Reducing Infant Mortality in Michigan

Genesee County Racial and Ethnic Approaches to Community Health (REACH) USOctober 12, 2011

Undoing RacismAn Essential Approach to Addressing African American Infant MortalityGenesee County Health Department 10/12/20111REACH US Who are we?The Genesee County REACH US project is a Center of Excellence in the Elimination of Disparities (CEED) in AA infant mortalityconsists of 4 components:Community-based approachesLocal ActivitiesLegacy Projects (Including REHDAI)Dissemination/Training

Genesee County Health Department 10/12/2011REACH US PartnersFlint Odyssey House/Health Awareness CenterGenesee County Community Action Resource Department (GCCARD)Genesee County Health Department (Central Coordinating Agency)Greater Flint Health CoalitionHurley Medical CenterPrograms to Reduce Infant Deaths Effectively (PRIDE)Priority ChildrenUniversity of Michigan/Prevention Research CenterYOUR CenterGenesee County Health Department 10/12/2011REACH USIn 1999 Genesee County became a CDC-funded REACH 2010 project;

In 2007 GC was designated as a Center of Excellence in the Elimination of Health Disparities (CEED)

GOAL: Reduce racial disparities in infant mortality with a particular focus on African Americans.Genesee County Health Department 10/12/20114Our ProblemGenesee County Health Department 10/12/2011

On average 65 infants die each year (2000-2009 Infant Deaths)Among white births 5 out of 1000 die, Among black births 18 out of 1000 die, 6,054 births per year (2000-2009 average)In Genesee County.Black babies die 3 times more often than other babiesGenesee County Health Department 10/12/201148504Infant DeathsGenesee CountyCity of Flint/Burton2005-2009

= 1 Black Infant Death= 1 Other Infant Death= 1 White Infant Death

N=1704850948505

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485064850448503Genesee County Health Department 10/12/2011Year 1: Develop Community Action Plan (CAP)Held over 25 focus group with populations of focusPresented to 35-40 agencies/organizations in the community to garner supportHeld community eventPresented CAP to community for feedbackGenesee County Health Department 10/12/2011Community Action Plan (CAP) derived from two points of view:Bench (Science)No single intervention is likely to eliminate racial disparities in infant mortalityThe period of pregnancy is simply too short to effectively address many risk factors important to infant health

Trench (Community)LanguageCommunicationTrustRacism

REACH USGenesee County Health Department 8/8/2011If you always do what youve always done, youll always get what youve always got. If you want something youve never had, youve got to do something youve never done.A.J. McKnightGenesee County Health Department 10/12/201110MATERNAL-INFANTHEALTH

FosteringCommunityMobilizationEnhancing the BabycareSystemReducing RacismCommunity Action Plan -A Multi-faceted Life-course ApproachGenesee County Health Department 10/12/201111As the Community Action Plan continued to take shape, the interventions that were being proposed fit into the following 3 themesREACH US Local ActivitiesMIHASACEDC - History & Culture EducationPRIDE Medical Services CommitteeCommunity Dialogue Action GroupsBlack Men for Social ChangeWomen Taking Charge of Their Health DestinyUndoing Racism WorkshopsCommunity Windshield ToursEvaluation

Genesee County Health Department 10/12/2011Reduce RacismCommunity Windshield TourFacilitated by the MIHASUndoing Racism WorkshopsFacilitated by the Peoples Institute for Survival and Beyond New Orleans, LA2 Days REACH US ActivitiesGenesee County Health Department 10/12/2011Reduce RacismProduct of Asset Mapping

Designed to provide a visual observation of barriers/resources in the zip codes with the highest infant mortality rates exist

Physicians, hospital personnel, national representatives, foundation/funder representatives, and community residents

Community Windshield ToursGenesee County Health Department 10/12/2011Reducing RacismUndoing Racism Workshops30 workshops and over 1000+ participantsFollow-up working groups:community residentsagencies/organizations

Genesee County Health Department 10/12/2011

Why focus on racism?

Racism is a public health issue ...

You cannot reduce racial and ethnic health disparities in infant mortality without looking at the role that race, culture, and history plays. Genesee County REACH 2010 Coalition - April 2000

Harvard researchers documented that a mere 1% increase in incidences of racial disrespect translates to an increase in 350 deaths per 100,000 African Americans. How? Being on the receiving end of overt or subtle racism creates intense and constant stress that boosts the risk of developing an illness Sid Kirchheimer, WebMD Health News January 2003

Genesee County Health Department 10/12/2011Genesee County REACH USs Objective for the URWFacilitate a change in attitude and a critical understanding of the ways that culture and racism affect racial disparities in infant mortality.

Populations of focus audience includes healthcare providers, business leaders, and community members.

