Along with the educational disparities being addressed, health disparities are also being tackled successfully, despite some tough odds.
Black children are often disadvantaged even before they are born. In Detroit, even with its four major health systems, thousands of doctors and countless social service programs, the infant mortality rate rivals that of many developing nations. It means in any given year, 150 to 200 babies born in the city die before their first birthday. Most of them are black.
To address this imbalance, Women-Inspired Neighborhood Network focuses on reaching new parents in underserved pockets of Detroit. The program matches pregnant women with community health workers who provide support and health monitoring throughout the pregnancy and for one year following birth. With a regional long-term goal of decreasing the infant mortality rate, the program is making headway. The initial cohort of more than 300 parents resulted in no infant deaths.
If there’s one issue that draws sympathy and action from both political parties, it’s the nation’s infant mortality rate, which is one of the worst in the developed world.
In fact, the United States even trails behind developing countries like Cuba. According to the CIA,for every 1,000 births in America, nearly six babies die before their first birthday.
The infant mortality rate is a good, albeit tragic, indicator of the overall health of a community. If many women aren’t giving birth to healthy babies, it may, for example, signify a widespread drug problem among expecting mothers. The most common causes of infant mortality in America are complications stemming from low birth weight, premature birth, unsafe sleep environments and exposure to secondhand smoke.
In the past decade, several cities with high infant mortality rates have spent money and resources trying to get them down. But despite their efforts, babies are still dying in these communities more often than one would expect for a developed nation.
Columbus, Ohio, provides a stark example of how difficult it can be to address this issue. Since the city made it a priority, the infant mortality rate has actually gone up.
In 2015, the city launched CelebrateOne — a campaign to target eight neighborhoods with high rates of infant mortality. Since then, the infant mortality rate rose from 7.7 deaths per 1,000 births to 9 deaths per 1,000 births. Most disappointingly, most of the uptick was for sleep-related deaths — something CelebrateOne focused on preventing.
Erika Clark Jones, the new executive director of CelebrateOne, says the city only had money for the campaign through the end of 2015. Additionally, the city didn’t deploy a key part of its strategy, community health workers, until June 2016.
“We have to be driving that safe sleep message all of the time,” says Jones. “We need to be constantly reminding them and holding events to keep it in mom’s minds.”
Despite their lack of progress so far, Jones is cautiously optimistic about the future. Her team has an ambitious set of goals that includes reducing the rate of unsafe sleep deaths by 31 percent by the end of the year and an overall 40 percent reduction of infant mortality by 2020.
“We know our goal is aggressive. We’re trying to build in the supports to improve the upstream stuff,” she says.
But it’s not enough to simply throw money at the problem. Practitioners say it has to be targeted to the right people, places and programs. The main drivers of infant mortality are well-known to experts, but they can differ depending on the region.
Shelby County, Tenn.
When Shelby County, Tenn., Mayor Mark Luttrell was elected in 2010 and dug into health data, he found that teen pregnancies and smoking were among the biggest contributors to infant mortality.
Studies have shown that pregnant teens are more likely to smoke and carry sexually transmitted diseases; their young age also puts them at higher risk of complicated pregnancy and premature birth.
In 2003, Memphis’ infant mortality rate was higher than that of Saudi Arabia and Venezuela — nearly 15 deaths per 1,000 births. But by focusing on teen pregnancy and smoking, the city has been able to cut its infant mortality rate in almost half. At 8.2 deaths per 1,000 births in 2016, it dipped to its lowest level ever, though it’s still above the national average.
“We regularly look at data and adjust our approach,” says Alisa Haushalter, director of Shelby County’s health department. Now, the city is focused on promoting breastfeeding, which the World Health Organization says reduces infant mortality, and getting fathers more involved in raising their babies.
When Kimberlydawn Wisdom was appointed surgeon general of Michigan in 2003, she knew she wanted to address the city’s high infant mortality rate. But she didn’t just want to start another educational campaign that would be forgotten or write another grant for a program that might go underutilized.
“Every time an administration changes and people leave their posts, the rate climbs back up. Let’s tackle this in a sustainable way,” she recalls thinking.
