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Undoing Racism An Essential Approach to Addressing African American Infant Mortality

Undoing Racism An Essential Approach to Addressing African American Infant Mortality. Genesee County Racial and Ethnic Approaches to Community Health (REACH) US October 12, 2011. Genesee County Health Department 10/12/2011. REACH US – Who are we?.

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Undoing Racism An Essential Approach to Addressing African American Infant Mortality

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  1. Undoing RacismAn Essential Approach to Addressing African American Infant Mortality Genesee County Racial and Ethnic Approaches to Community Health (REACH) US October 12, 2011 Genesee County Health Department 10/12/2011

  2. REACH US – Who are we? • The Genesee County REACH US project is a Center of Excellence in the Elimination of Disparities (CEED) in AA infant mortality • consists of 4 components: • Community-based approaches • Local Activities • Legacy Projects (Including REHDAI) • Dissemination/Training Genesee County Health Department 10/12/2011

  3. REACH US Partners • Flint Odyssey House/Health Awareness Center • Genesee County Community Action Resource Department (GCCARD) • Genesee County Health Department (Central Coordinating Agency) • Greater Flint Health Coalition • Hurley Medical Center • Programs to Reduce Infant Deaths Effectively (PRIDE) • Priority Children • University of Michigan/Prevention Research Center • YOUR Center Genesee County Health Department 10/12/2011

  4. REACH US • In 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 10/12/2011

  5. Our Problem Genesee County Health Department 10/12/2011

  6. In Genesee County…. 6,054 births per year (2000-2009 average) On average 65 infants dieeach year (2000-2009 Infant Deaths) Among white births 5 out of 1000 die, Among black births 18 out of 1000 die, Black babies die 3 times more often than other babies Genesee County Health Department 10/12/2011

  7. Infant Deaths Genesee County City of Flint/Burton 2005-2009 48506 48505 48502 48504 48509 48532 48503 48519 = 1 Black Infant Death = 1 Other Infant Death = 1 White Infant Death N=170 48529 48507 48504 Genesee County Health Department 10/12/2011

  8. Year 1: Develop Community Action Plan (CAP) • Held over 25 focus group with populations of focus • Presented to 35-40 agencies/organizations in the community to garner support • Held community event • Presented CAP to community for feedback Genesee County Health Department 10/12/2011

  9. REACH US • Community Action Plan (CAP) derived from two points of view: • Bench (“Science”) • No single intervention is likely to eliminate racial disparities in infant mortality • The period of pregnancy is simply too short to effectively address many risk factors important to infant health • Trench (“Community”) • Language • Communication • Trust • Racism Genesee County Health Department 8/8/2011

  10. “If you always do what you’ve always done, you’ll always get what you’ve always got. If you want something you’ve never had, you’ve got to do something you’ve never done.” A.J. McKnight Genesee County Health Department 10/12/2011

  11. MATERNAL-INFANT HEALTH Fostering Community Mobilization Enhancing the Babycare System Reducing Racism Community Action Plan -A Multi-faceted Life-course Approach Genesee County Health Department 10/12/2011

  12. REACH US – Local Activities • MIHAS • ACEDC - History & Culture Education • PRIDE Medical Services Committee • Community Dialogue Action Groups • Black Men for Social Change • Women Taking Charge of Their Health Destiny • Undoing Racism Workshops • Community Windshield Tours • Evaluation Genesee County Health Department 10/12/2011

  13. Reduce Racism • Community Windshield Tour • Facilitated by the MIHAS • Undoing Racism Workshops • Facilitated by the People’s Institute for Survival and Beyond – New Orleans, LA 2 ½ Days REACH US Activities Genesee County Health Department 10/12/2011

  14. Reduce Racism Community Windshield Tours • Product 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 Genesee County Health Department 10/12/2011

  15. ReducingRacism Undoing Racism Workshops • 30 workshops and over 1000+ participants • Follow-up working groups: • community residents • agencies/organizations Genesee County Health Department 10/12/2011

