Eliminating Racial Disparities in Birth Outcomes

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Eliminating Racial Disparities in Birth Outcomes
Conference on Ending Family Homelessness Worksh
op Healthcare Matters Providing Health
Services to Diverse Populations February 7,
2008 Susan Barkan, Public Health Seattle King
County Melanie Whitfield, People of Color Against
AIDS Network Maria Carlos, Public Health Seattle
King County
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Acknowledgements

• Susan Barkan
• Kathy Carson
• Maria Carlos
• Eva Wong Doctoral Student, Department of
  Epidemiology,
• University of Washington
• Alice Park
• Mei Castor Urban Indian Health Institute
• Shira Rutman
• Jim La Roche
• Leslie Randall Northwest Portland Area Indian
  Health Board
• Leah Henry Native American Womens Dialog on
  Infant
• Tanner Mortality (NAWDIM)
• Jim Gaudino Oregon State Department of Health

Parent Child Health, Public Health-Seattle King
County
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Infant Mortality Rates US, Washington State, King
County, Seattle Three Year Rolling Average,
1981-2004
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Contributions to the Overall Decline in Infant
Mortality in King County

• First Steps
• Maternity support and expansion of Medicaid
  coverage of prenatal services
• Safe Sleep
• Back to Sleep Campaign
• Medical Advances
• Neonatal intensive care
• Behavioral
• Decline in use of tobacco, alcohol, unintended
  pregnancies

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Infant Mortality Rates by Race/Ethnicity, King
County, Three Year Rolling Averages, 1985-2004
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Perinatal Periods Of Risk (PPOR) Approach

• A simple approach.
• identify gaps in the community.
• target resources for prevention activities.
• mobilize the community to action.

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PPOR guides strategies to improve birth outcomes

• Prematurity and low birthweight lead to infant
  mortality.
• PPOR method gives information that guides
  community strategies to help infants be born
  healthy.

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PPOR FindingsWA State, 2000-2004

• Infant Health is the highest contributor to
  preventable FIMR among American Indian/Alaska
  Natives
• Maternal Health/Prematurity is the highest
  contributor among African Americans and the
  second highest contributor among AI/AN.
• Maternal Care is the third highest contributor to
  among AI/AN.
• Newborn Care is consistently the lowest and is
  similar for all racial/ethnic groups.

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Implications/Opportunity Gaps
Preconception Health Health Behaviors Perinatal
Care EXPAND STRATEGIES to address social
factors giving rise to disparities
Sleep Position Breast Feeding Injury
Prevention Medical Care for Infections and
Chronic Conditions
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Prevalence and Trends in Birth Risk Factors by
Race, King County
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How Stress Can Affect Health

• Increased cortisol (fight/flight hormones)
  results in increased cardiovascular function
• Can lead to high blood pressure, depressed immune
  function with increased vulnerability to
  infection, and depression. All of these can
  contribute to risk of preterm delivery.
• These stress responses are designed to help us
  deal with short term threats, but for many, the
  stressors dont go away.
• Long-term, chronic stress does not allow for
  system recovery and predisposes to adverse health
  effects

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INSTITUTIONALIZED RACISM/ Historical Trauma
Discrimination
Poverty
Abuse
Internalized Racism

• Health Care
• Housing
• Legal System
• Employment
• Refused care over IHS status

• Affordable Housing
• Moving frequently
• Adequate Education
• Employment
• Access to Health Care
• Perceived as wealthy

• Institutional
• Interpersonal
• Cycles
• Substance

• Hopelessness
• Self-hatred and blame
• Inability to see family/ community as support
• Ancestry seen as hindrance to lifes goals

STRESS
Direct Effects Endocrine System Response -
Increased cortisol levels, decreased immune
function, increased vulnerability to infection,
trigger onset of labor Indirect Effects Maternal
Behaviors Smoking, alcohol, substance use, poor
nutrition, survival supersedes wellness
Mayet Dalila, IntraAfrikan Konnections
DISPARITIES IN BIRTH OUTCOME
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Indigenist model of trauma, coping, and health
outcomes for American Indian women (Walters K.
2002)
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What more needs to be done

• Continue support of pregnant womens health care
  prenatal care, MSS/ICM, outreach.
• Find support for community mobilization efforts
• Community collaboration around housing, income
  equity, access to quality education, access to
  culturally relevant, culturally appropriate
  health care. . .
• Decrease the impact of inequalities and racism on
  women and families through community support.
• NAWDIM Brown Sugar Babies

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What more needs to be done

• Continue the PPOR analysis and community
  engagement process to use the data to target
  prevention efforts and support the work of the
  community
• Need for prevention to focus on preconceptional
  health, health behaviors, and specialized
  perinatal care services
• Sustained need for early and continuous prenatal
  care services, referral of high-risk pregnancies
  and good medical management of medical problems
• Continued need for programs that support infant
  health such as SIDS prevention, access to a
  medical home, and injury prevention

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What You Can Do

• Work on adequate housing, income equity, quality
  education, access to culturally appropriate
  health social services.
• Provide culturally appropriate mental health
  services for people of color low-income folks.
• Get training on undoing institutionalized racism
• Undoing Institutionalized Racism, Peoples
  Institute for Survival Beyond
• PBS Video Race The Power of Illusion
• PBS Video Unnatural Causes Is Racism Making Us
  Sick? (March, 2008)
• Involve community members, clients, consumers in
  defining your work.
• Injustice anywhere is a threat to justice
  everywhere.
• Martin Luther King, Jr.

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Thank you!