Wisdom, now the senior vice president of community health at the Henry Ford Health System, which oversees Detroit’s infant mortality program, discovered that the city had 100 programs dedicated to infant and maternal health. “But they were undersubscribed,” she says. That’s the bad news. The good news is that “it wasn’t like we didn’t have the resources.”
So she rerouted some of those resources to create a community health program. PSAs and billboards, she says, are useless unless someone links mothers and fathers to the right program — in person. That’s where community health workers come in.
“Community health workers are ultimately the secret sauce to make that connection to different programs; it isn’t going to happen organically,” says Wisdom.
A community health worker is an advocate, often from the place they’re serving, who understands the health disparities and barriers to care that are specific to the community. Their ultimate goal is to help improve new and expecting mothers’ overall well-being in ways that a traditional doctor doesn’t — like securing transportation to the clinic and improving eating habits.
Wisdom did ultimately use grant money to kick off the community health worker program, initially called “Sew Up the Safety Net.” It has since been rebranded to the Women-Inspired Neighborhood Network.
Detroit still has a long way to go. The city’s 2015 infant mortality rate (at 13.3 deaths per 1,000 births) was one of the highest in the country. But Wisdom is encouraged.
In 2012, 323 women were matched up with a community health worker throughout their pregnancy and the baby’s first year. There were no deaths. In the most recent group to be matched, starting in April 2016, there so far have been no deaths. And, 100 percent of the mothers are breastfeeding.
“These women have been having outstanding health outcomes,” says Wisdom.
Despite four major health systems, thousands of doctors, and countless social service programs, Detroit’s infant mortality rate rivals that of a developing nation.
“We lose, in any given year in the city of Detroit—not in southeast Michigan, but in Detroit—150 to 200 babies before their first birthday,” says former Michigan surgeon general Dr. Kimberlydawn Wisdom, now senior vice president of community health & equity and chief wellness & diversity officer at Henry Ford Health System.
The numbers are especially sobering among African American babies. For Detroit’s white population, the average infant mortality rate between 2012 and 2014 per 1,000 live births was 10.4. For black babies in Detroit, the rate was 14.5 during the same years.
Detroit physicians, community organizations, health workers, and state and local government entities agree that this situation cannot persist, and are ramping up efforts to combat the city’s high infant mortality rate. In doing so, they’re reframing Detroit as a city that’s good for babies, with a strong support system and vibrant, caring communities that prioritize the needs of infants, as well as their parents and caregivers.
“We have an incredibly deep culture of parenting in the city,” says Dr. Abdul El-Sayed, former executive director and health officer for the City of Detroit. “There’s multigenerational, connected families—mom, aunt, grandmother—in the same home. It’s a great environment for a child. With a number of organizations in the city that are dedicated to giving babies the best shot at health, we are activating and leveraging these networks for the best health experience for moms and babies.”
Connecting women to improve birth outcomes
In 2008, to address the alarming numbers, Nancy Schlichting, then CEO at Henry Ford Health System, and her peers at Detroit Medical Center, St. John Providence Health System and Oakwood Healthcare, approached Wisdom to form the Detroit Regional Infant Mortality Reduction Task Force.
Wisdom and her team found 100 programs at risk of losing funding because they were not connecting to the women they were designed to serve. In response, they wrote a grant to bridge the divide, gaining funding from The Kresge Foundation, The Robert Wood Johnson Foundation, and each of the health systems involved.
In In 2012, an initial cohort of 323 women were identified and supported by community health workers throughout pregnancy and for one year following birth. The result: no infant deaths.
“We were really thrilled,” says Wisdom. “The community health worker is the secret sauce” and can level the playing field. She goes to the womens’ homes, becomes their mentor, best friend, biggest supporter. It’s pretty amazing.”
In April 2016, WIN adopted a centering pregnancy model which brings 10 to 12 women together from several health systems for 10 two-hour, education- and support-focused prenatal visits, group-taught by a doctor or nurse midwife and a community health worker.
Currently, 120 women are enrolled, and among the approximately 40 births in the current group, women are reaching due dates, achieving normal birth weights, and have a 100 percent breastfeeding initiation rate.
