Public Policy and Racial Disparities in Birth Outcomes: Connecting the Dots

1. Public Policy and Racial Disparities in Birth Outcomes: Connecting the Dots Gail C. Christopher, D.N. Vice President, Office of Health, Women and Families Director, Health Policy Institute Joint Center for Political and Economic Studies Presentation: Improving African American Birth Outcomes. Solving Health Disparities Through Interdisciplinary Research Conference University of Michigan Ann Arbor, Michigan June 20-21, 2005

2. NIH Roadmap Initiatives Designed to lower organizational barriers that impede research and enable scientists to conduct research across disciplines, creating solutions to biomedical problems that have not been solved using traditional disciplinary approaches.

3. Interdisciplinary approach to developing strategies that lead to improved birth outcomes among African Americans. Three dimensions: Leaders Providers Patients

4. This presentation focuses on two aspects of the previous assertions: • Leaders: Influencing public policy makers and advocates (2) Solutions: Moving to action in a results oriented governance milieu

5. Joint Center for Political and Economic Studies • A national, nonprofit research and public policy institution. • Founded in 1970 by black intellectuals and professionals to provide training and technical assistance to black elected officials. • Today, the Joint Center is recognized as one of the nation’s premier think tanks on issues of concern to African Americans and other minority populations. • As the nation’s only full-service minority think tank, our research and program activities help to empower minorities through information and technology.

6. Joint Center Health Policy Institute • Established in 2002 by the Joint Center, with a grant from the W. K. Kellogg Foundation. • Mission: To ignite a “Fair Health” movement that gives people of color the inalienable right to equal opportunity for healthy lives.

7. Joint Center Health Policy Institute Focus Areas • The goal of HPI is to help communities of color identify short- and long-term policy objectives and related activities in the following key areas: • Identifying and addressing the economic, social, environmental and behavioral determinants that can lead to improved health outcomes. • Increasing resource allocations for prevention, wellness and health promotion, as well as effective management of chronic illness. • (3) Informing the policy and practice of reducing infant mortality and improving child and maternal health.

8. Joint Center Health Policy Institute Focus Areas • Reducing risk factors and supporting healthy behaviors among children and youth. • Improving mental health and reducing factors that promote violence. • Optimizing healthcare access and quality. • Creating conditions for healthy aging and improving the quality of life for seniors.

9. The Courage to Love: Implications for Care, Research, and Public Policy to Reduce Infant Mortality Rates Commission To review the history of infant mortality rate analysis and interpretation, redefine the problem, examine basic assumptions, and imagine new possibilities for action. Specifically, the Commission will focus on the new and promising research on the lack of social support and presence of unmitigated stress – relationality – as potentially contributing factors in preterm births and infant mortality rates. The intentional focus on relationality has potential implications for improved pregnancy outcomes, economic prosperity, and meaningful political participation for all women and women of color in particular. The Commission will elaborate those implications and publish them as a report with a blueprint for action.

10. Poor birth outcomes are a shared experience. • Impact is felt by mothers, fathers, families and communities. • Cost is borne by multiple institutions. • Solutions require multiple, simultaneous efforts at individual, family, community, institutional, governmental levels.

11. American Academy of Pediatrics “Interventions must not only include health-related measures that have a direct bearing on perinatal and/or neonatal outcomes, but several other ancillary measures of equal importance.” Source: American Academy of Pediatrics 2005 Report on perinatal and neonatal health outcomes in developing nations.

12. American Academy of Pediatrics “These measures include poverty alleviation, improved opportunities for female education, and improvement of women’s social status, including empowerment and improvement of women’s decision-making ability.” Source: American Academy of Pediatrics 2005 Report on perinatal and neonatal health outcomes in developing nations.

13. Molecular Evidence of An Interaction Between Prenatal Exposures on Birth Outcomes Exposure to common environmental pollutants at levels currently encountered in New York City can act in combination to affect adversely fetal development. Source: Perera, F.P. et al., Columbia Center for Children’s Environmental Health

14. Joint Center Health Policy Institute Place Matters • Place Matters will profile relevant conditions and circumstances in counties with the highest percentage or highest number of people of color. • It will serve as a tool for counties to benchmark their progress toward creating the conditions and circumstances in which all of their residents have an equal opportunity to live healthy lives. • It will recognize counties that take the most effective action in pursuit of related improvements, through annual or biennial awards celebrations.

15. Maternal support in the delivery room or factors closely associated with it significantly decreases the odds of delivering a VLBW infant for African American women. Source: Lespinasse, A. et al., J Nat Med Association 2004:96 187-195

16. State Level Programs State level programs focus on behaviors that affect infant health. These include information distribution to encourage healthy behaviors among women. Prenatal care, smoking cessation, alcohol and drug avoidance, and nutrition are emphasized.

17. Augmented or enhanced prenatal care improved birth outcomes in California’s high risk population. • UCSF study finds odds for a good birth outcome were 3 times higher if women received support services in each trimester. Source: UCSF Today, www.ucsf.edu/today/

18. Federal HHS Initiative: 2005 “What to Do for Life Campaign” • Gospel recording artists encourage audiences to learn more about SIDS and risk factors for low birth weight and premature delivery. • Tool kit for community and faith-based organizations.

19. Formal authority to make decisions Contingent inducements to influence other participants Persuasiveness Deference from other participants Strategic skills Potential Sources of Power Influencing Health Policy

20. Two critical questions: • Is relevant biomedical or social science research guiding public policies to address this health disparity? (2) Can more be done to implement effective public policies?

21. “No problem can be solved by the same consciousness that created it.” Albert Einstein