AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
MILLIE JONES: Good afternoon. I'm going to share kind of third handed here Wisconsin's RED BOAT experience. We named our initiative Racial and Ethnic Disparities in Both Outcome Action Team only to discover that that actually spelled out RED BOAT. And after hearing Marion Abrams' presentation today, I have more appreciation for the name because I feel like we are just a very small entity swimming in a sea of hugeness and I think the RED does speak to the severity and the crisis situation we are facing.
I want to give credit to my co-workers, Murray Catcher, Patrice Anheimer and Terry Coupe. They have been the primary team leading this initiative in the State of Wisconsin, and we were scheduled to have the presentation delivered by Susan Utech, a co-worker of mine today. And I'm giving her one more chance to walk through the door. Okay, Susan. Okay. She's not working with me today. She was delayed because of a flight cancellation out of Detroit.
The problem in Wisconsin, like many states, but unfortunately we are finding in some ways unique to Wisconsin, we have an infant mortality rate among black infants that is three times the rate for our white infants. Using data from 2003, our black infant mortality is 15.3, and the white infant mortality is 5.3. That's unacceptable. And even more acceptable is what has happened in our state. In 1979 to '81, our data had us ranked as third best. By 2001, we had dropped to 32nd among 34 states with at least 5,000 black births during the three-year period. And our infant mortality dropped.
Similar things have occurred with our Hispanic and Latino infant mortality rate. We looked at some data from the MMWR out of CDC in 2002, and at that time, the city of Milwaukee had the highest Spanish/Latino infant mortality among the United States' 60 largest cities, and that was an infant mortality of 10.8. Again, unacceptable. So what happened and what should we do?
Well, I'll tell you what we are doing. We are gaining high level attention, both good and bad. We are challenging our thinking. We are mobilizing our public health partners. We are creating sustainable action. We are integrating models into maternal child health projects and we are trying to maintain some of the synergy that is happening in our state and increasing their accountability.
Gaining high level attention. And again, I think it can be good and bad. Our Governor two years and to the terms, Governor Dole, has implemented a Kids First initiative. And in that initiative he has identified infant mortality as one of the highest priorities for the State. Our Lieutenant Governor, Barbara Lofton, has identified reproductive health and economic issues as a main agenda item and has formed a task force and has made great inroads and has joined us in the Division of Health at the table to talk about reproductive health, family planning issues. And within our department where I'm located, our Department of Health and Family Services, Secretary Nelson has implemented a state health plan, and in that has released her executive staff proposal and primarily has issued a mandate to each of her division administrators, her management team, that there will be a level of accountability and reporting from each division as to the inroads and the differences that are being made in addressing this issue of infant mortality.
Our state health plan, Health West Wisconsin, 20/10, is a partnership to improve the health of the public and we identify three goals, to provide the health of all to eliminate health disparities and to transform our public health system. Each of the realms of health disparities has become the bulging pride of our administration.
Other ways that we move forward in gaining high level attention, recent additions of our state medical journal in Wisconsin has featured maternal and child health issues. And in the edition most recently released we looked at trends in maternal and child health outcomes.
And what does this ranking mean in the national context? It's become a wonderful document we've been able to use and share with our partners and it's also been brought up by the medical community in this partnership.
One of the more definitive actions we undertook was in the summer, July of 2003. And we hosted a Healthy Babies in Wisconsin, a call to action. And this was a perinatal summit, again, done in partnership. In hosting that summit, we brought to the state Dr. Michael Lou who was very instrumental in really sharing some of the information he shared today for the first time in Wisconsin and really helped us change the paradigm and change our thinking about what it's going to take to make a difference.
As I talk about challenging our thinking about ways to eliminate health disparities, we must go beyond the traditional factors in explaining racial and ethnic disparities. I think our speakers from this morning did a wonderful job in challenging us. And again, it's become the basis for what we've used for our research and evidence-based practice. We want to explore that new research that is evidence based and to think about the time before pregnancy, preconception, and I know that CDC in partnership with AMCHP will be initiating a preconceptual campaign later this summer, and we look forward to having that partnership.
Mobilizing our public health partners. We can't do anything without our partners. This public health system is vast. And the group of partners and the collective work that has to occur from all of those partners is core if we are to make a difference.
the State Division Of Public Health is to serve in a leadership role of our Title V funds all of the people I reference to date as well as myself, and we really see that we have a leadership role in mobilizing these partners around this issue.