Identifying and reducing preterm and low birth weight risks
In Detroit, 50 percent of infant mortality can be attributed to low birth weight, according to information from Make Your Date Detroit. Funded in part by the DMC Foundation, March of Dimes ,and WSU, Make Your Date works to identify and treat women at risk for preterm birth.
“There are many long-term complications from early birth, including cerebral palsy, respiratory problems, cognitive and learning disabilities,” says Dr. Sonia Hassan, associate dean of maternal, perinatal and child health at Wayne State University School of Medicine. “The focus of this program is to get evidence-based strategies—tested medical interventions that are known to reduce preterm birth—and make sure women have access to them.”
Since launching in May 2014, Make Your Date has provided care to more than 5,000 women to determine cervical length, a risk indicator for preterm birth that can be congenital or caused by infection.
“If we find [her cervix] to be short, we know she’s at high risk for preterm birth,” says Hassan. “Then we give progesterone and have decreased the rates of preterm birth by 45 percent. We were the first to offer group prenatal care on a large scale.”
Make Your Date is focused on outreach and education to help more women in Detroit, and is building a data registry to study factors and outcomes.
“We take the approach of following patients and connecting them to what they need. There are a lot of holes that people fall through that we are trying to fit in. It’s not just medical, but other factors as well,” says Hassan.
Hassan says the program is the first of its kind, and could be replicated in other urban centers with similar risk factors. “We have been asked by other cities and are considering it,” says Hassan. “But our focus is Detroit. And that will never change.”
“Baby friendly” is a commitment to put the needs of baby first, before profit and convenience. Sometimes, that means a top-down reframing of policy, procedure, and focus.
To achieve the stringent, evidence-based practices outlined in the Baby Friendly Hospital Initiative (BFHI), St. John Hospital in Detroit got every department on board.
“What makes a hospital run for the Baby Friendly Initiative successful is commitment at all levels,” says St. John Providence Health System breastfeeding coordinator Dr. Paula Schreck. “It’s a comprehensive accreditation that’s not just about medical practices, but also purchasing, marketing, and education.”
Prior to implementing BFHI in 2009 and 2010, breastfeeding initiation rates at St. John Hospital were about 50 percent. They’re currently around 75 percent. “More importantly, we’ve narrowed or eliminated racial and social gaps of those initiation rates,” says Schreck, adding that equal and equitable education to all groups helps achieve these numbers.
And breastfeeding’s enormous benefits are even more impactful in preterm and low-birth weight situations. Shreck says breastfeeding contributes to the decreased incidence of SIDS, otitis media, gastrointestinal disease, and pneumonia. The benefits follow the baby into childhood to reduce Type 2 diabetes and asthma and improve school performance.
“For the mother, there’s a decreased lifetime risk of breast and ovarian cancers, cardiovascular disease and decreased post partum depression, which affects one in three mothers. It enhances maternal-infant bonding and the economic benefit is huge,” Schreck says.
St John is currently the only Detroit BFHI hospital, but Schreck credits local health systems for working toward accreditation and for their collaborative work to make Detroit a more baby-friendly city.
The Black Mothers Breastfeeding Association (BMBFA) was founded to reduce racial disparity in breastfeeding success for black families through a breastfeeding helpline, breastfeeding club, and a community-based doula program, so women will initiate and continue breastfeeding.
Michigan black breastfeeding rates are lower than white rates, but the numbers are improving, according to BMBFA founder Kiddada Green.
In 2016, the BMBFA breastfeeding club served 137 families and the peer counselor program made 493 home visits, while the doula program made 345 home visits and supported 100 percent breastfeeding initiation at 24 births.
BMFBA provides culturally appropriate support through health providers in Indiana, Illinois, Washington, and Colorado to reduce racial inequities in breastfeeding, and Green acknowledges the nationwide impact of strides made in Detroit. She’s also quick to recognize collaborative efforts like the Detroit Institute for Equity in Birth Outcomes to create the cultural shift toward a baby-friendly environment
“One of the great things happening in Detroit is the collaborative spirit about moving forward and working together to make sure we save babies’ lives.”
