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Wisconsin’s Greatest Challenge. African American Infant Mortality in Wisconsin A Tragic Problem and a National Disgrace that Urgently Needs and Deserves More Attention, Resources, and Leadership. Philip M. Farrell, MD, PhD Professor of Pediatrics and Population Health Sciences

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wisconsin s greatest challenge
Wisconsin’s Greatest Challenge

African American Infant Mortality in Wisconsin

A Tragic Problem and a National Disgrace that Urgently Needs and Deserves More Attention, Resources, and Leadership

Philip M. Farrell, MD, PhD

Professor of Pediatrics and Population Health Sciences

WPP Oversight and Advisory Committee member

UW School of Medicine and Public Health

important definitions
Important Definitions

Infant Mortality:

Death of a baby before his/her first birthday; usually expressed per 1,000 live births in a geographically defined region

Health Disparities:

Differences in the quality of health or health care across racial, ethnic, and socioeconomic groups

part i the problem
Part I: The Problem
  • Infant mortality rates in African Americans residing in Wisconsin are very high
  • The black/white disparity gap has existed for at least 3 decades in affected WI communities
  • The geographic distribution is highly specific

(currently: Southeastern Wisconsin + Beloit)

  • Many lifelong maternal stresses are responsible
  • Babies are innocent victims of long term risk factors, but mortality is the “tip of the iceberg”
african american infant mortality rates reporting states and dc 2004 2006
African American Infant Mortality Rates, reporting states and DC, 2004-2006

U.S. African American IMR: 13.52 per 1,000 live births

Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics reports; vol 58 no 17. Hyattsville, MD: National Center for Health Statistics, 2010.

Infant Mortality Rates, by country, 2007

U.S. Census International Database, countries with population greater than 250,000. 02/11/09.


Wisconsin data, WISH, 2005-2007.


1986-2008(3-Year Rolling Averages)

Wisconsin Births and Infant Deaths, 2008

Infant Mortality Rates, 2004-2008

WISH (Wisconsin Interactive Statistics on Health), Infant Mortality Module, accessed 11/30/09.


Geographical Distribution of

African American Infant Deaths,


Southern, Western, Northern, Northeastern Regions





City of Milwaukee Target

Zip Codes

(53204-06, 08, 12, 33)



Remaining Southeastern Region

Remaining City of Milwaukee



75% of Wisconsin’s African American infant deaths occurred in the City of Milwaukee from 2006-2008

The Southeast Region accounts for 88% of African American infant deaths.

(Wisconsin Total N=326)

disparities in infant mortality rate by maternal education wisconsin 2006 08
Disparities in Infant Mortality Rate by Maternal Education, Wisconsin, 2006-08

WISH (Wisconsin Interactive Statistics on Health), Infant Mortality Module, accessed 11/25/09.

Disparities in Infant Mortality Rate by Maternal Age, Wisconsin, 2006-08

WISH (Wisconsin Interactive Statistics on Health), Infant Mortality Module, accessed 11/25/09.

disparity crisis in wisconsin
Disparity Crisis in Wisconsin
  • African American infant mortality rate is approximately 3 times the white rate
  • In 2004, Wisconsin met Healthy People 2010 goal of 4.5 per 1,000 live births for white infants, but was highest in the nation for African American infant mortality at 19.4 per 1,000 live births
  • If the disparity were eliminated, at least 1 African American infant would be saved each week in WI
part ii the program
Part II: The Program
  • The Wisconsin Partnership Program

(created in 2004 and engaged in a 5 year Plan)

  • The Healthy Birth Outcomes Initiative a thoroughly analyzed and comprehensively planned program
  • The Life-course Initiative for Healthy Families a 2 phase project targeting 4 key WI communities
the priorities
The Priorities
  • Milwaukee, Racine, Kenosha, and Beloit
  • A comprehensive life-course strategy
  • A public health driven, long-term initiative
  • A collaborative, community embedded effort
  • An innovative thrust that respects cultures
life course perspective
Life-Course Perspective

Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Matern Child Health J. 2003;7:13-30.

lihf goals and outcomes
LIHF Goals and Outcomes
  • Improved health status of African American women over the lifespan
  • Improved African American infant survival and health
  • Elimination of racial and ethnic disparities in birth outcomes
lihf program resources
LIHF Program Resources
  • Investment of up to $10 million over the next 5 -10 years
  • Senior Program Consultant: Lorraine Lathen
  • UW SMPH Faculty and Academic Partner Team
  • Collaboration with the Wisconsin Department of Health Services
  • Other funding partners, including private and public sectors
  • Potential grant funding
steering committee activities
Steering Committee Activities
  • ~$1 million grants for planning/capacity development in the 4 targeted communities
  • Raise public awareness of birth outcome disparities and especially mortality risks
  • Identify and engage other funding partners
  • Build and strengthen community capacity
  • Expand access to high quality services
  • Engage UW SMPH faculty partners
part iii the possibilities
Part III: The Possibilities
  • What more can the State of Wisconsin do to reduce infant mortality in African Americans?
  • New strategies and policies for the benefit of African American maternal and child health
  • More resources and appealing opportunities for prenatal and infant care in the 4 communities
  • Interconceptional care initiatives with education
a new mch policy agenda
A New MCH Policy Agenda

Birth Early childhood Pre-teen Teen Young adult Women 35≥ Seniors

why a new mch agenda
Why a New MCH Agenda?
  • Prioritize public expenditures
  • Invest in more effective policies and programs
  • Update our strategies with new information
  • Acknowledge critical or sensitive periods of development over the life span
  • Need multifaceted and integrated approaches
  • Focus on family-supportive policies and system-level changes
new strategies and policies
New Strategies and Policies

“Public investment in reducing the rate of preterm birth has the potential to result in large cost savings not only to society as a whole but also to the public sector”

Finding 14-3 Institute of Medicine, 2006, Preterm Birth: Causes, Consequences, and Prevention, National Academy Press

medical and societal costs of preterm birth
Medical and Societal Costs of Preterm Birth

Source: Institute of Medicine. 2006. Preterm Birth: Causes, Consequences, and Prevention. National

Academy Press, Washington, D.C.


Birth Weight and Infant Hospitalization Average Charges During the First Year of Life2005 Medicaid Births in Selected Counties(Dane, Kenosha, Milwaukee, Racine, and Rock Counties)

Linked Birth Events File, Bureau of Health Information and Policy

Total Overall Charges: $112,775,535

improve healthcare access
Improve Healthcare Access

In Wisconsin:

  • 23% of African American women of reproductive age are uninsured for all or part of a12-month period (Family Health Survey)
    • Approximately 35% of eligible African American pregnant women receive Prenatal Care Coordination (PNCC) services
evidence based programs and policies
Evidence-Based Programs and Policies
  • Healthy Child Development
    • Head Start
    • Early childhood home visitation
    • Child Parent Centers
  • Education
    • Drop-out prevention program
    • Youth development programs
  • Income and Employment
    • State Earned Income Tax Credit
    • Workforce Investment Act
  • Community Programs
    • Women Infant and Children (WIC)
    • Breastfeeding
    • Teen Pregnancy Prevention
  • Housing
    • Community Development Grants
    • Home Investment Partnership
    • Housing Tax Credits
  • Health Care Financing
    • Medicaid Expansions
    • Case Management
    • Centering Pregnancy/Group prenatal
  • Health System
    • Pre and Inter-conception care
    • Behavioral health services
    • Culturally relevant health professions education
    • Community health/lay workers

What Works for Health: Programs and Policies to Improve Wisconsin’s Health - 2010 UW SMPH

  • The Life Course approach is an important framework for guiding policy and solving challenging issues such as African American Infant Mortality Disparities.
  • This challenge will require many years of synergistic, innovative efforts targeting the key communities.
  • Deep and sustained partnerships, along with more resources, will be essential for success.