  16. 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 10/12/2011

  17. Genesee County REACH US’s Objective for the URW Facilitate 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, andcommunity members. Genesee County REACH 2010 Coalition April 2000 Genesee County Health Department 10/12/2011

  18. Community Perspectives (2005):Were Goals/Expectations Met? • 82.0% of AAs and 79.1% of EAs said yes: • EA goals met: • gaining better insight or learning more about racism • how to address racism in work or the community • EA goals NOT met: • the URW was focused on the negative/blamed whites • there was too little time for group discussion or too little focus on solutions • AA goals met: • gaining more insight about racism • find ways to reduce racism • AA goals NOT met: • too little focus on what action can be taken to undo racism. URW Surveys were developed by REACH 2010 Evaluators. Data was analyzed and presented by Cameron Shultz, PhD Genesee County Health Department 10/12/2011

  19. Provider Perspectives (2005):Were Goals/Expectations Met? (Yes) • “I came to the workshop with a very naïve 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, PhD Genesee County Health Department 10/12/2011

  20. Community Perspectives(2009) • 95% felt it changed their knowledge about racism • 90% felt it changed their attitude about racism • 89% stated it would change the way they will act in the workplace • 80% said they would definitely recommend the workshop to a friend or colleague REACH US URW Evaluations 2007-2010 Genesee County Health Department 10/12/2011

  21. What you can do to reduce impact of [racism] to improve AA mother-infant health (2011) • Action • Advocacy (many repeats) • Be aware • Action research • Redefine self • Assume responsibility; sense of obligation with the new knowledge • Teach providers what racism really is • Work with communities in education • Teach AA mothers how to care for themselves • Help mothers before they become pregnant • Share information/progress on MCH strategies and IM • Participate in community outreach • Support REACH US Genesee County Health Department 10/12/2011

  22. What you can do to reduce impact of [racism] to improve AA mother-infant health (2011) • Action • Listen • Foster RELATIONSHIPS • Approach churches to empower community • Help transport neighbors • Become involved in community efforts • Become more familiar with area resources in order to appropriately refer • Work to create community that is more aware of social determinants of health • Increase education-awareness • Support small/positive business Genesee County Health Department 10/12/2011

  23. Undoing Racism Workshop (Linkages to IM reduction…) Genesee County Health Department 10/12/2011 • Foster understanding/awareness • Reviewing demographics and disparities • Importance of community engagement—participatory approach • Bench-(Science Knowledge) • Infant mortality is a life course issue • A multifaceted problem in need of multiple solutions • Trench-(Community Knowledge) • Need for enhanced communication and trust; focus on racism • Common definition, history, root causes, institutions, internalized racial oppression and superiority

  24. Undoing Racism Workshop (Linkages to IM reduction…) Genesee County Health Department 10/12/2011 • Awareness/Understanding (cont.) • Less self-blame and more system blame • Frequent integration of health disparities focus • Integration of Windshield Tour • Direct Impact of Racism • Stress (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)

  25. Undoing Racism Workshop (Linkages to IM reduction…) Genesee County Health Department 10/12/2011 • Skills/Call to Action • Change in institutions begins with change in self • Tools and skills to become more aware and be better communicators • Self-awareness of personal bias • Honesty • A return to the social change focus of public health • Avoid gatekeeping; empower community • Community leadership-advocacy • Community organizing experiences and approaches

  26. Change is Possible • Genesee 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 10/12/2011

  27. Genesee County REACH US Shannon Brownlee, MPH REACH US CEED Coordinator Genesee County Health Department (810) 341-7661 sbrownlee@gchd.us Tonya French-Turner, BBA REACH US Program Coordinator Genesee County Health Department (810) 257-3194 tturner@gchd.us Daniel Kruger, PhD REACH US Program Evaluator University of MI/Prevention Research Center (734) 936-4927 kruger@umich.edu Denise Carty, PhD Candidate REACH US Program Evaluator University of MI/Health Behavior & Health Education (608) 217-9072 dccarty@umich.edu Genesee County Health Department 10/12/2011

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