This article is part of Michigan Nightlight, a series of stories about the programs and people that positively impact the lives of Michigan kids. It is made possible with funding from the W.K. Kellogg Foundation. Read more in the series here.
A few more high heels will strut the University of Michigan campus next weekend, but they’re not strutting to frat parties.
The 17th annual NOiR Runway Fashion show will be held in a tent on Ingalls Mall, the area in front of the Burton Memorial Tower, on Saturday. The largest fashion show on campus is run by the student group NOiR, which means “black” in French.
“It’s is for students of color to celebrate positive body image,” says NOiR president Kendall Johnson, a first-year graduate student in the School of Social Work.
Johnson, a 22-year-old from Detroit, got involved after watching the show as an undergraduate student at UM. “I really love the fact that it combines fashion and philanthropy. This organization allows me to be involved in two things that I really care about,” she says.
As a fashion philanthropy organization, the 50 models in the show and executive board members are required to perform at least two hours of community service. The group also donates all ticket sales to a cause of their choice. In 2015, NOiR raised around $3,000 for the Children’s Literacy Network of Ann Arbor. This year, all proceeds go to the Women-Inspired Neighborhood Network, a program sponsored by Henry Ford Health System focused on reducing infant mortality in Detroit.
In 2012, Detroit’s infant mortality rate was roughly 15 deaths per 1,000 live births, compared to the state average of seven deaths . Noticing the disparity, four Detroit health systems — the Detroit Medical Center, Henry Ford, St. John Providence and Oakwood Healthcare — formed the Detroit Regional Infant Mortality Reduction Task Force.
The WIN Network (formerly known as Sew Up the Safety Net for Women and Children) spun out of the task force and kicked off in 2012 to provide education and resources to 375 low-income pregnant women and over 1,200 non-pregnant women from Detroit enrolled in the program.
Jaye Clement, director of Henry Ford Health System’s community health program and strategies, oversees WIN. She says their efforts have led to fewer premature births, and there’s been zero infant deaths among the women who’ve given birth. Another bonus: The program instills “a sense of hope,” she says.
“More of these women are finishing high school or their GED requirement, or finding employment and finding stable housing and really transforming their lives,” Clement says.
NOiR partnered with WIN because there’s a closet connection — WIN often provides clothing for infants and mothers.
“We’ve had situations where the mother has a job interview coming up and needs clothes, and we’ve had situations where just having maternity clothes is a struggle,” Clement says.
NOiR hopes to raise at least $4,000 for the program, Johnson says. The models — who are “from all different backgrounds and races and body size,” she adds — will wear apparel from student designers and local retailers Windsor, Bivouac and Renaissance.
Celebrity stylist Dutch Davis, aka “Dutch The Omen,” (he’s dressed A-listers Nicki Minaj, Nelly and Ashanti) is returning for the third year to style models for the final NOiR scene.
Davis described his collection as “confused and mixed.”
“You might see a boy in a skirt, a girl in a pant suit. You might see a big gown. It will be a lot of black, a lot of militant looks,” he says during a telephone call from Chicago.
He’s not afraid to shake up the Wolverine fashion scene.
“I know the designers in Detroit and Michigan,” he says. “They bring it safe, and I’m not going to bring it safe. I’m going to bring something different.”
Southfield native Malaya Watson, “American Idol” Season 13 contestant, will be hosting the giveaway portion of the show. Items include a football signed by Michigan head football coach Jim Harbaugh and products from sponsors Steve Madden, Mary Kay and Hampton Creek.
Former Michigan football player Devin Funchess, now a wide receiver for the Carolina Panthers, also is on the attendance list.
The last scene may push fashion boundaries thanks to Davis, but we’re guessing Funchess won’t be arriving in heels.
Despite the existence of high quality, nationally recognized health systems in metropolitan Detroit, the appalling rates of death and racial health disparities among the most vulnerable members of our community – infants – rival that of third-world countries.
The reasons behind these disparate health outcomes are complex, but likely include the absence of a coordinated, public-private effort to link at-risk women to needed medical and social resources in a timely manner. Consequently, the safety net has gaping holes.
