SPEAK TO YOUR HEALTH PRC Community Survey

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Daniel Kruger, PhD Tonya M. French-Turner, BBA
Academy for Health Equity Conference June 26-27,
2008
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Genesee County, Michigan
Genesee County Health Department 6/2008
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Our Partners

• Genesys Regional
• Medical Center
• Greater Flint Health Coalition
• Hurley Medical Center
• Mott Childrens Health Center
• PRIDE
• Priority Children
• U-M Flint

• FACED
• Flint Family Road
• Flint Odyssey House/
• Health Awareness Center
• GCCARD
• Genesee County
• Health Department
• U-M SPH/PRC

Genesee County Health Department 6/2008
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REACH Coalition

• Made of existing Partners from previously
  established collaboratives
• Broome Team
• PRIDE
• Prevention Research Center
• Others in community with same goal

Genesee County Health Department 6/2008
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Genesee County Health Department 6/2008
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Our Problem
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Rate of Infant Deaths by RaceGenesee County, MI
1998-2000
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
Genesee County Health Department 6/2008
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• Why focus on Infant Mortality?
• Indicator of community health
• A step through the lifestyle door
• Impact on other health disparities
• Readily measurable
• Existing coalition with commitment to issue

Genesee County Health Department 6/2008
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Genesee County Health Department 6/2008
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Thinking Outside of the Box
A Different Approach to Address Infant Mortality
Genesee County Health Department 6/2008
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Our Community Action Plan
New Knowledge

• Derived from two points of view
• Bench
• Trench

Genesee County Health Department 6/2008
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• Bench
• Racial disparities in infant mortality rates have
  persisted
• despite at least 2 decades of applied
  contributions
• from clinical practice, the scientific
  laboratory, and
• legislation to reduce racial disparities.
• Two explanations
• 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.

Genesee County Health Department 6/2008
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• Trench
• If you always do what youve always done, youll
  always get what youve always got. If you want
  something youve never had, you have got to do
  something youve never done.

Genesee County Health Department 6/2008
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Socio-Ecological Model
Genesee County Health Department 6/2008
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REACH 2010 Our Model
MATERNAL-INFANT HEALTH IMPROVEMENT
Fostering Community Mobilization
Enhancing the Babycare System
Reducing Racism
Genesee County Health Department 6/2008
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Fostering Community Mobilization
Community Media Campaign

• 5 waves placed around Genesee County

Genesee County Health Department 6/2008
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Community Dialogue Groups

• Priority setting and problem-solving regarding
  infant mortality
• Outgrowths
• Black Men for Social Change
• Women Taking Charge of Their Health Destiny
• Volunteer Assistance to Mothers
• Community Empowerment Education
• All-male retreat
• Reproductive Health Education
• Health Fairs

Genesee County Health Department 6/2008
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Community Van Tours

• Required for hospital staff, medical residents,
  health professions and social work students

Genesee County Health Department 6/2008
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Enhancing the Babycare System

• P.R.I.D.E. Medical Services Committee
• Linkage with FIMR shared data
• Perinatal Risk Assessment Tool (PRAT)
• Emphasis on psychosocial factors
• Utilized by 30 of prenatal providers
• Perinatal Mortality and Morbidity Reviews
• Face Up to Wake Up Always Alone in a Crib of
  Their Own
• Increased awareness of infant safe sleep
  situations
• Fewer infant deaths in Genesee County related to
  unsafe sleep situations

Genesee County Health Department 6/2008
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University Course

• Cultural competency training
• Client advocate training
• Improved communication between diverse providers
  and clients
• Patients more likely to keep prenatal care
  appointments

Genesee County Health Department 6/2008
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Reducing Racism
Genesee County Health Department 6/2008
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Reducing Racism

• Undoing Racism Workshops
• 24 workshops and over 880 participants
• Designed to impact
• Knowledge, attitudes, and beliefs towards racism
• Strategies to reduce race-based health
  disparities
• Follow-up working groups of community residents

Genesee County Health Department 6/2008
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African Culture Education Development Center

• Paradigm shift in thinking related to racism,
  health promotion, and infant mortality
• African American Educational Lectures Tours
• Middle Passage Experience

Genesee County Health Department 6/2008
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Success!
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Annual Infant Mortality Rates by RaceGenesee
County, MI 1999-2006
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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Infant Mortality Disparity RatioGenesee County,
Michigan 1999-2006
African American to White Disparity Ratios
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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3-Year Moving Average Infant Death RatesCity of
Flint, Genesee County and Michigan 1997-2006
Source Michigan Department of Community Health,
Vital Records Health Data Development Section.
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• REACH US
• Center of Excellence to Eliminate Disparities
• Disseminate findings
• Replication in other communities

Genesee County Health Department 6/2008
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Dissemination

• Article published A Partnership to Reduce
  African American Infant Mortality in Genesee
  County, Michigan Published in Public Health
  Reports July August 2003,
• Article published A Birth Records Analysis of
  the Maternal Infant Health Advocate Services
  Program A Paraprofessional Intervention Aimed at
  Addressing Infant Mortality in African Americans
  summer 2004 edition of Ethnicity and Disease
• Teaching Cultural Competence to Reduce Health
  Disparities. Journal of Health Promotion
  Practice, July 2006.

