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Undoing Racism An Essential Approach to Addressing African American Infant Mortality. Genesee County Racial and Ethnic Approaches to Community Health (REACH) US October 12, 2011. Genesee County Health Department 10/12/2011. REACH US – Who are we?.

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undoing racism an essential approach to addressing african american infant mortality

Undoing RacismAn Essential Approach to Addressing African American Infant Mortality

Genesee County Racial and Ethnic Approaches to Community Health (REACH) US

October 12, 2011

Genesee County Health Department 10/12/2011

reach us who are we
REACH US – Who are we?
  • The Genesee County REACH US project is a Center of Excellence in the Elimination of Disparities (CEED) in AA infant mortality
    • consists of 4 components:
        • Community-based approaches
        • Local Activities
        • Legacy Projects (Including REHDAI)
        • Dissemination/Training

Genesee County Health Department 10/12/2011

reach us partners
REACH US Partners
  • Flint Odyssey House/Health Awareness Center
  • Genesee County Community Action Resource Department (GCCARD)
  • Genesee County Health Department (Central Coordinating Agency)
  • Greater Flint Health Coalition
  • Hurley Medical Center
  • Programs to Reduce Infant Deaths Effectively (PRIDE)
  • Priority Children
  • University of Michigan/Prevention Research Center
  • YOUR Center

Genesee County Health Department 10/12/2011

reach us
REACH US
  • In 1999 Genesee County became a CDC-funded REACH 2010 project;
  • In 2007 GC was designated as a Center of Excellence in the Elimination of Health Disparities (CEED)
  • GOAL:
  • Reduce racial disparities in infant mortality with a particular focus on African Americans.

Genesee County Health Department 10/12/2011

slide5

Our Problem

Genesee County Health Department 10/12/2011

slide6

In Genesee County….

6,054 births per year

(2000-2009 average)

On average 65 infants dieeach year

(2000-2009 Infant Deaths)

Among white births 5 out of 1000 die,

Among black births 18 out of 1000 die,

Black babies die 3 times more often than other babies

Genesee County Health Department 10/12/2011

slide7

Infant Deaths

Genesee County

City of Flint/Burton

2005-2009

48506

48505

48502

48504

48509

48532

48503

48519

= 1 Black Infant Death

= 1 Other Infant Death

= 1 White Infant Death

N=170

48529

48507

48504

Genesee County Health Department 10/12/2011

year 1 develop community action plan cap
Year 1: Develop Community Action Plan (CAP)
  • Held over 25 focus group with populations of focus
  • Presented to 35-40 agencies/organizations in the community to garner support
  • Held community event
  • Presented CAP to community for feedback

Genesee County Health Department 10/12/2011

reach us1
REACH US
  • Community Action Plan (CAP) derived from two points of view:
    • Bench (“Science”)
      • No single intervention is likely to eliminate racial disparities in infant mortality
      • The period of pregnancy is simply too short to effectively address many risk factors important to infant health
    • Trench (“Community”)
      • Language
      • Communication
      • Trust
      • Racism

Genesee County Health Department 8/8/2011

slide10

“If you always do what you’ve always done, you’ll always get what you’ve always got. If you want something you’ve never had, you’ve got to do something you’ve never done.”

A.J. McKnight

Genesee County Health Department 10/12/2011

community action plan a multi faceted life course approach

MATERNAL-INFANT

HEALTH

Fostering

Community

Mobilization

Enhancing

the

Babycare

System

Reducing

Racism

Community Action Plan -A Multi-faceted Life-course Approach

Genesee County Health Department 10/12/2011

reach us local activities
REACH US – Local Activities
  • MIHAS
  • ACEDC - History & Culture Education
  • PRIDE Medical Services Committee
  • Community Dialogue Action Groups
    • Black Men for Social Change
    • Women Taking Charge of Their Health Destiny
  • Undoing Racism Workshops
  • Community Windshield Tours
  • Evaluation

Genesee County Health Department 10/12/2011

reduce racism
Reduce Racism
  • Community Windshield Tour
    • Facilitated by the MIHAS
  • Undoing Racism Workshops
    • Facilitated by the People’s Institute for Survival and Beyond – New Orleans, LA

2 ½ Days REACH US Activities

Genesee County Health Department 10/12/2011

reduce racism1
Reduce Racism

Community Windshield Tours

  • Product of Asset Mapping
  • Designed to provide a visual observation of barriers/resources in the zip codes with the highest infant mortality rates exist
  • Physicians, hospital personnel, national representatives, foundation/funder representatives, and community residents

Genesee County Health Department 10/12/2011

slide15

ReducingRacism

Undoing Racism Workshops

  • 30 workshops and over 1000+ participants
  • Follow-up working groups:
    • community residents
    • agencies/organizations

Genesee County Health Department 10/12/2011

why focus on racism
Why focus on racism?

Racism is a public health issue ...

  • “You cannot reduce racial and ethnic health disparities in infant mortality without looking at the role that race, culture, and history plays.”Genesee County REACH 2010 Coalition - April 2000
  • “Harvard researchers documented that a mere 1% increase in incidences of racial disrespect translates to an increase in 350 deaths per 100,000 African Americans.

How?Being on the receiving end of overt or subtle racism creates intense and constant stress that boosts the risk of developing an illness”Sid Kirchheimer, WebMD Health News –January 2003

Genesee County Health Department 10/12/2011

genesee county reach us s objective for the urw
Genesee County REACH US’s Objective for the URW

Facilitate a change in attitude and a critical understanding of the ways that culture and racism affect racial disparities in infant mortality.

Populations of focus audience includes healthcare providers, business leaders, andcommunity members.