The Sew Up the Safety Net for Women and Children (SUSN) program was designed by the Detroit Regional Infant Mortality Reduction Task Force to “sew up the safety net” by connecting the right people (at-risk women and neighborhood navigators) to the right places (clinical and social services in or near their neighborhood), at the right time (before women present with poor birth outcomes). The Women Inspired Neighborhood (WIN) Network: Detroit is a part of the SUSN program for the Detroit community.
“The solution to adult problems tomorrow depends in large measure upon how our children grow up today.” – Margaret Mead, American Anthropologist
While poor access to primary care continues to pose a fundamental challenge, women most at-risk for infant mortality often live in neighborhoods surrounded by underutilized healthcare and social services and other community entities that could support the health and wellbeing of their families. WIN Network: Detroit focuses on three of the city’s neighborhoods: Brightmoor, Chadsey-Condon, and Osborn. Although infant mortality rates are higher in these neighborhoods, residents are surrounded by a strong network of organized services that offer resources, accessible medical care, and assistance for everyday life. Our Community Neighborhood Navigators (CNNs) are based in community centers in each of these areas. WIN Network: Detroit connects women in these neighborhoods to the programs and resources that exist to serve them.
The following table shows the percentage of certain indicators of infant mortality for each of the three neighborhoods that WIN Network: Detroit works in. (Note: Data is from 2006-2008)
Contributors to Infant Death in Detroit:
Prematurity and low birth weight – 29%
Intermediate or inadequate prenatal care – 61%
Less than a 12th grade education – 42%
Unintended pregnancy – 30.5%
Multiple stressors/social chaos – 21.3%
A week in a Detroit hospital emergency room can be an education.
Dr. Kimberlydawn Wisdom worked in one for 20 years.
She encountered nearly every possible injury and ailment during her decades as an emergency department doctor with the Henry Ford Health System.
The most frustrating cases for her involved diseases and tragedies that might have been prevented through better personal behaviors and public health campaigns.
“Seeing the types of challenges that came in, that really informed a lot of my work,” Wisdom, the former Michigan surgeon general, recalled recently. “I realized that if we’re really going to improve health, we need to step outside of the four walls of the health system and go into the community and effect change there.”
That epiphany would guide Wisdom through the next phase of her career in public service and health care administration, developing programs that have improved the lives of thousands of Michigan men, women and children. She became the first state-level surgeon general in the country and, at the conclusion of her terms, returned to the Henry Ford Health System, where she is now an executive in charge of community-level wellness initiatives.
Today, her programs are making progress in improving Detroit’s high infant mortality rate, preventing unintended pregnancies, combating obesity and boosting fruit and vegetable consumption among low-income school children.
Wisdom, 58, is the recipient of this year’s Eleanor Josaitis Unsung Hero Award, sponsored by the Detroit Free Press and the Metropolitan Affairs Coalition.
“She has the ability to make quick, decisive decisions that comes from her experience as an emergency department physician,” said Robert Riney, chief operating officer for the Henry Ford Health System, “but she also has the patience to understand how you have to navigate through the political process when you’re trying to really create policy or financial infrastructure for an initiative.”
As Henry Ford’s senior vice president of community health and equity and the chief wellness and diversity officer, Wisdom is focused on improving the many “social determinants” of health among metro Detroit residents, such as access to nutritional foods and to prenatal care for expectant mothers.
One of her programs aimed at eliminating race and class inequities in health care last month won the national Equity of Care Award from the American Hospital Association.
“There are many social determinants of health that are outside of the medical arena,” Wisdom explained in an interview from her office at Henry Ford’s Detroit headquarters. “That means we can have the finest highest-quality medical care, but if we don’t help people with jobs and transportation and access to healthy foods, then we’re not going to have the outcomes that we need to see.”
She is extremely passionate about lowering the infant mortality rate in Detroit, where an average of 200 babies a year were once dying before their first birthday, a rate that rivaled that of some third-world countries.
Wisdom convened a regional infant mortality task force, which led to the creation of the Women-Inspired Neighborhood Network alliance between metro Detroit hospitals and health care providers. This alliance aims to help expectant mothers from Detroit’s most underserved neighborhoods.