Genesee County Health Department 6/2008
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Dissemination

• Scheduled for Publication
• Summer 2008 Using a Cultural Framework to Assess
  the Nutrition Influences in Relation to Birth
  Outcomes among African American of childbearing
  Age Application of the PEN-3 Theoretical Mode1
  Journal of Health Promotion Practice (On-line
  version available as of March 19, 2008)
• Numerous presentations American Public Health
  Association (APHA), Chronic Disease, REACH 2010
  Technical Assistance workshop, Society of Public
  Health Educators (SOPHE), Columbia University,
  Michigan Department of Community Health, MALPH

Genesee County Health Department 6/2008
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REACH Evaluation
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REACH Evaluation
Designed to assess
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REACH Evaluation
Designed to assess Process Documentation of
activities
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REACH Evaluation
Designed to assess Process Documentation of
activities Outcomes Changes in systems and
individuals
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REACH Evaluation
Designed to assess Process Documentation of
activities Outcomes Changes in systems and
individuals Impact Changes in African
American infant mortality rate and
disparities with White
infant mortality rate
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Genesee County, Michigan
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REACH 2010 Logic Model
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REACH 2010 Logic Model
Vital Statistics
Racism and Health Disparities Survey
Process Evaluation
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Reduce/Undo Racism
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Enhance Baby Care System
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Mobilize Community
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Education Activities
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Outreach Activities
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Facilitating Policy Change
Graph Represents Institutional Policy Changes
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REACH 2010 Evaluation

• Racism and Health Disparities Survey
• Asses experiences of racism, responses to
  experiences of racism, perceptions of the health
  care system, relationships with partners, health
  and birth outcomes.
• Telephone interviews were conducted by the
  Michigan Public Health Institute in April and
  May, 2007
• Respondents included REACH Program participants,
  randomly selected community members aged 18-45 in
  the REACH focus ZIP Codes in Genesee County, and
  randomly selected community members aged 18-45 in
  demographically similar ZIP Codes in neighboring
  Saginaw County.

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Descriptives of Survey Sample
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Descriptives of Survey Sample
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Attitudes, Beliefs, and Knowledge regarding Racism
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I believe that racism exists in our society today
(Controlling for educational attainment)
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Even today Blacks feel the effects of slavery and
segregation
(Controlling for educational attainment)
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How much do you think racism affects people in
your ethnic group?
(Controlling for educational attainment)
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Experiences of racial discrimination
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Beliefs regarding racism in healthcare
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Blacks and Whites receive the same quality of
health care
(Controlling for educational attainment)
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Blacks and Whites are treated with the same level
of dignity and respect
(Controlling for educational attainment)
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Change is Possible

• 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.

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Mobilize Community

• G.C.C.A.R.D. (Healthy Eating Program)
• Youth and adult obesity prevention
• Foster healthy prenatal and general nutrition

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Mobilize Community
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Prenatal Care Education
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Cultural Competence

• I sometimes wonder how often patients have left
  our office feeling as though they were not
  treated as the whole individual. How often did
  we miss what the real problem was, or how we
  should really go about trying to treat an
  illness? How often have I or the doctor related
  a patients inconsistency with their medication
  as just stubbornness? Now though, I am much more
  confident in feeling that I address the whole
  patient when they walk through our door. I
  conduct my histories that I take on a patient
  much more differently than I previously would
  have in the past.

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Genesee County REACH
Vital Statistics Analyses
Part 1 Perinatal Health Behaviors
Data Source Michigan Department of Community
Healths vital statistics
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Month of Pregnancy when African American Mothers
entered Prenatal CareBy County
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Number of Prenatal Health CareVisits by African
American MothersBy County
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Kessner Index for adequacy of African American
pre-natal care(lower scores indicate greater
adequacy)
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Genesee County REACH
Vital Statistics Analyses
Part 2 Perinatal Health Outcomes
Data Source Michigan Department of Community
Healths vital statistics
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Weeks of Gestation for African American
InfantsBy County
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Percent of births that are premature among
African American Infants
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African American Birth Weightin grams by County
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Proportion of African American Infants with Low
Birth Weight
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1 Minute APGAR Scores for African American
InfantsBy County
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5 Minute APGAR Scores for African American
InfantsBy County
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Percent of African American Pregnancies with
Medical RisksBy County
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African American Infant Mortality Rate By County
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Statistical Process Control Chart forAfrican
American Infant Mortality Rate
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Infant Mortality Disparity RatioGenesee County
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Genesee County REACH
Vital Statistics Analyses
Part 3 Socio-demographic trends
Data Sources Michigan Department of Community
Healths vital statistics and U.S. Census
American Community Survey
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Socio-demographic trends in the Michigan
Department of Community Healths vital statistics
and U.S. Census American Community Survey
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Percent of Births to Women Aged 15-19
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Percent of African American Births to Unmarried
Women
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Percent of African Americans 25 with less than
a High School Degree
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Percent of African Americans 25 with a
Bachelors Degree
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Percent of African Americans with Income Below
the Poverty Line
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African American Mortality Rate, ages 5
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African American Infant Mortality Rate By County
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Socio-demographic trends American infant
mortality rates would be difficult to explain by
trends in the teen birth rate, percentage of
births to unmarried women, educational
attainment, household income, or poverty. No
other age group of African Americans (assessed in
5 year age groups) exhibited a decline in
mortality rates in 2004 and 2005 as African
American infants did.
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Conclusion
The reduction in infant mortality rates in
Genesee County, especially for African American
infants, encourages the continuation and
replication of activities in Genesee Countys
REACH 2010 program.These activities continue as
the Genesee County REACH partnership was selected
to be a Center of Excellence in the Elimination
of Disparities in the CDCs REACH US program.
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Contact Us
Tonya Turner, Coordinator REACH US
Program Genesee County Health Department (810)
257-3194 tturner_at_gchd.us Daniel Kruger,
PhD Prevention Research Center University of
Michigan School of Public Health (734)
936-4927 djk2012_at_gmail.com