Data Development Section, Michigan Department of Community Health
Reference
Overall IMR= 5.3
American Indian PPOR compared to the reference group, Michigan 2006-08
Overall Excess: 6.9
Maternal Health/Prematurity
2.1
Maternal Care
1.3
Newborn Care
1.0
Infant Health
0.9
PRIME Goals
Develop a training model and resources that promote understanding of practices that support institutional racism & help to eliminate racial disparities in infant mortality
Use state/local partnership network to codify effective efforts that undo racism & help to eliminate racial disparities in infant mortality
Establish a sustainable quality assurance process for these efforts within the BFMCH
PRIME Funding and Structure
Kellogg awarded one-year grant May 2010
Kellogg awarded 2 additional years December 2010
Steering Team Intervention Workgroup Evaluation Workgroup Local Learning Collaborative
PRIME Steering Team Public Health Administration
J. Chabut B. Pash
FMCH Bureau A. Carr B. Jegede C. Ogan B. Fink P. Dobynes-Dunbar C. Celestin L. Barnett B. Pash S. Bien
Epidemiology B. Coughlin
Minority Health Section S. Weir H. Nichol
University of Michigan D. Griffith J. Ober Allen T. Reischl
Local Public Health R. Canady Hammami
CBO E. Clement E. Kushman L. Abramson D. Peterson
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
Healthy Start Programs Detroit Genesee Grand Rapids Kalamazoo Native American (Sault Ste. Marie) Saginaw
Community-based Organizations ACCESS, Dearborn Dispute Resolution Center, Ann
Arbor Grand Rapids African American
Health Initiative MI Minority Health Coalition National Kidney Foundation
Promising Practices Overview
Conceptual
Practical
Technical Organizational
Black-White & Native American-White
Disparities in Infant Mortality
Conceptual
• Individual (risk factors) vs. Population Health approach
• Make explicit and plain what SDOH mean for how we think about racial disparities
• Incorporate social and cultural assets
• Unique social, cultural and historical roots of racial disparities - AA-White and AI-White
Practical
• Develop and pilot resources and experiences that help staff incorporate SDOH in their day-to-day work
• Create tools that promote staff accountability and increase staff capacity to attend to SDOH
• Increase the capacity of staff and teams to assess and address their training needs in these areas
Technical
• Create separate but complementary plans to address AA-White and AI-White disparities in infant mortality
• Improve the quality of data available to inform statewide strategies to address AA-White and AI-White disparities in infant mortality
• Increase capacity for BFMCH for staff to use data to inform decisions, practices and policies
Organizational
• Revise strategic plans and other documents
• Decrease duplication of BFMCH and MDCH programs that affect infant mortality
• More effective utilization of inter-division expertise, resources and data and better quality improvement
• Increase capacity for BFMCH to support local efforts to address racial disparities in infant mortality
Contextual Conditions
•>20 year disparity in infant mortality in MI
•MI economic challenges
•Decreasing MDCH budget
• large percentage of MDCH staff are eligible for retirement
Human Resources
•Leadership of MCH Bureau Director
•Co-Investigator and Evaluator from UMSPH
•Collaborators: NACCHO, local health officials, & MDCH directors & staff
•External training consultants, content experts, contractors & facilitators
Opportunities for Inter- & Intra-departmental
collaboration (i.e., HDRMH, DHS, Medicaid, etc.)
OUTCOMES
Short-Term Outcomes
• Increased Knowledge of Staff
•Tool kit & curriculum
•Change in BFMCH policies that may contribute to the racial disparity in IM
• Increased monitoring of SDOH in statewide health disparity report
• Increased continuous quality improvement and public sharing of measurable outcomes that reflect racial equity and health equity
• Increased BFMCH-local partnership efforts to reduce racial disparities in IM
INPUTS ACTIVITIES OUTPUTS
Recruit & hire project coordinator &
leadership team to lead bureau efforts
•Project coordinator•# of leadership team meetings
•Meeting minutes•# of leaders involved in meetings and training activities
Promising Practices To Reduce Infant Mortality through EquityPrincipal Investigator, Alethia Carr
Revised, June 17, 2009
Documents•Epidemiologic report to monitor IM disparities
•Green paper review of possible intervention strategies
•White paper of new policies & guidelines
•Distribution of Green and White papers to key people for feedback
Long-Term Goal
•Reduction in the black/ white racial disparity in infant mortality in MI
Review of bureau and non-health policies
and practices
Create tool kit and curriculum on social
determinants of racial disparities
Staff training
•# of meetings or discussions devoted to Bureau Review activity
•# of participants involved in meetings and training activities
•# of Employee Hours devoted to project activities
Write and get expert feedback on reports, green paper, & white
paper
Evaluation
Review of existing models and curricula
Conduct self-assessment of MDCH
social justice orientation
“The aim of research on health disparities is not to just accurately describe health differences or determine their cause, but to do so in a way that will be useful to making predictions, preventing greater health disparities, and improving human health.”
(de Melo-Martin & Intemann, 2007)