Beyond Infant Mortality: What’s Poverty and Race Got To Do With It?

Just about everything when it comes to staying healthy in Memphis.

NNIP Spring 2010

Phyllis G. Betts, Director

Contact [email protected]

Center for Community Building and Neighborhood Action and InfoWorks Memphis School of Urban Affairs and Public Policy The University of Memphis

Key Sources

• Populations of Color in Tennessee: Health Status Report. Tennessee Department of Health Office of Policy, Planning, and Assessment and Office of Minority Health. Kenneth Robinson, et. al. 2007.

• Center for Community Building and Neighborhood Action: analysis of birth and infant mortality and other indicators for Memphis and Shelby County. Ongoing.

Infant Mortality Initiative

• • • • • • • Commercial Appeal feature followed by Babyland Shelby County Summit TN Office for Children’s Coordinated Care Infant Morality “Core Group” Established Shelby County Office for Early Childhood and Youth Early Success Coalition Voices for Memphis’ Children

Infant Mortality: Canary in the Coal Mine

• • • • • • • • 14 per 1000 2006 baseline African American twice as high as white births Drivers: Pre-maturity and low birth weight 30% African American teens give birth by age 17 (city of Memphis) NICU progress at The Med Individual education and

social support

: Blues Project, Moses Model, Centering Pregnancy Social Marketing w/ Community Voice FIMR: Community Action Team

2006 % Births w/ Infant Death of All Births, Shelby County

2.50% 2.00% 1.50% 1.00% 0.50% 0.00% 1999 2000 2001 2002

Year

2003 2004 2005 2006 All Mothers African American Mothers

Deaths Per 1000 Live Births, Top Ten Leading Causes of Death Shelby County, TN, 2006 Source: Death Certificate Data (Tennessee Resident Data),Tennessee Department of Health http://hit.state.tn.us/, accessed 5/11/2010

Early Success Coalition

• • • • • • • • Nurse Family Partnership and support for building infrastructure (HHS) LeBonheur (Methodist) Children’s Hospital and Shelby County Office for Early Childhood and Youth 65 provider partners Linked with Site Based Services Collaborative Data Partners: CBANA-InfoWorks and UTHSC Preventive Medicine/CANDLE National Mathematica evaluation Collaborative planning and grantwriting Advocacy: Voices for Memphis’ Children

Getting Organized

Voices for Memphis’ Children Provider Partners Early Success Coalition Shelby County Early Childhood and Youth

Early Success Focus Areas

• • • • • • • Infant Mortality Initiative Home Visitation Parenting Support Headstart-PreK-Child Care Early Intervention JustCare Family Network and JustCare 180 Children’s Exposure to Violence → Community Risks and Assets: CBANA-InfoWorks → Policy Advocacy: Poverty as a Risk Factor

Voices “Five Hopes”

• Health • Behavioral Health • Education • Juvenile Justice • Social Equity: Unnatural Causes

Poverty as a Risk Factor: Kids

Heightened probability outcomes:

• • • • • • • •

Infant mortality/prematurity/low birth weight and related diagnosis Child obesity and diabetes Lead poisoning/other heavy metal toxins Asthma/other respiratory diagnosis (second hand smoke) Nutrition-related developmental and cognitive diagnoses Stimulation-related developmental shortfalls Injuries from abuse, neglect, and neighborhood violence Homicide

Child Poverty in Shelby County

28% Below Poverty Dire Poverty 15%

Low Income 24% Moderate and Higher Income 48%

Reaching Families Where They Live

• • • • •

Early Impact of Disparities Framework

Broaden focus to include Zone 2 Asset Mapping Transformation Institute: wrap-around system of care Link with Site-Based Resident Services Collaborative: Reaching Families Where They Live Toward a risk, assets, and segmentation model to drive action: Fragile Families framework

The Bigger Picture: Social Determinants

•

Why are poverty and low educational attainment predictive of “unhealthy lifestyles”?

•

Hint: “ignorance” is an insufficient answer

• • • •

Aggravating factor: hardship Mediating factor: stress → depression Mitigating factor: social support Theory of change: stronger families in stronger communities

– Confronting poverty

Emerging Evidence: Stress

•

Cortisol, adrenalin, and inflammation

•

Biological markers vs. self-reports

•

Depression, self-medication, and immobilization vs. sense of efficacy and proactive self-care

•

Apparently self-destructive behavior is not just about poor self-esteem

Primary Social Support Systems

• Family • Neighborhood • Schools • Work • Housing as a Platform

100 90 80 70 60 50 40 30 20 10 0

1-Year Clinic Visit Data Outcome Measures

Parental Stress Index Total Score (N = 114) 20.2

79.8

Clinically Significant Not Clinically Significant

100 90 80 70 60 50 40 30 20 10 0

1-Year Clinic Visit Data Outcome Measures

Child Abuse Potential Score (N = 116) 83.6

16.4

Elevated Normal

Reaching Families Where They Live: Peacemaking Circles at Autumn Ridge