THE EVOLUTION OF A COMMUNITY’S DESIRE TO LIVE “Saving Lives and Saving a Community”
– W E LCO M E M E S S A G E – Strong, civilized societies with a healthy, engaged, educated citizenry are fundamental to peace, prosperity, and stability in our world and in our local communities. Only through strategic investments in programs and institutions that help build strong and healthy families, accelerate prosperity, and strengthen democracy can we build successful societies. Infant mortality is one of the most pervasive health problems facing Greater Racine, Wisconsin. The effects of the problem have been devastating to African American families; however the long term impact on the greater community is equally challenging on many levels. The severity of the problem, its root causes, and its far-reaching implications, if not addressed, will negatively impact Racine’s future. When faced with a problem of this magnitude, the Greater Racine community came together to find a solution, realizing that despite the fact that on the surface only one segment of the community was affected, this was a problem for the entire community that could not be ignored. Armed with a sincere desire to make a difference, a group of community participants convened by the Johnson Foundation at Wingspread including, health departments, health care providers, social service agencies and community members-at-large came together to form the Greater Racine Collaborative for Healthy Birth Outcomes (GRC4HBO). Over the past several years, GRC4HBO members committed their time, talent, intellect and resources to fuel what has become a movement to improve birth outcomes for Greater Racine. It is through their efforts that GRC4HBO has become the leading collaborative advocating for a solution to this problem. GRC4HBO has increased awareness of the problem throughout the community, provided educational resources for those impacted by the problem, strengthened community engagement and recommended long-term systemic solutions, that if implemented could significantly reduce infant mortality rates in Greater Racine. With Racine Kenosha Community Action Agency, Inc. as the convening agency, GRC4HBO continues to keep the importance of reducing infant mortality rates, top of mind across all of facets of the broader community.
“THE COLLABORATIVE CONSISTS OF ORGANIZATIONS THAT HAVE UNIFIED TO EXPRESS ONE VOICE TO ELIMINATE RACIAL DISPARITY IN AFRICAN-AMERICAN BIRTH OUTCOMES”.
To continue the work of GRC4HBO in addressing the systemic issues that contribute to the high infant mortality rates plaguing Greater Racine, we need to raise $ 2.5 million to underwrite the GRC4HBO’s programmatic and administrative work. Your financial support will help us continue to implement strategies of the Collaborative, including work of the backbone agency for this collective impact initiative. More importantly, it will have an impact on the most vulnerable of our citizens, African American infants and while assuring a positive future for Greater Racine. We’d like to share the remarkable story of how this community came together to reduce a dismal infant mortality rate and encourage you to become part of our long-term efforts to save lives and save our community. Please join us in making a difference—our community’s future depend on it. Visit our website at healthybabiesracine.org to learn more about the GRC4HBO’s work and how you can become a part of the solution today! GRC4HBO Members and Staff
“I’m a retired special education teacher, so I know firsthand about the health problems facing our children in Racine. When I heard a speech from the lady who managed The Birthing Project since 1984, and she spoke about
the challenges African American mothers ages 16-44 faced during their pregnancies I became deeply concerned and joined the group that day. I attended a session at Gateway, where health care providers, social workers and legislators shared research about the problem. I was not aware that they had pinpointed African Americans as having higher mortality rates than the other races. Once I heard the statistics and stories
from mothers whose babies died before the age of one, I said to myself and the group, we have to do something about this, we’re in crisis.” — Mrs. Betty Stinson, Retired Educator
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A COMMUNIT Y IN CRISIS—A FUTURE IN PERIL Infant mortality is one of the most critical health problems facing Racine, Wisconsin. The effects have been devastating to African American families, however the long-term impact on the greater community is equally challenging on many levels. The severity of the problem, its root causes, and far reaching implications, if not addressed will negatively impact Racine’s future. WHY ARE AFRICAN AMERICAN BABIES DYING AT SUCH AN ALARMING RATE IN RACINE, WISCONSIN? HOW DOES A COMMUNITY BEGIN TO GRABBLE WITH FINDING A SOLUTION TO CORRECT A PROBLEM OF THIS MAGNITUDE WHEN THE FACT THAT IT EXISTS AT ALL IS UNIMAGINABLE? Recently, research has focused attention on factors outside of healthcare to answer the question, “Why are African American babies dying at a higher rate than any other ethnicity?” Researchers are examining the role that community and societal conditions play in health disparities. In essence, the question is “will efforts to improve the mental and physical health of African American women and infants lead to improved biological, environmental, behavioral, and social conditions that impact healthy birth outcomes?”
