1 / 30

African American Infant Mortality City of Milwaukee

African American Infant Mortality City of Milwaukee. Discussion and Policy Recommendations Patricia McManus, PhD, RN, GCNPM September 8, 2010. “ Of all the forms of inequality, Injustice in health is the most shocking and the most inhumane.” Dr. Martin Luther King, Jr., 1966.

chapa
Download Presentation

African American Infant Mortality City of Milwaukee

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. African American Infant Mortality City of Milwaukee Discussion and Policy Recommendations Patricia McManus, PhD, RN, GCNPM September 8, 2010 Black Health Coalition of Wisconsin, Inc.

  2. “Of all the forms of inequality, Injustice in health is the most shocking and the most inhumane.” Dr. Martin Luther King, Jr., 1966 Black Health Coalition of Wisconsin, Inc.

  3. AFRICAN AMERICAN CITIZENSHIP STATUS & HEALTH EXPERIENCE FROM 1619 TO 2006 TIME SPAN CITIZENSHIP STATUS -YRS Experience accounts for this proportion of time in US STATUS HEALTH & HEALTH SYSTEM EXPERIENCE 1619-1865 246 years 64% Chattel slavery Disparate/inequitable treatment poor health status & outcomes. “Slave health deficit” & “Slave health sub-system” in effect 1865-1965 100 years 26% Virtually no citizenship rights Absent or inferior treatment and facilities. De jure segregation/ discrimination in South, de facto throughout most of health system. “Slave health deficit” uncorrected 1965-2006 41 years 10% Most citizenship rights: USA struggles to transition from segregation & discrimination to integration of AA So. med school desegregation 1948. Imhotep Hospital Integration Conf 1957-1964, hospital desegregation in federal courts 1964. Disparate health status, outcomes, and services with apartheid, discrimination, institutional racism and bias in effect. TOTAL 387 years 100% HEALTHDISPARITIES/ INEQUITIES “Struggle” Source: Byrd, WM, Clayton, LA. An American Health Dilemma, Volume 1, A Medical History of African Americans and the Problem of Race: Beginnings to 1900, New York, NY: Routledge. 2000.

  4. White Reproductive Potential Risk Factors African American Protective Factors Life Course 0 5ys Puberty Pregnancy The Racial Gap in Reproductive Potential: A Life-Course Perspective Lu and Halfon,MCHJ, 2003

  5. Race “Race” is not a biological construct that reflects innate differences, but a social construct that precisely captures the impacts of racism. (Jones, AJPH, 2000)

  6. MATERNAL LIFETIME EXPOSURE TO INTERPERSONAL RACISM IN 3 OR MORE DOMAINS AND INFANT BIRTH WEIGHT(Collins et al, AJPH, 2004)

  7. MATERNAL LIFETIME EXPOSURE TO INTERPERSONAL RACISM AND INFANT BIRTH WEIGHT(Collins et al, AJPH, 2004)

  8. African American Infant Mortality It must be understood that the health of a people begins with the family (Semmes, 1991) Public Health – Population Health US Medical System – Individual Health Black Health Coalition of Wisconsin, Inc.

  9. Elements of African American Culture (Noble, 1986) • Strong kinship bonds and sense of family and community. • Strong religious belief system • Strong history of self help • Present time focus • Action valued over words • Importance of children Black Health Coalition of Wisconsin, Inc.

  10. Elements of African American Culture • Tend to respond to things in terms of the whole picture instead of its parts; • Tend to prefer inferential reasoning (intuition) to deductive or inductive reasoning; • Tend to approximate space, numbers, and time rather than stick to accuracy; Black Health Coalition of Wisconsin, Inc.

  11. Elements of African American Culture • Tend to prefer to focus on people and their activities rather than on things; • Tend to lean toward altruism, a concern for one’s fellow man; • Tend to prefer novelty, freedom and personal distinctiveness; • Tend not to be “word” dependent. They tend to be very proficient in nonverbal communications Black Health Coalition of Wisconsin, Inc.

  12. Resiliency • An asset-based approach which explore factors associated with positive outcomes Does not ignore risk factors. • Includes values, beliefs, attitudes, and behaviors • Results in health maintenance, well-being, and thriving despite life’s difficulties and stresses. • Analysis of the context and relationships among individuals, families, communities, and the healthcare system (intergenerational, perinatal) Black Health Coalition of Wisconsin, Inc.

