Beyond Infant Beyond Infant Mortality:Mortality:

What’s Poverty and What’s Poverty and Race Got To Do With Race Got To Do With

It? It? Just about everything when it Just about everything when it comes to staying healthy in comes to staying healthy in

Memphis.Memphis.

NNIP Spring 2010NNIP Spring 2010

Phyllis G. Betts, Phyllis G. Betts, DirectorDirector

Contact Contact pbetts@memphis.edupbetts@memphis.edu

Center for Community Building and Center for Community Building and Neighborhood Action and Neighborhood Action and

InfoWorks MemphisInfoWorks Memphis

School of Urban Affairs and Public PolicySchool of Urban Affairs and Public PolicyThe University of MemphisThe University of Memphis

Key SourcesKey Sources

• Populations of Color in Tennessee: Health Status Populations of Color in Tennessee: Health Status Report. Tennessee Department of Health Office of Report. Tennessee Department of Health Office of Policy, Planning, and Assessment and Office of Policy, Planning, and Assessment and Office of Minority Health. Kenneth Robinson, et. al. 2007.Minority Health. Kenneth Robinson, et. al. 2007.

• Center for Community Building and Center for Community Building and Neighborhood Action: analysis of birth and infant Neighborhood Action: analysis of birth and infant mortality and other indicators for Memphis and mortality and other indicators for Memphis and Shelby County. Ongoing. Shelby County. Ongoing.

Infant Mortality Infant Mortality Initiative Initiative

• Commercial Appeal feature followed by Commercial Appeal feature followed by Babyland Babyland

• Shelby County SummitShelby County Summit• TN Office for Children’s Coordinated Care TN Office for Children’s Coordinated Care • Infant Morality “Core Group”Infant Morality “Core Group”• Established Shelby County Office for Established Shelby County Office for

Early Childhood and YouthEarly Childhood and Youth• Early Success CoalitionEarly Success Coalition• Voices for Memphis’ ChildrenVoices for Memphis’ Children

Infant Mortality: Infant Mortality: Canary in the Coal Mine Canary in the Coal Mine

• 14 per 1000 2006 baseline14 per 1000 2006 baseline• African American twice as high as white birthsAfrican American twice as high as white births• Drivers: Pre-maturity and low birth weight Drivers: Pre-maturity and low birth weight • 30% African American teens give birth by age 17 30% African American teens give birth by age 17

(city of Memphis)(city of Memphis)• NICU progress at The MedNICU progress at The Med• Individual education and Individual education and social supportsocial support: Blues : Blues

Project, Moses Model, Centering PregnancyProject, Moses Model, Centering Pregnancy• Social Marketing w/ Community VoiceSocial Marketing w/ Community Voice

• FIMR: Community Action TeamFIMR: Community Action Team

2006 % Births w/ Infant Death of All Births, Shelby County

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

1999 2000 2001 2002 2003 2004 2005 2006

Year

Perc

ent o

f All

Birt

hs

All Mothers

African American Mothers

Deaths Per 1000 Live Births, Top Ten Leading Causes of DeathDeaths Per 1000 Live Births, Top Ten Leading Causes of DeathShelby County, TN, 2006Shelby County, TN, 2006

Source: Death Certificate Data (Tennessee Resident Data),Tennessee Department of Healthhttp://hit.state.tn.us/, accessed 5/11/2010

Early Success CoalitionEarly Success Coalition• Nurse Family Partnership and support for Nurse Family Partnership and support for

building infrastructure (HHS)building infrastructure (HHS)• LeBonheur (Methodist) Children’s Hospital LeBonheur (Methodist) Children’s Hospital

and Shelby County Office for Early Childhood and Shelby County Office for Early Childhood and Youthand Youth

• 65 provider partners65 provider partners• Linked with Site Based Services CollaborativeLinked with Site Based Services Collaborative• Data Partners: CBANA-InfoWorks and Data Partners: CBANA-InfoWorks and

UTHSC Preventive Medicine/CANDLEUTHSC Preventive Medicine/CANDLE• National Mathematica evaluationNational Mathematica evaluation• Collaborative planning and grantwritingCollaborative planning and grantwriting• Advocacy: Voices for Memphis’ ChildrenAdvocacy: Voices for Memphis’ Children