INFANT MORTALITY DATA Wisconsin’s rank for African American infant mortality has fallen from among the best in the country to third worst. Being born full-term, at a healthy birth weight, and surviving beyond the first birthday substantially increases the odds of living a healthy full life. Yet, in Racine, Wisconsin almost 14 percent of African American babies are born with a low birth weight, 18 percent are born prematurely and approximately 15 African American babies, per 1,000 live births will not survive until their first birthday (Wisconsin Interactive Statistics on Health (WISH) 2011-2013).
Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system, http://dhs.wisconsin.gov/wish/, Infant Mortality Module, accessed 5/17/2017
In Racine during 2007-2008, the African American infant mortality rate was 20 deaths per 1,000 live births, still over 3 times the rate for White infants (Wisconsin Interactive Statistics on Health (WISH). Even now with a positive outlook, a disparity continues to exist with the African American infant mortality rate in Wisconsin being 17 deaths per 1,000 live births.
“My colleagues and I at All Saints realized early that the infant mortality rates and its causes was reaching epidemic proportions and this health status indicator deserved out immediate attention. We’re on the front lines and we see what happens to families whose babies are dying. Over the past several years it has become a priority for the hospital and we’re proud to be involved in finding solutions to this health care disparity. My participation on the Collaborative has been invaluable. Our work on crafting the Community Action Plan recommendations and working together with various Collaborative members from Greater Racine to implement those recommendations gave me the impetus and backing to go back to my organization with other voices to get things done. The Administration at All Saints is very excited and so am I. We are
really making a difference. But we have so Much more work to do.”
— Margaret Malnory, MSN, RN, Administrative Director, Women & Children’s Services, Wheaton Franciscan Healthcare - All Saints
RACINE’S AFRICAN AMERICAN POPULATION – A SNAPSHOT In 2013: • African Americans made up almost 23% of the total population • 41% of African Americans lived in poverty • 39% of African American families lived in poverty1 • 30% had less than a high school education • 16% of African American were unemployment The chronic stress of not being able to financially provide for a family or themselves can result in chronic disease as can continuous pressure to succeed. Individuals with only a high school degree seldom have job opportunities that pay enough to support a family or provide adequate, if any, health insurance. Chronic conditions such as diabetes, high blood pressure, and coronary disease occur at higher rates in the African American community across all income levels2.
Figure 1: African American Householder Income, Census 2010 and American Community Survey 2005-2009 1 2009-2013 American Community Survey 5-Year Estimates
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“This has been a grass root effort at many different levels and the funding helps support the outreach all the way from working with at risk individuals to including, embracing and communicating others that have resources to help with the Collaborative’s mission”.
— Teresa S. Johnson, PhD, RN, College of Nursing, University of WI-Milwaukee
THE LIFECOURSE PERSPECTIVE Opportunities to improve infant health start long before a woman becomes pregnant. The life course perspective model views health as more than just the treatment of illnesses. Rather, it suggests a “complex interplay of biological, behavioral, psychological, social protective and risk factors that contribute to health outcomes across the span of a person’s life and even across generations. To have the greatest impact, a reproductive plan is initiated at the beginning of a person’s reproductive years and continues to the end of a person’s reproductive years. Emphasis is placed on a seamless approach to health care before, during and after pregnancy. (Lu & Halfon, 2003) While research into this disparity continues, many risk factors or root causes of African-American infant mortality have been identified. Ensuring healthy birth outcomes for African-American mothers and babies requires a good understanding of these complex and interrelated causes. As illustrated in the graphic below, there are multiple factors that contribute to the high infant mortality rate among African-Americans living in Greater Racine as well as in other communities. Whether one, a few or all of these risk factors exist in the lives of childbearing African-American women in Greater Racine, healthy birth comes are impacted.
