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
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%
Percent of All Births
2.00%
1.50%
All Mothers
African American Mothers
1.00%
0.50%
0.00%
1999
2000
2001
2002
2003
Year
2004
2005
2006
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
Early
Success
Coalition
Provider
Partners
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
Low Income
24%
Dire Poverty
28%
Below
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
• 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
1-Year Clinic Visit Data
Outcome Measures
Percentage
Parental Stress Index Total Score (N = 114)
100
90
80
70
60
50
40
30
20
10
0
79.8
20.2
Clinically Significant
Not Clinically Significant
1-Year Clinic Visit Data
Outcome Measures
Percentage
Child Abuse Potential Score (N = 116)
100
90
80
70
60
50
40
30
20
10
0
83.6
16.4
Elevated
Normal
Reaching Families Where They Live:
Peacemaking Circles at Autumn Ridge