Wisconsin’s Greatest Challenge

1. Wisconsin’s Greatest Challenge African American Infant Mortality in Wisconsin A Tragic Problem and a National Disgrace that Urgently Needs and Deserves More Attention, Resources, and Leadership Philip M. Farrell, MD, PhD Professor of Pediatrics and Population Health Sciences WPP Oversight and Advisory Committee member UW School of Medicine and Public Health

2. Important Definitions Infant Mortality: Death of a baby before his/her first birthday; usually expressed per 1,000 live births in a geographically defined region Health Disparities: Differences in the quality of health or health care across racial, ethnic, and socioeconomic groups

3. Part I: The Problem • Infant mortality rates in African Americans residing in Wisconsin are very high • The black/white disparity gap has existed for at least 3 decades in affected WI communities • The geographic distribution is highly specific (currently: Southeastern Wisconsin + Beloit) • Many lifelong maternal stresses are responsible • Babies are innocent victims of long term risk factors, but mortality is the “tip of the iceberg”

4. African American Infant Mortality Rates, reporting states and DC, 2004-2006 U.S. African American IMR: 13.52 per 1,000 live births Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics reports; vol 58 no 17. Hyattsville, MD: National Center for Health Statistics, 2010.

5. Infant Mortality Rates, by country, 2007 U.S. Census International Database, countries with population greater than 250,000. 02/11/09. http://www.census.gov/ipc/www/idb/ Wisconsin data, WISH, 2005-2007.

6. WISCONSIN INFANT MORTALITY RATES BY RACE/ETHNICITY 1986-2008(3-Year Rolling Averages) Wisconsin Births and Infant Deaths, 2008

7. Infant Mortality Rates, 2004-2008 WISH (Wisconsin Interactive Statistics on Health), Infant Mortality Module, accessed 11/30/09.

8. Geographical Distribution of African American Infant Deaths, 2006-2008 Southern, Western, Northern, Northeastern Regions 12% (40) 29% (94) City of Milwaukee Target Zip Codes (53204-06, 08, 12, 33) 13% (42) Remaining Southeastern Region Remaining City of Milwaukee 46% (150) 75% of Wisconsin’s African American infant deaths occurred in the City of Milwaukee from 2006-2008 The Southeast Region accounts for 88% of African American infant deaths. (Wisconsin Total N=326)

9. Disparities in Infant Mortality Rate by Maternal Education, Wisconsin, 2006-08 WISH (Wisconsin Interactive Statistics on Health), Infant Mortality Module, accessed 11/25/09.

10. Disparities in Infant Mortality Rate by Maternal Age, Wisconsin, 2006-08 WISH (Wisconsin Interactive Statistics on Health), Infant Mortality Module, accessed 11/25/09.

11. Disparity Crisis in Wisconsin • African American infant mortality rate is approximately 3 times the white rate • In 2004, Wisconsin met Healthy People 2010 goal of 4.5 per 1,000 live births for white infants, but was highest in the nation for African American infant mortality at 19.4 per 1,000 live births • If the disparity were eliminated, at least 1 African American infant would be saved each week in WI

12. Part II: The Program • The Wisconsin Partnership Program (created in 2004 and engaged in a 5 year Plan) • The Healthy Birth Outcomes Initiative a thoroughly analyzed and comprehensively planned program • The Life-course Initiative for Healthy Families a 2 phase project targeting 4 key WI communities

13. LIHF Steering Committee

14. The Priorities • Milwaukee, Racine, Kenosha, and Beloit • A comprehensive life-course strategy • A public health driven, long-term initiative • A collaborative, community embedded effort • An innovative thrust that respects cultures

15. Life-Course Perspective Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Matern Child Health J. 2003;7:13-30.

16. LIHF Goals and Outcomes • Improved health status of African American women over the lifespan • Improved African American infant survival and health • Elimination of racial and ethnic disparities in birth outcomes

17. LIHF Program Resources • Investment of up to $10 million over the next 5 -10 years • Senior Program Consultant: Lorraine Lathen • UW SMPH Faculty and Academic Partner Team • Collaboration with the Wisconsin Department of Health Services • Other funding partners, including private and public sectors • Potential grant funding

18. Steering Committee Activities • ~$1 million grants for planning/capacity development in the 4 targeted communities • Raise public awareness of birth outcome disparities and especially mortality risks • Identify and engage other funding partners • Build and strengthen community capacity • Expand access to high quality services • Engage UW SMPH faculty partners

19. Part III: The Possibilities • What more can the State of Wisconsin do to reduce infant mortality in African Americans? • New strategies and policies for the benefit of African American maternal and child health • More resources and appealing opportunities for prenatal and infant care in the 4 communities • Interconceptional care initiatives with education

20. A New MCH Policy Agenda Birth Early childhood Pre-teen Teen Young adult Women 35≥ Seniors

21. Why a New MCH Agenda? • Prioritize public expenditures • Invest in more effective policies and programs • Update our strategies with new information • Acknowledge critical or sensitive periods of development over the life span • Need multifaceted and integrated approaches • Focus on family-supportive policies and system-level changes

22. New Strategies and Policies “Public investment in reducing the rate of preterm birth has the potential to result in large cost savings not only to society as a whole but also to the public sector” Finding 14-3 Institute of Medicine, 2006, Preterm Birth: Causes, Consequences, and Prevention, National Academy Press

23. Medical and Societal Costs of Preterm Birth Source: Institute of Medicine. 2006. Preterm Birth: Causes, Consequences, and Prevention. National Academy Press, Washington, D.C.

24. Birth Weight and Infant Hospitalization Average Charges During the First Year of Life2005 Medicaid Births in Selected Counties(Dane, Kenosha, Milwaukee, Racine, and Rock Counties) Linked Birth Events File, Bureau of Health Information and Policy Total Overall Charges: $112,775,535

25. Improve Healthcare Access In Wisconsin: • 23% of African American women of reproductive age are uninsured for all or part of a12-month period (Family Health Survey) • Approximately 35% of eligible African American pregnant women receive Prenatal Care Coordination (PNCC) services

26. Evidence-Based Programs and Policies • Healthy Child Development • Head Start • Early childhood home visitation • Child Parent Centers • Education • Drop-out prevention program • Youth development programs • Income and Employment • State Earned Income Tax Credit • Workforce Investment Act • Community Programs • Women Infant and Children (WIC) • Breastfeeding • Teen Pregnancy Prevention • Housing • Community Development Grants • Home Investment Partnership • Housing Tax Credits • Health Care Financing • Medicaid Expansions • Case Management • Centering Pregnancy/Group prenatal • Health System • Pre and Inter-conception care • Behavioral health services • Culturally relevant health professions education • Community health/lay workers What Works for Health: Programs and Policies to Improve Wisconsin’s Health - 2010 UW SMPH

27. Conclusions • The Life Course approach is an important framework for guiding policy and solving challenging issues such as African American Infant Mortality Disparities. • This challenge will require many years of synergistic, innovative efforts targeting the key communities. • Deep and sustained partnerships, along with more resources, will be essential for success.

28. Questions