Preliminary data show that there were no infant deaths among the first 200 babies born between 2012 and 2013 whose mothers enrolled in the alliance network.
Wisdom grew up in Groton, Conn., where her father was an architectural engineer who helped design the USS Nautilus, the world’s first nuclear-powered submarine. She was one of the few black girls in her school and dreamed of becoming a doctor, despite the advice of a school guidance counselor who had warned that “there’s no such thing as a Negro doctor. No such thing as a woman doctor, you should choose a profession in keeping with your race,” she recalled.
Undeterred, she went on to college at the University of Pennsylvania and later to medical school at the University of Michigan. But it was in Henry Ford’s emergency rooms in New Center and Dearborn that Wisdom encountered the sort of health problems that became the focus of her later work. This included preventable blindness and amputations from Type 2 diabetes.
“Where I really received a major education was in that emergency department,” Wisdom said.
In 2003, she was tapped by then-Gov. Jennifer Granholm for the new position of Michigan surgeon general. Until that time, no state had its own surgeon general. She served until the end of the Granholm administration in December 2010.
“I accepted the challenge and felt very honored and privileged to serve in that post and to continue to drive change at the state level on many of the same initiatives — chronic diseases, childhood obesity reduction, infant mortality, teen pregnancy prevention — that I cared about here in the (Henry Ford) system,” Wisdom said.
As surgeon general, Wisdom launched public health initiatives to combat obesity, childhood lead poisoning, unintended teen pregnancies and to reduce smoking. She gave more than 400 speeches across the state and advocated for the 2004 increase to the tobacco tax.
She helped start Generation with Promise, an initiative that educates students from low-income families in Detroit and Macomb County about boosting their fruit and vegetable consumption and physical activity.
Wisdom was recruited back to Henry Ford at the end of her time as surgeon general. She brought the Generation with Promise initiative with her, which now serves more than 20,800 individuals a year, or twice as many as in 2012.
“Beyond all of her clinical and administrative skills, it’s her personal passion for equity of care, for eliminating disparities and for health and prevention that are probably her greatest gifts,” Riney said.
In February 2012, President Barack Obama appointed Wisdom to be a member of the Advisory Group on Prevention, Health Promotion and Integrative and Public Health — a creation of the Affordable Care Act.
Gov. Rick Snyder did not continue Michigan’s surgeon general position when his administration took office, “but I’m still hopeful that he will consider it at some point,” Wisdom said.
“This is about the health of communities and is a nonpartisan issue,” she said. “We all should care about the health of our young people, our seniors, our community, because a healthier community drives a healthier economy.”
In 2007, Henry Ford Health System in Detroit began to look into ways to address the rate of infant deaths throughout the area, which for years has been one of the highest in the country.
Michigan’s infant mortality rate has remained above the national average since at least the 1980s. A major driver is the disproportionately high number of deaths among black infants, who died at a rate that was nearly double the overall rate for the state, at 13.1 for every 1,000 live births in 2013, according to the Michigan Department of Community Health. Detroit accounts for a significant portion of that high rate.
“The infant mortality rate is largely a black infant death problem,” said Dr. Kimberlydawn Wisdom, chief wellness officer at Henry Ford Health.
So in 2008, Henry Ford began collaborating with three competing regional healthcare providers—Detroit Medical Center, St. John Providence Health and Oakwood Healthcare systems—to form the Detroit Regional Infant Mortality Reduction Task Force. The effort, now known as the Women-Inspired Neighborhood (WIN) Network, partners systems with community organizations and local health departments to offer a comprehensive approach—addressing clinical and social factors associated with infant mortality.
“We are taking what we call a ‘social determinants of health’ approach,” Wisdom said. “We look not only at the clinical (factors) for why these babies die, such as prematurity, but we look at other factors in the home and social factors during pregnancy.”
The program trains community “navigators” who connect women with services that address factors that put them at risk for infant mortality. These include low birth weight, malnutrition during pregnancy, smoking and drinking alcohol. Navigators also help with transportation to doctor visits during pregnancy and nonmedical assistance, such as finding resources for education, employment, stable housing and food.