  13. RESILIENCY IN AFRICAN AMERICAN FAMILIES Definitions of resiliency: • The ability to resist the pressures of negative forces. (Primary Prevention) 2. The ability to cope positively with adversity (Secondary Prevention) Black Health Coalition of Wisconsin, Inc.

  14. RESILIENCY IN AFRICAN AMERICAN FAMILIES • A continuum of Resiliency - If family resiliency is defined in terms of the ability to cope positively with adversity or to resist the pressures of negative forces. It is evident that it is not an “all-or-none” attribute. Black Health Coalition of Wisconsin, Inc.

  15. RESILIENCY IN AFRICAN AMERICAN FAMILIES • Rather, resiliency should be viewed as a continuum along which families can be ordered, depending on the extent to which they needed help. Black Health Coalition of Wisconsin, Inc.

  16. Life Course Principles • 1. Socialhistorical and geographical location • Timing of lives • Heterogeneity or variability • Linked lives and social ties to others • Human agency and personal control and • How the past shapes the future. Black Health Coalition of Wisconsin, Inc.

  17. Reduction of Health Disparities in African American Birth Outcomes Black Health Coalition of Wisconsin, Inc.

  18. Milwaukee Healthy Beginnings Project (MHPB) Highlights Of MHBP Impact Evaluation Report 2004-2008 Black Health Coalition of Wisconsin, Inc.

  19. Milwaukee Healthy Beginnings Project (MHPB) • Funded by federal government in 1998 • Targeted population, pregnant women, infants, interconceptional women and their families. • Started as a primarily outreach and referral program until 2004. • Since 2000 provides case management, health education, mental health, AODA and domestic violence services in the Milwaukee County Jail. Currently 60% of participants are from jail. Black Health Coalition of Wisconsin, Inc.

  20. Milwaukee Healthy Beginnings Project (MHPB) • Since 2004 provide home based case management, health education, mental health, AODA, and DV services by professionals and paraprofessionals • Required to provide intensive services to family until youngest child is two. 90% of clients and family are African American. • Consortium which is co lead by participants. • Provide community health education forums on a variety of topics. Black Health Coalition of Wisconsin, Inc.

  21. Low Birth Weight (LBW) • City- five year average – 10.2 • Project Area – 8.4 • MHBP Participants – 10.4 • prevalence rose slightly among project area infants between 2004-2008. Among MHBP participants, the LBW increased in 2006 (13.6) and 2007 (10.9%) , but declined back to the 2004 percentage of 9% in 2008. Black Health Coalition of Wisconsin, Inc.

  22. Very Low Birth Weight (VLBW) • City – 2.8 • Project Area – 2.6 • MHBP Participants – 1.28 • 3.0% to 0.00 in 2008. • There was not significant change in LBW treads, but for VLBW statistically significant decreases were found in both MHBP clients and the project area as a whole. Black Health Coalition of Wisconsin, Inc.

  23. Preterm25-36 weeks • City – 13.9 • Project Area – 11.34 • MHBP Participants – 12.64 • The data indicated a modest significant decline in the prevalence of premature infants in the project area and even a more drastic decrease (14.6-9.8) in 2008 among MHBP clients. Black Health Coalition of Wisconsin, Inc.

  24. 1st Trimester Prenatal Care • City – 77% • Project Area – 74% • MHBP Participants – 66% • There was a significant decrease between 2004-2008 among both the project area and MHBP participant mothers. There was a 5% in the project area and 10% with MHBP, but no rates of change between groups over the time period. Black Health Coalition of Wisconsin, Inc.

  25. Late or No Prenatal Care • City – 2% • Project Area- 5.34% • MHBP Participants – 8.2% • The rate increased significantly in the project area over the time period, but the increase for MHBP participants was not significant. Black Health Coalition of Wisconsin, Inc.

  26. Policy Recommendations • Mandated HIV testing as a part of all prenatal panels. • Provide funding for promising practices that are serve pregnant women and their families in a culturally manner. • Provide funding to state healthy start sites increase capacity of services to at risk populations Black Health Coalition of Wisconsin, Inc.

  27. Policy Recommendations • Expand allowable cost of existing funding to reduce impact of social determinants on birth outcomes. • Promote policies which reduce the barriers experienced by fathers who want to provide support to their families. Black Health Coalition of Wisconsin, Inc.

More Related