promising practices to reduce infant mortality through equity

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


2.1

Maternal Care

1.3

Newborn Care

1.0

Infant Health

0.9

American Indian

Overall IMR= 12.2


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


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

Individual Focus

Population Health Focus

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)

Derek M. Griffith, [email protected]

University of Michigan School of Public Health