The WIN Network is one of many approaches around the country developed by healthcare providers and others in recent years to identify and solve the root causes behind a national infant mortality rate that’s one of the highest among advanced industrialized countries. Infant death rates vary greatly among the states, with New Hampshire reporting the lowest at 4.2 for every 1,000 live births in 2010, while Mississippi had the highest, with a rate of 9.9 deaths.
A big part of the effort addresses preterm births, a major contributor to infant mortality. Many programs are funded under the five-year, $1.5 billion federal Maternal, Infant, and Early Childhood Home Visiting program, which is part of the Affordable Care Act. State Home Visiting Programs have provided more than 1.4 million home visits since 2012, and in fiscal 2014, they served about 115,500 parents and children through hundreds of programs around the country, according to the U.S. Health Resources and Services Administration.
Among the services the program provides are weekly home visits by a nurse to low-income, first-time mothers under the Nurse-Family Partnership program, first established in the 1970s by Dr. David Olds, a professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Denver.
But the federal home visiting program expires at the end of this month and it’s far from certain whether Congress will reauthorize it. President Barack Obama has requested $500 million for fiscal 2016, as well as an additional $15 billion over the next 10 years for the program’s continuation.
Preterm birth is defined as a birth that occurs before 37 weeks of pregnancy. The infant mortality rate per 1,000 live births among children born after less than 32 weeks of pregnancy was 70 times greater than for those born between 37 and 41 weeks, according to a January 2013 report from the HHS Secretary’s Advisory Committee on Infant Mortality. The Centers for Disease Control and Prevention estimated that the number of premature births in the U.S. totaled more than 450,000 in 2012, which accounts for about two-thirds of all infant deaths up to 1 year of age.
“The premature birth rate is a very high driver for infant mortality in the U.S.,” said Dr. Henry Chong Lee, assistant professor of pediatrics at the Stanford University School of Medicine. “The U.S. does have a significantly higher rate of premature births compared to other countries that are similar to us.”
Preterm birth was estimated to cost employers more than $12 billion a year in excess healthcare expenses, according to a 2014 report from the March of Dimes. The average medical cost for a baby born at full term through its first year was $5,085, of which $4,389 was paid by employer health plans, according to the report. For babies born after less than 37 weeks of pregnancy, the average cost rose to $55,393, of which $54,149 was paid by employer health plans.
Mothers’ socioeconomic status has been a key indicator for premature birth, where a correlation has been found between poverty and higher risk for infant mortality. A woman’s marital status, her level of education and her age are believed to play a role in determining how much of a risk she faces for infant mortality, according to a study published last September by the University of Wisconsin-Madison’s Institute for Research on Poverty.
UHC began its care-management program about five years ago, seeking to identify at-risk mothers and provide them with medical and social resources, said Tracy Davidson, CEO of the plan, which serves about 275,000 Medicaid beneficiaries. Like the WIN Network, coordinators provide transportation for doctor visits, educate mothers on proper neonatal care, conduct home visits and connect patients with assistance programs for food, housing or employment.
“It really became very important for us to be on the ground,” Davidson said. “Telephonic care management certainly has its place, but actually engaging with the community, doing home visits and beginning to have a real relationship with consumers changes the dynamic of how we’re able to transform healthcare.”
UHC’s program was recognized last year by Ohio Gov. John Kasich for inclusion in a statewide strategy to reduce infant mortality among the Medicaid population in areas identified as having the highest rates.
“Healthier babies being delivered means you have fewer babies in the (neonatal intensive-care unit),” Davidson said. “Providing prenatal care and postpartum care as well as then providing social supports and giving individuals additional resources bends the cost curve from a medical-clinical perspective as well as from a socioeconomic perspective.”
Davidson said her plan’s transient membership has made it difficult to obtain definitive data on the care-management program’s impact in reducing the infant mortality rate. Another issue is that Ohio’s Medicaid managed-care program only started serving beneficiaries on a statewide basis in July 2013. Davidson said she expected to have better outcomes data in the future.