Genesee County REACH 2010 Coalition

April 2000

Genesee County Health Department 10/12/2011

community perspectives 2005 were goals expectations met
Community Perspectives (2005):Were Goals/Expectations Met?
  • 82.0% of AAs and 79.1% of EAs said yes:
    • EA goals met:
      • gaining better insight or learning more about racism
      • how to address racism in work or the community
    • EA goals NOT met:
      • the URW was focused on the negative/blamed whites
      • there was too little time for group discussion or too little focus on solutions
    • AA goals met:
      • gaining more insight about racism
      • find ways to reduce racism
    • AA goals NOT met:
      • too little focus on what action can be taken to undo racism.

URW Surveys were developed by REACH 2010 Evaluators. Data was analyzed and presented by Cameron Shultz, PhD

Genesee County Health Department 10/12/2011

provider perspectives 2005 were goals expectations met yes
Provider Perspectives (2005):Were Goals/Expectations Met? (Yes)
  • “I came to the workshop with a very naïve understanding of race. The historical perspective opened my eyes, especially recognizing that definitions are not based on biology but politics”
  • “If you are white you are given preference in most, if not all, fields;…medical access is better provided [to whites] as blacks are thought not to comply to medication”
  • “open discussion, they let us debate openly”
  • “it helped me understand how systems can be created to discriminate”
  • “I liked having an honest perspective from African Americans about what its like to live as an African American in this country”

URW Surveys were developed by REACH 2010 Evaluators. Data was analyzed and presented by Cameron Shultz, PhD

Genesee County Health Department 10/12/2011

community perspectives 2009
Community Perspectives(2009)
  • 95% felt it changed their knowledge about racism
  • 90% felt it changed their attitude about racism
  • 89% stated it would change the way they will act in the workplace
  • 80% said they would definitely recommend the workshop to a friend or colleague

REACH US URW Evaluations 2007-2010

Genesee County Health Department 10/12/2011

what you can do to reduce impact of racism to improve aa mother infant health 2011
What you can do to reduce impact of [racism] to improve AA mother-infant health (2011)
  • Action
    • Advocacy (many repeats)
    • Be aware
    • Action research
    • Redefine self
    • Assume responsibility; sense of obligation with the new knowledge
    • Teach providers what racism really is
    • Work with communities in education
    • Teach AA mothers how to care for themselves
    • Help mothers before they become pregnant
    • Share information/progress on MCH strategies and IM
    • Participate in community outreach
    • Support REACH US

Genesee County Health Department 10/12/2011

what you can do to reduce impact of racism to improve aa mother infant health 20111
What you can do to reduce impact of [racism] to improve AA mother-infant health (2011)
  • Action
    • Listen
    • Foster RELATIONSHIPS
    • Approach churches to empower community
    • Help transport neighbors
    • Become involved in community efforts
    • Become more familiar with area resources in order to appropriately refer
    • Work to create community that is more aware of social determinants of health
    • Increase education-awareness
    • Support small/positive business

Genesee County Health Department 10/12/2011

slide23

Undoing Racism Workshop (Linkages to IM reduction…)

Genesee County Health Department 10/12/2011

  • Foster understanding/awareness
    • Reviewing demographics and disparities
    • Importance of community engagement—participatory approach
    • Bench-(Science Knowledge)
      • Infant mortality is a life course issue
      • A multifaceted problem in need of multiple solutions
    • Trench-(Community Knowledge)
      • Need for enhanced communication and trust; focus on racism
    • Common definition, history, root causes, institutions, internalized racial oppression and superiority
slide24

Undoing Racism Workshop (Linkages to IM reduction…)

Genesee County Health Department 10/12/2011

  • Awareness/Understanding (cont.)
    • Less self-blame and more system blame
    • Frequent integration of health disparities focus
    • Integration of Windshield Tour
  • Direct Impact of Racism
    • Stress (physiological damage; allostatic load)
    • Poor health related to…(education, unemployment, housing, neighborhood risks; diet)
    • Self-neglect ; depression (internalized oppression)
    • Provider mistreatment; healthcare bias (internalized superiority)
slide25

Undoing Racism Workshop (Linkages to IM reduction…)

Genesee County Health Department 10/12/2011

  • Skills/Call to Action
    • Change in institutions begins with change in self
    • Tools and skills to become more aware and be better communicators
      • Self-awareness of personal bias
      • Honesty
    • A return to the social change focus of public health
    • Avoid gatekeeping; empower community
    • Community leadership-advocacy
    • Community organizing experiences and approaches
change is possible
Change is Possible
  • Genesee County URW Participant (2008)

“Ultimately, I believe that change is possible. I can dismantle racism through individual efforts in my own sphere of influence. I can affirm diversity by respecting and being open to other races and cultures. I can mentor and volunteer. I have come to realize that my commitment has to be more active and that it is not as daunting as first perceived.”

Genesee County Health Department 10/12/2011

genesee county reach us
Genesee County REACH US

Shannon Brownlee, MPH

REACH US CEED Coordinator

Genesee County Health Department

(810) 341-7661

sbrownlee@gchd.us

Tonya French-Turner, BBA

REACH US Program Coordinator

Genesee County Health Department

(810) 257-3194

tturner@gchd.us

Daniel Kruger, PhD

REACH US Program Evaluator

University of MI/Prevention Research Center

(734) 936-4927

kruger@umich.edu

Denise Carty, PhD Candidate

REACH US Program Evaluator

University of MI/Health Behavior & Health Education

(608) 217-9072

dccarty@umich.edu

Genesee County Health Department 10/12/2011