Figure 2: Tree of LIHF The figure illustrates the social determinates of health that have an impact of the health of an infant, as represented by this tree.
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THE COMMUNITY RESPONSE In September 2008, The Johnson Foundation at Winspread convened a small group representing the Racine Infant Mortality Coalition, the City of Racine Health Department and Wheaton Franciscan Healthcare-All Saints to assist in developing a local conference concerning infant mortality in Racine. Without regard to a specific funding source, the meetings included previous and ongoing efforts by a wide array of entities and organizations. Initially, planning did not focus on the Lifecourse perspective, but as we learned more it became the focus of our work. Between October 2008 and August 2009 what is now called the Greater Racine Collaborative for Healthy Birth Outcomes (GRC4HBO/the Collaborative) (1) identified Strengths, Weaknesses, Opportunities and Threats for addressing infant mortality in Greater Racine; (2) developed a Framework for a Strategic Plan for Reducing Infant Mortality in Greater Racine; (3) defined preliminary goals to reduce the African American infant mortality rate by 50% in 5 years as compared to 2007 and reduce by 25% the African American delivery of pre-term babies in 5 years, as compared to 2007; and (4) expanded a Directory of Services to Reduce Fetal and Infant Mortality in Greater Racine initially developed by the Racine Infant Mortality Coalition. Collaborative members committed their time, talent, intellect and resources to work together to fuel a movement to improve birth outcomes for the Greater Racine. The Collaborative was awarded funding for the planning phase from the University of Wisconsin–Madison, School of Medicine and Public Health, Wisconsin Partnership Program in 2010 through the Lifecourse Initiative for Healthy Families project (LIHF). These funds were used to support the initial work of the Collaborative including the hiring of staff, underwriting research and sponsoring community awareness activities and programs. Racine LIHF is a project of the Greater Racine Collaborative for Healthy Birth Outcomes, convened by the Racine Kenosha Community Action Agency, Inc. After in-depth review of research data, community discussions, visits to impacted communities, feedback on recommended actions, it became clear that GRC4HBO needed a long-term strategy to improve healthy birth outcomes. GRC4HBO found that despite many assets, the community must address pressing needs such as: (1) improved coordination and linkage across and within existing systems, services and programs (2) expansion of selected programs to reach more individuals (3) enhanced delivery of services (4) the addition of best practice program/models within existing organizations and agencies (5) increased employment opportunities, and (6) promotion of existing programs that provide pathways out of poverty. GRC4HBO’s recommendations address the root causes of unhealthy birth outcomes and provide specific actions than can be implemented and used by the priority population and the community-at-large to positively impact the lifecourse of African-American families in Greater Racine.