Genesee County REACH 2010 Coalition April 2000

Genesee County Health Department 10/12/201182.0% of AAs and 79.1% of EAs said yes:EA goals met: gaining better insight or learning more about racismhow to address racism in work or the communityEA goals NOT met: the URW was focused on the negative/blamed whitesthere was too little time for group discussion or too little focus on solutionsAA goals met:gaining more insight about racismfind ways to reduce racismAA goals NOT met:too little focus on what action can be taken to undo racism.

Community Perspectives (2005):Were Goals/Expectations Met?

URW Surveys were developed by REACH 2010 Evaluators. Data was analyzed and presented by Cameron Shultz, PhDGenesee County Health Department 10/12/2011Provider Perspectives (2005):Were Goals/Expectations Met? (Yes)I came to the workshop with a very nave understanding of race. The historical perspective opened my eyes, especially recognizing that definitions are not based on biology but politics

If you are white you are given preference in most, if not all, fields;medical access is better provided [to whites] as blacks are thought not to comply to medication open discussion, they let us debate openly

it helped me understand how systems can be created to discriminate

I liked having an honest perspective from African Americans about what its like to live as an African American in this country

URW Surveys were developed by REACH 2010 Evaluators. Data was analyzed and presented by Cameron Shultz, PhDGenesee County Health Department 10/12/2011Community Perspectives(2009)95% felt it changed their knowledge about racism90% felt it changed their attitude about racism89% stated it would change the way they will act in the workplace80% said they would definitely recommend the workshop to a friend or colleagueREACH US URW Evaluations 2007-2010Genesee County Health Department 10/12/201120ActionAdvocacy (many repeats)Be awareAction researchRedefine selfAssume responsibility; sense of obligation with the new knowledgeTeach providers what racism really isWork with communities in educationTeach AA mothers how to care for themselvesHelp mothers before they become pregnantShare information/progress on MCH strategies and IMParticipate in community outreachSupport REACH USWhat you can do to reduce impact of [racism] to improve AA mother-infant health (2011)Genesee County Health Department 10/12/2011ActionListenFoster RELATIONSHIPSApproach churches to empower communityHelp transport neighborsBecome involved in community effortsBecome more familiar with area resources in order to appropriately referWork to create community that is more aware of social determinants of healthIncrease education-awarenessSupport small/positive businessWhat you can do to reduce impact of [racism] to improve AA mother-infant health (2011)Genesee County Health Department 10/12/2011Foster understanding/awarenessReviewing demographics and disparitiesImportance of community engagementparticipatory approachBench-(Science Knowledge)Infant mortality is a life course issueA multifaceted problem in need of multiple solutionsTrench-(Community Knowledge)Need for enhanced communication and trust; focus on racismCommon definition, history, root causes, institutions, internalized racial oppression and superiority

Undoing Racism Workshop (Linkages to IM reduction)Genesee County Health Department 10/12/2011Awareness/Understanding (cont.)Less self-blame and more system blameFrequent integration of health disparities focusIntegration of Windshield Tour

Direct Impact of RacismStress (physiological damage; allostatic load)Poor health related to(education, unemployment, housing, neighborhood risks; diet)Self-neglect ; depression (internalized oppression)Provider mistreatment; healthcare bias (internalized superiority)Undoing Racism Workshop (Linkages to IM reduction)Genesee County Health Department 10/12/2011Skills/Call to ActionChange in institutions begins with change in selfTools and skills to become more aware and be better communicatorsSelf-awareness of personal biasHonestyA return to the social change focus of public healthAvoid gatekeeping; empower communityCommunity leadership-advocacyCommunity organizing experiences and approaches

Undoing Racism Workshop (Linkages to IM reduction)Genesee County Health Department 10/12/2011Change is PossibleGenesee County URW Participant (2008)Ultimately, I believe that change is possible. I can dismantle racism through individual efforts in my own sphere of influence. I can affirm diversity by respecting and being open to other races and cultures. I can mentor and volunteer. I have come to realize that my commitment has to be more active and that it is not as daunting as first perceived.Genesee County Health Department 10/12/2011Genesee County REACH USShannon Brownlee, MPHREACH US CEED CoordinatorGenesee County Health Department(810) 341-7661sbrownlee@gchd.usGenesee County Health Department 10/12/2011Tonya French-Turner, BBAREACH US Program CoordinatorGenesee County Health Department(810) 257-3194tturner@gchd.usDaniel Kruger, PhDREACH US Program EvaluatorUniversity of MI/Prevention Research Center(734) 936-4927kruger@umich.eduDenise Carty, PhD CandidateREACH US Program EvaluatorUniversity of MI/Health Behavior & Health Education (608) 217-9072dccarty@umich.edu