This is a list of some of those partners. In no way is it an exhaustive list, but our local public health departments, our healthcare providers, the consumers, our families, hospitals, advocacy groups, our faith based community, professional organizations, elected officials, university, the law enforcement foundation, business media. Again, I could go on. But these are entities that we have definitively earmarked and have invited to join us.
In the call to action, we had over 240 state elders come together to identify new approaches to improve the birth outcome and to reduce racial and ethnic disparities. Our Lieutenant Governor kicked off the summit and our secretary of our department delivered the welcome speech and issued this call to action.
At the summit, again, this was the summit taking place in July of '03, the participants were introduced to the perinatal periods of risk, the light horse perspective and then some date that that had been gathered from our fetal infant mortality review out of Milwaukee. And this was conducted by the city of Milwaukee Health Department in partnership with our black health coalition federally funded our Healthy Beginnings Healthy Start project. As an outgrowth of the summit, we formed action teams to support sustainable activities to improve the health of mothers and babies in Wisconsin, and we took a regional approach.
So we formed a five regional, geographical regional action teams and steering committees to take on initiatives within their regional and from their particular prospectives, and we also formed a Native American steering team, and then the RED BOAT, which was the action team formed out of our internal department partners. So that's the internal infrastructure.
Again, the RED BOAT representing the Racial and Ethnic Diparities in Birth Outcomes Action Team is an action team, and we were charged with focusing specifically on African American infant death in southern and south eastern Wisconsin. If you know Wisconsin, you know that that south eastern part, the largest city is Milwaukee, and in order for us to make any end roads in the numbers or rates in Wisconsin, we have to first make a difference in Milwaukee.
So we begin as a maternal child health program action team to follow up on the 2003 summit, and given the increasing visibility and importance of this issue, the secretary of our department asked us to expand this RED BOAT initiative to include other departmental representatives and those departmental representatives included our healthcare financing, members throughout -- again, all of those parties that had and should have a vested interest on what's happening around this issue of infant mortality.
we wanted to keep the momentum as so important to sustain these actions and to keep this issue on the radar. So we hosted a follow-up meeting in May of 2004 in Milwaukee, and it was specific to talk about the momentum that had grown out of the summit from 2003 and especially to talk about what could or should be some action steps, specifically focusing on the southern and south eastern parts of our state.
In that summit, again, we tried to maintain the momentum and the visibility from a political stance. And our Milwaukee mayor, Tom Baron, you may actually recognize that name because he was in Congress representing Wisconsin and now he's come back and is serving as mayor in Milwaukee, and he kicked off and welcomed the participants in that summit and shared his concern and his interest and support for reducing disparities, particularly in the Milwaukee community. Again, our department secretary was at the table with us and gave the call to action. And at that summit, we had invited about 150 civic health and Social Service agency representatives and consumers.
Sustaining this action is, again, I can't tell you how important it is, and I know if your life is like mine, you have so many issues that come to you every day that has its own level of importance. You have to fight to keep some of these long term efforts on the table and on the front radar, but we are doing it. One of the actions that occurred was we tried really look at and learn from other entities that have made some end roads. We had staff attend a model in New York City to learn about the efforts occurring there around the reduction in infant mortality and specifically looked at some of the partnerships and the community driven initiatives that had occurred in the Bronx to really make a difference in their birth outcomes.
As part of sustaining, you always get assignments, so we had to get our assignment, so our department secretary assigned the RED BOAT. Again, this departmental action team, to develop a strategic departmental action plan with community partners in Milwaukee and to include this combined approach between Medicaid and the public health and other agencies such as our department, a work force development, and our Department of Public Instruction.
At our Governor level, he has formed a team between our Secretaries of Health, Department of Work Force
Development, and who happens to be all women, and he's charged them with really taking a leadership role in moving us forward in a comprehensive plan as we address the issues around children and families particularly related to his Kids First initiative. So in keeping with that, we felt it was very important to have staff and others representing those departments at the table so that we could have internal and kind of grass roots movement as well as the big picture approach with all of these departments.
In conjunction with the steering committee and the Maternal and Child Health Program leadership, these regional healthy birth action teams have actually taken the perinatal periods of risk into their communities at a local level, and they are continuing to have this discussion and get the buy in around the PPOR model and the life force approach, again wanting very much to have this trickle down to the community and agency level so that as we have this discussion, our partners really know and understand both the model and the intent of what we are trying to do in partnership with them.
