improving infant mortality in ohio - Maternal and Child Health ...

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esearch approach and based on a socioecological model.The plan derived both from "bench” science and “trench”study with community residents. Its theoretical foundationswere grounded in a philosophy of public health as socialjustice and based on the understanding that culture can beboth protective and harmful. No single intervention willeliminate racial health disparities. Interventions aimed atreducing infant mortality must precede, include, and followthe period of pregnancy. Core themes for the work of thisinitiative included fostering community awareness andmobilization, enhancing the “baby care” (medical care andsocial services) system, and reducing racism. The overarchinggoal of the REACH project was to effectcommunity and systems change sufficient to improve thelocal infant mortality problem. At the start of the project,African American infants in Genesee County were dying ata rate greater than three times that of European Americaninfants. Major outcome objectives in the project’s logicmodel included: (1) reducing racism; and (2) reduction ininfant mortality rates and the disparity ratio from 1999-2000 baseline data. Project interventions within thissuccessful model’s three interconnected spheres of activityincluded: community dialogue sessions; undoing racismworkshops; university cultural competency in health carecurriculum; African Culture Education DevelopmentCenter; maternal/infant health advocates; PRIDE(Programs to Reduce Infant Deaths Effectively) medicalservices committee; community media campaign; healthyeating curriculum; and Harambee celebrations. Throughthis multifaceted array of successful practice-basedinterventions, the REACH Community Action Plancontributed significantly to the decline in the infantmortality disparity ratio and a historic low rate of AfricanAmerican and overall infant deaths in Genesee County.4. The REACH planning process examined racial disparitiesin infant mortality from both “bench” (science) and“trench” (community) perspectives. Racial disparities ininfant mortality in Genesee County have persisted despiteat least two decades of applied contributions from theclinical, scientific laboratory, and legislative “benches” toreduce these gaps. Although many explanations have beenproposed for the failure of standard interventions to reduceracial disparities, two of the most compelling explanationshave been central to the REACH project: 1. No singleintervention is likely to eliminate racial disparities in infanthealth. Racial disparities arise from multiple factors: poor
outreach to and coordination of public health and medicalservices for high-risk patients; informal access barriers toneeded services; cultural barriers that hinder access andpatient adherence to beneficial health behaviors; structuralinequalities that promote poverty and communitydislocation; and internalized racism that fosters desperationand spiritual exhaustion in those communities at greatestrisk. 2. The period of pregnancy is simply too short toaddress effectively many risk factors important to infanthealth. A life-course perspective that focuses on improvedmaternal health is essential to improve birth outcomes inthe African American population. From this perspective,effective infant mortality prevention requires variedinterventions that go beyond prenatal or postpartum clinicalcare, to include primary prevention well before firstpregnancies; preconceptional care for planned pregnancies;postnatal intervention to prevent adverse outcomes amongnewborns and older infants and also to provide primaryprevention for future pregnancies and to increase intervalsbetween pregnancies. Given the multifaceted nature of thispublic health problem, multifaceted solutions are required.The Genesee County REACH initiative set in motion acomprehensive and sustainable process to improvematernal and infant health rather than provide for a specifichigh-profile intervention in the hope of dramatic short-termgains.5. With a vision of "Better Life Through Better Health" and amission to protect and promote the community's health, theGenesee County Health Department (GCHD) was asked byits community partners to serve as the Central CoordinatingOrganization (CCO) because of its experience andrecognized success in facilitative, coordinating roles and itsleadership in community-based public health work. TheGCHD has broad experience as a coordinator of andparticipant in community-based work and as a catalyst forplanning and implementing change in public healthpractice, academic training, and community-based work.The membership of the Genesee County REACH Coalitionhas been composed of 10 core partners over the past sevenyears: (1) the Genesee County Health Department; (2)University of Michigan-School of Public Health-AnnArbor, (3) University of Michigan-Flint; (4) Faith Accessto Community Economic Development; (5) the GreaterFlint Health Coalition; (6) Genesee County CommunityAction Resource Department; (7) PRIDE (Programs toReduce Infant Deaths Effectively) Medical Services
Page 1 and 2: IMPROVING INFANT MORTALITY IN OHIOT
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