Getting OrganizedGetting Organized

Provider Partners

Shelby County

Early Childhood and Youth

Voices for Memphis’Children

Early Success Coalition

Early Success Focus Early Success Focus AreasAreas

• Infant Mortality InitiativeInfant Mortality Initiative• Home VisitationHome Visitation• Parenting SupportParenting Support• Headstart-PreK-Child CareHeadstart-PreK-Child Care• Early InterventionEarly Intervention• JustCare Family Network and JustCare 180JustCare Family Network and JustCare 180• Children’s Exposure to Violence Children’s Exposure to Violence

→ Community Risks and Assets: CBANA-Community Risks and Assets: CBANA-InfoWorksInfoWorks

→ Policy Advocacy: Poverty as a Risk FactorPolicy Advocacy: Poverty as a Risk Factor

Voices “Five Hopes”Voices “Five Hopes”

• HealthHealth

• Behavioral HealthBehavioral Health

• EducationEducation

• Juvenile JusticeJuvenile Justice

• Social Equity: Unnatural Causes Social Equity: Unnatural Causes

Poverty as a Risk Factor: Poverty as a Risk Factor: KidsKids

Heightened probability outcomes:Heightened probability outcomes:

• Infant mortality/prematurity/low birth weight and Infant mortality/prematurity/low birth weight and related diagnosisrelated diagnosis

• Child obesity and diabetesChild obesity and diabetes• Lead poisoning/other heavy metal toxinsLead poisoning/other heavy metal toxins• Asthma/other respiratory diagnosis (second hand Asthma/other respiratory diagnosis (second hand

smoke)smoke)• Nutrition-related developmental and cognitive Nutrition-related developmental and cognitive

diagnosesdiagnoses• Stimulation-related developmental shortfallsStimulation-related developmental shortfalls• Injuries from abuse, neglect, and neighborhood Injuries from abuse, neglect, and neighborhood

violenceviolence• HomicideHomicide

28% Below

Poverty

Dire Poverty

15%Moderate and Higher Income

48%

Low Income24%

Child Poverty in Shelby Child Poverty in Shelby CountyCounty

Reaching Families Where Reaching Families Where They LiveThey Live

Early Impact of Early Impact of Disparities FrameworkDisparities Framework

• Broaden focus to include Zone 2Broaden focus to include Zone 2• Asset MappingAsset Mapping• Transformation Institute: wrap-around Transformation Institute: wrap-around

system of caresystem of care• Link with Site-Based Resident Services Link with Site-Based Resident Services

Collaborative: Reaching Families Collaborative: Reaching Families Where They LiveWhere They Live

• Toward a risk, assets, and Toward a risk, assets, and segmentation model to drive action: segmentation model to drive action: Fragile Families framework Fragile Families framework

The Bigger Picture:The Bigger Picture:Social DeterminantsSocial Determinants

• WhyWhy are poverty and low educational are poverty and low educational attainment predictive of “unhealthy attainment predictive of “unhealthy lifestyles”? lifestyles”?

• Hint: “ignorance” is an insufficient answerHint: “ignorance” is an insufficient answer

• Aggravating factor: hardshipAggravating factor: hardship• Mediating factor: stress Mediating factor: stress → depression→ depression• Mitigating factor: social supportMitigating factor: social support• Theory of change: stronger families in Theory of change: stronger families in

stronger communities stronger communities – Confronting povertyConfronting poverty

Emerging Evidence: Emerging Evidence: StressStress

• Cortisol, adrenalin, and inflammationCortisol, adrenalin, and inflammation

• Biological markers vs. self-reportsBiological markers vs. self-reports

• Depression, self-medication, and Depression, self-medication, and immobilization vs. sense of efficacy and immobilization vs. sense of efficacy and proactive self-careproactive self-care

• Apparently self-destructive behavior is Apparently self-destructive behavior is not just about poor self-esteem not just about poor self-esteem

Primary Social Support Primary Social Support SystemsSystems

• FamilyFamily

• NeighborhoodNeighborhood

• SchoolsSchools

• WorkWork

• Housing as a PlatformHousing as a Platform

1-Year Clinic Visit Data1-Year Clinic Visit DataOutcome MeasuresOutcome Measures

Parental Stress Index Total Score (N = 114)

20.2

79.8

0102030405060708090

100

Clinically Significant Not Clinically Significant

Per

cen

tag

e

1-Year Clinic Visit Data1-Year Clinic Visit DataOutcome MeasuresOutcome Measures

Child Abuse Potential Score (N = 116)

16.4

83.6

0102030405060708090

100

Elevated Normal

Pe

rce

nta

ge

Reaching Families Where They Live: Reaching Families Where They Live: Peacemaking Circles at Autumn RidgePeacemaking Circles at Autumn Ridge