Member states were asked to answer the following question:
What is your advice to other state agencies, organizations and communities that are looking to tackle infant mortality by focusing on racism and racial inequities?
CityMatCH Member Representative from the Aurora, Colorado Team
Rita Beam, MS, RN
Aurora Healthier Beginnings
Healthier Beginnings for African American/Black Communities
An Aurora Healthy Baby Initiative
First and foremost, it is critical to assess your communities’ readiness to tackle the infant mortality rate and to address issues of racism and racial inequities. It will be important to identify key leaders in the African American/Black population (or of the target population) to assess their view point and willingness to support your initiative. Identifying and engaging a champion from that target population who is well respected and active in the community will assist in forming partnerships to support your work. Next, assess what other agencies, organizations or community groups are currently working on this problem or have previously worked on the infant mortality rate. For example, an oversampling of Pregnancy Risk Assessment Monitoring System (PRAMS) data had been completed in 2002 in our community. This data analysis and outcomes set the stage for the initiative that was started four years later.
Another lesson we have learned is that many people do not recognize nor believe that racism and racial inequities are present in their communities, agencies or organizations. Therefore, an important activity is to conduct qualitative research by conducting interviews or forums within the lead agencies. This process is important to understand what the knowledge base is for those you interact with daily about racism and its impact on health and the well being of our nation’s children. This will be critical in moving forward because if you do not establish an understanding of institutional racism and evidence that it exists, it will be difficult to form an effective alliance with key stakeholders. If adequate time and focus is not dedicated to this phase of program development both human and economic resources may be wasted. This process may take a year or longer depending on the work that has been done previously to establish an understanding of the problem of infant mortality and of health disparities in your community. By taking the time to foster understanding of racism within your lead agencies you will be in a better position to create community mobilization, develop a strategic plan, strong grass roots support and political will.
It is not always necessary to have a funding source identified as you begin your work. Especially in the current economic climate it may be tempting to defer working on this issue because of a lack of funding. However, much of the work that is critical to developing a strong plan to approach this health disparity can be accomplished with a few dedicated leaders to establish a shared understanding of racism. This process may be accomplished with the assistance of resources within state health departments and/or academic institutions. Academic institutions may be willing to be involved even if they are not located in your state. Another recommendation is to establish political support with your local city council. The partnership that was established with a city council representative has enabled our community collaborative to engage other key partners in the community and has provided critical in-kind resources to our initiative.
Current data on the infant mortality rate for your targeted population is essential. That information is very important to engage key stakeholders partner with you in your approach. The Perinatal Period of Risk Assessment (PPOR) process is a valuable assessment in order to mobilize and prioritize efforts. Many times assumptions are made about where to focus efforts to improve birth outcomes based on observations and informal information. The PPOR process gives a community data upon which to focus efforts and interventions on the category of infant deaths that represent the greatest opportunity for prevention or reduction of deaths. Information about the PPOR process can be found on the National CityMatCH website.
AMCHP Member Representative from the Chicago, Illinois Team
Myrtis Sullivan, MD
Associate Director for Family Health
Illinois Department of Human Services
Division of Community Health and Prevention
Since there has never been a national comprehensive strategy for the MCH population, Title V of the Social Security Act, since its inception in 1935, has provided a foundation for ensuring the health of our nation's mothers and children.
Title V Directors play an important role in this process by administering their state MCH Block Grant funds and providing leadership in working with key MCH stakeholders to identify, develop and implement policies, programs and other activities to ensure optimal health and well-being of the entire MCH population, including children with special health care needs.
The strength and success of these strategies and programs are periodically assessed by utilizing key indicators and performance measures, and infant mortality is considered one of the most important indicators of the health of a nation. Recently, emphasis has been placed on eliminating ethnic and racial disparities in infant mortality by addressing social determinants of health such as stress, racism and health care inequities.
The Infant Mortality and Racism Action Learning Collaborative (ALC), which is funded by the Kellogg Foundation and supported by CityMatCH, AMCHP and National Healthy Start, is an initiative that is designed to examine these inequities and develop strategies to address them. As the Title V Director of Illinois (one of six states that were selected to participate in ALC), I feel very fortunate to participate in this novel and very innovative approach to address racism and other societal injustices that have such a negative impact on health. It has truly been an enlightening experience to collaborate with my Illinois colleagues and colleagues from the other states to develop effective strategies to tackle these to improve health by tackling these inequities throughout the life course.
Since infant mortality is a national problem, I encourage all state Title V Directors to partner with a diverse and wide range of stakeholders (health care providers, social service providers, educators, consumers, policymakers, etc.) to form collaboratives, coalitions and other groups to develop sustainable, multi-systemic and multi-level approaches to improve the health and well-being of all of our citizens.
National Healthy Start Association Member Representative from the Chicago, Illinois Team
Jerry Wynn, BS. MPH
Member of the Illinois ALC to reduce the impact of Racism on Infant Mortality
First, I would encourage anyone or any organization that is considering addressing the issue to do so. I would advise doing four things: 1. Do Home Work; 2. Enlist Leadership; 3. Gain Allies; and 4. Measure Progress in Small Steps.
1. Do Home Work: The term evidenced-based practice is in vogue, and the literature is replete with scientific evidence that there is connection between racism and birth outcomes. The documentary, “Unnatural Causes” approaches this issue in an insightful manner. It can be useful in forming strategies and increasing awareness. Obviously it’s a visual medium, and can be shown to audiences in a variety of settings. The studies and articles written by distinguished professionals such as doctors Michael Lu, Dick David, and James Collins are excellent. Additionally, the work of Tyan Parker Dominguez, PhD frames the issues in a straightforward manner.
2. Enlist Leadership: The leadership sets the tone for any organization whether it is a sports team, business organization or health department. The commitment of top leadership is crucial to success. This is important because an organization must be willing to take an objective look at its culture, values, norms and most importantly, its mission. I was impressed by the work and leadership at the Boston Health Department. The mayor supported the health department's efforts by meeting with the top five or six academic medical centers to state his commitment and to enlist these organizations in the effort. The Mayor of Boston clearly recognized the Public Policy Perspective and his leadership on this issue makes Boston a better city for all its residents.
3. Gain Allies: The organizational capacity exists to accomplish this effort. There are churches, advocacy agencies community groups and other stake holders that can play an important role in formulating strategies.
4. Measure Progress in Small Steps: In closing, it is important to realize this endeavor is possible to achieve but it will take time. Public Health measures the achievement of goals by achieving small time framed objectives. In 1961, President John F. Kennedy set the goal of reaching the moon in 10 years. We achieved this accomplishment in 1969. A number of small objectives were established to achieve this goal. The one that was most important was unwavering Belief and Determination to be successful.