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Infant Mortality and Racial Equity. Peggy Vander Meulen, RN, MSN Michigan Premier Public Health Conference October 12, 2011. Kent County Infant Mortality White, Black & Total - Three Year Averages. Infant Mortality Rate by Race Grand Rapids 2007-2009. Percent Low Birth Weight by Race - PowerPoint PPT Presentation
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Infant Mortality and Racial Equity
Peggy Vander Meulen, RN, MSN
Michigan Premier Public Health Conference
October 12, 2011
Kent County Infant MortalityWhite, Black & Total - Three Year Averages
19.4
5.2
7
16.8
0
5
10
15
20
25
Ra
te p
er
1,0
00
live
bir
ths
White 7 6.2 6.2 5.4 5.2 5.5 5
Black 19.4 19.1 17.6 18 16.8 14.4 13.4
2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009
6.24.4
13.5
17.3
0
5
10
15
20
25
% Low Birthweight Infant Mortality Rate
White
Black
Percent Low Birth Weight by RaceGrand Rapids 2009
Infant Mortality Rate by RaceGrand Rapids 2007-2009
(1,000 live births)
Community Response
Strong Beginnings
Funded in 2004 by a federal Healthy Start grant, Strong Beginnings is a
community-wide effort to lower infant mortality among the African-American population in
Grand Rapids
A Partnership of….
Cherry Street Health Services (St. Mary’s Health Care) Grand Rapids African American Health Institute Healthy Kent 2020 – Infant Health Implementation Team Kent County Health Department Metro Health Hospital Arbor Circle Spectrum Health MOMS The Salvation Army
Program Participants
African-American women Pregnant Mother of a child under 2
Capacity to enroll 280 women at any one time
1,800 families enrolled to date (80% high risk)
Infant Health I-Team StructureThe I-team serves as the:• Community Coalition for Strong Beginnings• Community Action Team for FIMR• Advisory Board for Nurse-Family Partnership
Healthy Kent 2020
Reduce overall infant mortality in Kent Co. Low birth weight & premature delivery SUID and sleep-related asphyxia
Eliminate racial disparities
Improve overall system of care
Strong Beginnings and IHIT Goals
Internalized Racism
Help women cope with the effects of internalized racism:
Poor self-image Stress Anger Depression
Internalized Racism
Frequent home visits by CHWs Social support, education and goal-setting “Finding the Gold Within” (self-worth, self-
determination, hope for better future)
Internalized Racism
Mental Health Services:
Crisis management
Individual counseling
Six-week therapeutic
support groups on stress, depression & anger mgt
Healthy Minds & Bodies
Internalized Racism
Parenting from an African
American perspective (EBP)
Builds confidence in parenting skills Develops pride in African American heritage Helps raise strong, confident children
Internalized Racism Asked FIMR to add questions regarding
women’s experience of discrimination
Measure participants’ satisfaction with cultural appropriateness of services and the treatment received from staff
Individually-mediated Racism
Helped develop a Cultural
Competency Curriculum for
Health Care Professionals
Held 12 trainings (5 weeks)
Trained 7 facilitators Reached >1200 professionals from 37 agencies Made curriculum available statewide through MALPH
Individually-mediated Racism
“Creating Inclusive Health Care Environment” workshops for 50 providers
Follow-up online survey on behavioral change
Individually-mediated Racism
Community presentations on link between racism & racial disparities in birth outcomes, e.g.: Unnatural Causes 1-hour radio interview Nursing & SW students Family Practice Residents Churches Community Summit
Institutional Racism
Created Health Care Sector for the Summit on Racism
Round-table discussions on recruitment & retention of employees of color in leadership
Staff attend 2 ½ days workshops
Institutional Racism
Infant Mortality Summit in Grand Rapids,150 participants: 75 community residents and 75 agency reps.
One message: “Create a mechanism to report poor quality care and discrimination in health care based on race or ethnicity”
Institutional Racism
Research and literature review
Focus Groups
Key Informant Interviews
Produced report and recommendations for developing an external reporting system
Key Components of Reporting System
Institutional Racism GRACE – PRFC conducts assessments for orgs
seeking racism-free credentialing (2008)
Documentation to meet criteria for 6 standards,
e.g., leadership engagement, internal policies, contractor / vendor practices, external relations
Institutional Racism
Teams meet with agency staff
Review documents
Deliberation team assigns status: Not at this time, Provisional, Full, Credentialed
Make recommendations, develop action plan
Institutional Racism
Three pilot agencies 2009 Five organizations 2010-2011 Five organizations starting 2011-2012
Institutional Racism
Member PRIME workgroup
PEDIM ALC – to increase capacity at community, state & national levels to address impact of racism on birth outcomes & MCH
Next Steps R2R creating toolkits for providers &
consumers: Hidden bias tests Organizational assessments Local resources Patient rights Empowerment cards
Next Steps
Continue offering ½ day workshops
Train new staff as assessors for PRFC
Increase number of organizations seeking racism-free credentialing
Next Steps
Pursue mechanism for
reporting discrimination
Create local action plan based on learnings from PEDIM-ALC experts & teams
Next Steps
“Lines: The Lived Experience of Race” by Stephanie Sandberg
Video Clips & Facilitator guide to raise awareness & foster dialogue
THANK YOU!
Supported in part by project H49MC03591from the Maternal & Child Health Bureau (Title V, Social Security Act), Health Resources & Services Administration, Dept. of Health & Human Services
Contact Information
Peggy Vander Meulen Program Director Strong Beginnings (federally-funded Healthy Start) (616) 331-5838 [email protected]
Barb Hawkins-Palmer, BA Executive Director Healthy Kent 2020 (616) 632-7181 [email protected]