As -- We love Dr. Lou, so we keep inviting him back to Wisconsin, and he did come back and actually did a very hands-on approach in the city of Milwaukee working with our Perinatal --Wisconsin Association of Perinatal Coalition and the federal Healthy Start site in Milwaukee. We also invited representatives from our federal Healthy Start that's in Great Lakes intertribal which represents the northern part of our state and our Native American population.
And then, again, sharing these lessons learned from other region action teams. We are wanting very much to have -- we want a very practical approach and we want to share the models that can be adopted by the communities.
We continue to sustain the relationships that have come out of the Milwaukee City Health Department, the health maintenance organizations, the perinatal care and prenatal care providers and partners on a regular basis. They are key to our being able to develop a strategic plan that will really make a difference. And the secretary, again, I can't tell you what difference it has made in having our secretary at this highest level of agency have this personal and professional investment. And as part of that, she has assigned department staff to coordinate the efforts in Milwaukee, and these efforts again would be very cross-cutting between work force development, public instruction as well as our department. And because I've been on the road, I just read in my E-mail that such a person has actually been appointed and it's our new deputy secretary to the department, has actually been redeployed to Milwaukee and will spend the next six months working intensely on this project and reporting directly to the secretary. So again, we have the momentum.
Integrating the models into maternal and child health projects. We are looking at ways to sustain these efforts and we are doing so by having just released a request for proposal, and that is actually being bided on and I think applications are due the beginning of next month. But it is a Milwaukee comprehensive home visiting program, and I don't know if any of you had a chance to go to the session earlier today on home visiting programs, but we are trying to adopt many of the methods and the lessons learned that were shared in that session today.
So we are targeting pregnant women and families with infants and children up to age 4 or through age 4 for comprehensive home visitation and we will be using a nurse and a community worker model. As part of the writing of our next block grant effort, Title V block grant, we have incorporated a statewide program to improve maternal health, maternal care and to reduce the disparities in perinatal outcomes, we will be working very closely with our perinatal association. And then another statewide program specifically to address sudden and unexpected infant deaths and to reduce disparity in infant mortality. That's a statewide we've had ongoing for a little while and they've been a major player m the Back to Sleep campaign and some other initiatives targeted around reducing infant disparities.
And then maintaining this energy and the accountability. We want to make sure that everything we are doing really plays into the Governor's Kids First plan. And we are being held accountable both in aligning the programs and activities out of our bureau and division and department to make sure that those efforts are part of reducing disparities in birth outcomes. And then at the January '05, just last month, the mayor of Milwaukee actually addressed infant mortality in his meeting with the city of Milwaukee Health Department all staff meeting. So we are trying, and I think we are doing a good job of keeping this on the radar and having the issues of infant disparities, birth outcome become the new mantra throughout the State of Wisconsin.
I think I forgot to mention that with the RED BOAT activities that occurred first at the bureau level and now elevated to the department level, our secretary has been very clear that the expectation of that group and that initiative is to focus on improving the birth outcome specifically targeted the Milwaukee area. And as we move forward to make sure that there is the inclusion of language and efforts to include more partners and to advance the work and efforts that are ongoing by many of our partners, like many of you were challenged by financial resources, so it does limit what we can put out as new initiatives. But to be part of facilitating partnership and integration and collaboration continues to be the role and responsibility of Title V.
So, what's our conclusion? We recognize that this is a long-term issue, but we have our work cut out for us and we are not going to let go. It's going to be very important that we maintain and recognize that this is a multifaceted approach, not only increasing awareness of the problem or the challenges, but changing the attitudes and sharing the information like we heard this morning in our session both in the plenary session and some of the sessions I've gone to where we have to have our partners recognize that this isn't going to happen overnight. There's not one simple answer, and if we are truly going to make a difference, it has to have an ecological approach and changing those beliefs and behaviors continues to challenge each of us every day.
The data has just been critical for us gaining this high-level attention. You know, when you see the press releases, our Governor doesn't like it when it comes out from our vital records, our secretary doesn't like it and it trickles down. But the data comes out of our programs and we stand by it and we use it to our advantage to make this a statewide issue.
We've been able to bring the experts to Wisconsin to help us challenge the thinking and change some of the beliefs and the behaviors. Our role in spearheading the partners and having people join us at the table, the joint state and local partnership, without our local Health Department, there would be no way we could sustain this action. Our emphasis on a comprehensive services approach as we move with our block grant announcements and our release for proposals really becomes a way in which we address and identify the multi-facetedness of this. And then to support and challenge one another for the synergy and the accountability to keep us all willing to own what is going on in our state, and not just own it but to make a difference. And I think that was the last.