GRC4HBO WORK – A GAME CHANGER The task of addressing an issue as pervasive and challenging as infant mortality could overwhelm most communities. Instead of ignoring the problem and letting viable and actionable solutions become bogged down by ignorance, apathy and bureaucracy, GRC4HBO faced the issue head on. It did not take the Collaborative long to realize that the path to solving this problem required new strategies and approaches—it needed a game changer. The combination of increasing community awareness, education and support became the Collaborative’s primary ammunition in the fight to reduce infant mortality rates in Greater Racine. With the assistance of several funding sources, the GRC4HBO has given life to strategies such as: • Racine Home Visitation Network-Central Navigator based referral system for home visitation programs • Baby Express/Black Infant Health Program-Community based support program for parents that include transportation • Personal Responsibility Education Program-Adolescent focused initiative to reduce teen pregnancy, STI/STD rates, and implement youth friendly healthcare access points • Baby Expo-One stop shop community resource event for pregnant and parenting families • CenteringPregnancy-Medical model that uses group based learning and support • Expansion of evidence based programs such as Birthing Project USA and Nurturing Fathers-Social support models that focus on the needs of mothers and fathers These efforts have contributed to reducing the high infant mortality rates in Greater Racine. GRC4HBO has begun to investigate innovative systems change initiatives that will ultimately impact the effectiveness of future programs. Securing additional long-term funding will help keep the existing programs operational and continue to underwrite new strategies such as increasing breastfeeding rates and enhancing social support programming that significantly impact policy and systemic solutions as well as uncover new ways to help alleviate the infant mortality problem in Racine. Current 5-year implementation funding (2014-2019) from the Wisconsin Partnership Program has supported the work so far, but long term funding is needed. Most recent GRC4HBO initiatives include: • • • •
Established networks to educate the community about the Child Support and Family Court systems Formed a Home Visitation Network among prenatal care providers to increase access to services Hosted community events to provide direct access to community resources for families such as the Baby Expo Convene a stakeholder group to coordinate a city-wide effort to raise awareness of and to promote access to health care for your ages 15-19 years of age
“I joined the Collaborative because it brought all aspects of the community together to address this problem. It is, in my opinion the only collaborative
in Greater Racine that has been successful in bringing all of the key players together including the grass roots organizations who are on the front lines to discuss the issues and work solving the problem.” — GeorgAnn Stinson Dockery, President, Stinson & Boss Consulting Group, Inc.
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NEW HORIZONS Over the past several years the Collaborative has worked diligently to improve the health care of African American families in Racine. The model of this collaborative has been replicated in the community because it proved to be successful by leveraging financial support and reducing silos. The group is now poised to move forward and develop new strategic initiatives to address the problem such as: • Participate in and utilize the results of developing a preconception/interconception obesity research project and its impact on infant mortality rates • Working with community entities to create and support healthy breastfeeding environments throughout the city • Play an active role in the “Get Yourself Tested” Initiative sponsored by Planned Parenthood and the Racine City Health Department, to promote awareness and encourage testing for HIV and STD among adolescents in Racine
SAVING LIVES – SAVING A COMMUNITY For those who say our work is done, we say hardly. Have we made a difference? Yes we have, but we intend to work until the infant mortality rate in Greater Racine is “0”. We are committed to making sure that our community, the community of Greater Racine practices healthy behaviors and has access to options that support and enhance positive health outcomes for all residents, with concentrated efforts in zip codes 53402, 53403, and 53404. We will continue to keep this issue top of mind for all of the residents of Greater Racine through creative events, public meetings and various communications efforts. We have learned that this problem is impacted by a number of root causes that requires a comprehensive approach if we want to keep babies in Racine alive and well. GRC4HBO will continue to serve as an advocate, a resource, and a leader in bringing together organizations and individuals to help save lives. To that end our goals are as follows: • Reduce infant mortality 20% by 2019 • Reduce fetal mortality 20% by 2019 • Reduce prematurity 20% by 2019 These goals work under the overarching principle of eliminating racial disparity in African American birth outcomes. Solving a problem of this magnitude demands a level of dedication and perseverance that must not be deterred by limited funding or engagement. Through strategic investments in programs and institutions like GRC4HBO that help build strong healthy families, accelerate prosperity and create opportunities, we can build a successful community. Greater Racine’s survival as a community, demands that we help babies live and grow in our community.
“This type of work is never really done. We can’t save all the babies who die before their 1st birthday, but we can however reduce the numbers who die because of lack of knowledge, limited resources, and environmental stressors. Next steps should include more policy changes, and deeper community outreach . There needs to continue to be a focus on fathers because they can be extremely instrumental in how
the environment is maintained as a child grows.” — Zakee Darr, Focus on Fathers Coordinator, Racine Family YMCA
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For more information contact: Samantha J. Perry, MPH 262-637-8377 sperry@rkcaa.org www.healthybabiesracine.org Racine Kenosha Community Action Agency, Inc.