Still, she said the program has seen a reduction in the number of newborn babies with birth weights less than 1,500 grams, which are associated with a higher risk of infant mortality. Also, the infant mortality rate among her plan members is 1% lower than the overall rate for the state.
Check out the WIN Network in the news.
Impacting Wellness through Community Health Workers
Smart, caring, and with a keen eye on families, former Michigan Surgeon General Kimberlydawn Wisdom believes that community health workers are one route to improving public health and reducing health inequities in our most disadvantaged neighborhoods. Dr. Kimberlydawn Wisdom of Henry Ford Health Systems has a clear notion about improving public health outcomes for marginalized communities in Michigan.
And isn’t all about medical care.
The concept uses an atypical provider called a community health worker, a trained community member who coordinates care for struggling individuals well beyond the medical care provided by doctors and nurses. Community health workers bridge individuals in the community to medical, mental health, government, and social service systems. Wisdom believes these providers are key to changing the public health landscape.
And when it comes to public health issues and trends, Wisdom knows her stuff. She was appointed in 2003 as Michigan’s – and the nation’s – first state-level Surgeon General to address Michigan’s less than stellar health status. She is the recipient of numerous awards, has authored several peer-reviewed publications, has appeared on national television, including ABC’s Nightline, and has presented to audiences across the country and internationally. She is currently senior vice president of community health and equity and chief wellness officer at Henry Ford Health Systems.
HFHS is using the community health worker model with women living in three Detroit neighborhoods through the Women-Inspired Neighborhood (WIN) Network. The program links underserved women, ages 18-34, that are pregnant or of reproductive age to various resources in an effort to decrease the likelihood of infant death within the first year.
For the women that aren’t pregnant, “We try to work with them to space pregnancies and to address other, what we call, social determinants of health,” says Wisdom. Education, safe housing, consumption of fresh fruits and vegetables are examples of determinants that a community health worker would address, so that when or if a woman becomes pregnant,
Education, safe housing, consumption of fresh fruits and vegetables are examples of determinants that a community health worker would address, so that when or if a woman becomes pregnant, she’s healthier – thus reducing the incidence of infant mortality.
Wisdom is measuring the success of the WIN Network by how many connections each woman makes that she wouldn’t have made without the community health worker and WIN.
“For instance, some of these women have been taken out of homeless shelters and placed in apartments. That’s a connection. We’ve taken women who are not in any kind of education program and helped them get into a GED program. That’s a connection. We help them gain access to Bridge Cards for obtaining food and help them understand the Double Up Food Bucks program. That’s a connection.”
The connections might be for the woman’s health or overall stability or for the baby’s health, with prenatal care, breastfeeding support, or access to car seats, infant bedding, or Pack ‘n Plays.
In other countries, community health workers have been effective in addressing the health and well-being of communities, while here we rely on licensed health care professionals, like physicians, nurse practitioners, and social workers. Yet in comparison to other countries, particularly developing countries, Wisdom says that oftentimes U.S. healthcare is worse.
Community health workers strip down the obvious barriers to someone living a healthy life and raising healthy kids. They not only help individuals navigate through the healthcare system, but help find other needed resources.
In other countries, community health workers have been effective in addressing the health and well-being of communities, while here we rely on licensed health care professionals, like physicians, nurse practitioners, and social workers.
If it’s a prescription for medicine, that’s one thing says Wisdom. “But if the [medical] provider says, “I want you to have access to more fruits and vegetables, I want you to have a safer or less toxic housing environment,’ the community health outreach worker is in a perfect position to help fill those ‘prescriptions’ that a provider ma recommend.”
Community health workers are considered natural helpers, with shared roots and values in the community; they are able, willing and armed to help address social and medical conditions for those with limited resources.
“Health care providers are involved from a medical perspective, doing an excellent job in providing better and better quality, and with greater ability to conduct state of the art procedures… and I applaud those efforts,” says Wisdom. “But community health workers are going to be important in terms of really achieving overall health for our communities.
Dr. Kimberlydawn Wisdom, right, at a Real Moms of Detroit event in July 2013 with WIN Network participant Tiffany Nelson and baby Jade Jennings