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 pbetts@memphis. edu Center for Community Building and Neighborhood Action and Info. Works 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
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) • Le. Bonheur (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-Info. Works and UTHSC Preventive Medicine/CANDLE • National Mathematica evaluation • Collaborative planning and grantwriting • Advocacy: Voices for Memphis’ Children
Getting Organized Voices for Memphis’ Children Early Success Coalition Provider Partners Shelby County Early Childhood and Youth
Early Success Focus Areas • • Infant Mortality Initiative Home Visitation Parenting Support Headstart-Pre. K-Child Care Early Intervention Just. Care Family Network and Just. Care 180 Children’s Exposure to Violence →Community Risks and Assets: CBANA-Info. Works →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 Low Income 24% 28% Below Poverty Dire Poverty 15% 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 • Whyare 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
1 -Year Clinic Visit Data Outcome Measures
1 -Year Clinic Visit Data Outcome Measures
Reaching Families Where They Live: Peacemaking Circles at Autumn Ridge
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