Enforce laws and Regulations that Protect Health and Ensure Safety
Maternal & Child Health Among Detroit Michigan’s Lower Socioeconomic Group
Delroy Barnett
Christina Bergman
Maria Victoria Blanton
Veverly Brooks
Jennifer Castro
Ashford University
HCA415- Public and Community Health
Instructor: Tynan Mara
April 6, 2015
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Target Population
Detroit Michigan Population:688,701
Percent of White American: 10.6%
Percent of Black American: 82.7%
Percentage of Women: 52.7%
Pregnancy Related Deaths 36.6 per 100,000 births.
Pregnancy Associates Deaths 75 pre 100,000 births.
Pregnancy Related deaths - 50.8 per 100,000 births in African Americans.
-3rd highest in nation
As of 2010, Detroit Michigan has a total population of 688,701 people. Of the 688,701 people, 10.6 % are White American and 82.7% are Black American. The community of Detroit is dealing with a rising concern with maternal health and pregnancy related mortality rates. Of the total population, 52.7% (or 362,945) are women. The cause of mortality among maternal mothers is obstetric causes, medical, accidents, suicide, assaults, and other causes. Per year on average, 6 women die from pregnancy issues, this amount is three times higher than that of the national average. These high mortality rates are more common in African American women than other races. Pregnancy related deaths among African Americans is 50.8 per 100,000 live births. This makes Detroit Michigan the third highest city of pregnancy related mortality in the nation. The high mortality rates in Detroit are due to health conditions, poverty, and proper health care. These numbers show that it is dangerous for a pregnant women to live and give birth in Detroit.
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Thesis Statement
Thesis
The health disparities among women and children in Detroit are some of the worst in the nation. “The maternal mortality rate for black mothers in 2002 was almost 25 deaths per 100,000 live births, compared to nearly 6 deaths per 100,000 live births among white mothers and more than 7 deaths…among Hispanic mothers” (National Institute of Health, 2006, p.x). That is nearly four times the national average. More focus needs to be placed on maternal and child health in low socio-economic areas of Detroit.
Factors & Causes
Over 40% of population is living in poverty
Chronic Diseases
Limited access/ quality of health care
Obstetric, Medical, Accidents leading cause
While normally a major health concern in less developed countries, maternal and child health in the United States has become a major concern. “Child mortality is highly preventable and can be reduced greatly through improvement of environmental conditions and hygiene levels, as well as increased parental compliance with immunizations for vaccine preventable diseases…Many of these deaths were caused by preventable or easily treatable condition or by malnutrition (WHO, 2012c; WHO, 2012a)” (Friis, Bell, & Philibert, 2013). Poverty is a detrimental impact on the maternal health of women in Detroit. With the median income at $26,325, compared to $48,411 nationally, women do not have the financial means to properly take care of themselves. Quality food, vitamins (prenatal), access to hygiene, and access to healthcare are all factors that are the result of the poverty issue in Detroit. Chronic Diseases are also a major contributor to the mortality rate. Obesity, Diabetes, and high blood pressure are all common chronic diseases among maternal mothers in Detroit. These diseases increase the health risk of both the mother and fetus. The most common cause of death among maternal women in Detroit are Obstetric causes, Medical, and accidental deaths.
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Essential Services In Community
Harambee Care Program (MIHP)
In home visits
Nutritional help
Educational Classes
STARFISH Family Services
Financial Counseling
Books, Diapers, Family Activities
Baby Power Classes for new moms
There are several free programs that are offered in Detroit for pregnant mothers and their children. One of the programs is Harambee Care Program which is offered to women who are Medicaid Eligible. This program offers several different services which include but are not limited to: Parenting and Childbirth Educational Classes, In Home visits with registered nurses and social workers throughout a mothers pregnancy, nutritional help and assessments, and even transportation to educational classes if needed. This program is one of many programs that reach out to maternal mothers in Detroit to help them gain knowledge as well as have a safe pregnancy for both the mother and the child.
Another essential service is Starfish Family Services which is a nonprofit organization that works with families and children to help set them up successfully for the future. This organization works with new moms, infants and young children and provides programs such as 1:1 financial counseling and family planning strategies to help lower income families be able to provide the essentials for the family. They also provide books, diapers, and other family activities to help Detroit families and children prosper. The organization implemented the Inkster Childhood strategy which has made a tremendous impact in the community. It has provided help to mothers through a program called Baby Power, in which 60% of new moms had fewer symptoms of depression because of the program. The goal of Starfish Family Services is to “prevent problems before they escalate and help strengthen relationships to build solid families that work.” Starfish Family Services believes “in the potential of all children and the power of healthy parent-child relationships to break the cycles of poverty and create long-term positive outcomes for children.”
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Resources, Facilities, & Organizations
Millennium Development Goals 4 & 5
Head Start, Healthy Start, WIC, Medicaid
The National Survey of Children’s Health
Mortality Reduction Plan
In 2011, The Department of Maternal, Newborn, Child, and Adolescent Health set out to fulfill Millennium Development Goals (MDGs) number four, to reduce child mortality by two-thirds between 1990 and 2015, and MDG number five, to reduce maternal mortality by three quarters between 1990 and 2015. According to WHO (2015), the department is to “take the lead in WHO’s targeted efforts to improve the health of these population groups and support countries to achieve these MDGs”. The department is divided into three teams, all of whom report to the Director, Dr. Elizabeth Mason. These departments include Research and Development, Policy, Planning, and Programmers, and Epidemiology, Monitoring, and Evaluation. “Government initiatives are important particularly for reducing disparities that affect disadvantaged populations. Head Start, Healthy Start, WIC and Medicaid are four federal programs that target disparities in maternal and child health outcomes” (Taylor & Nies, 2012). The National Survey of Children’s Health (NSCH) collects information on physical, mental and social health indicators among children and other factors to find what influences their health and development. After the data is collected it is used to define what is needed for “the development, implementation, and monitoring of effective health promotion and disease prevention” (Kogan, 2012). They work in conjunction with the Data Resource Center for Child & Adolescent Health and the data are disseminated for free for policy makers, child advocates, and researchers in the hopes it will promote improved health for children. In 2012, the Department of Community Health for the State of Michigan set forth their Infant Mortality Reduction Plan which outlines eight initiatives. These include implementing a statewide coordinated prenatal system, promote adoption of policies to eliminate medically unnecessary deliveries before 39 weeks gestation, promote adoption of progesterone protocol for high-risk women, promote safer infant sleeping practices to prevent suffocation, expand home-visiting programs to support vulnerable women and infants, support better health status of women and girls, reduce unintended pregnancies, and weave the social determinants of health in to all target strategies to promote reduction of racial and ethnic disparities in infant mortality.
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Community Programs & Existing Policies
Programs
Wayne Children's Hospital
Access Program
Win Network of Detroit
Policies
Home Visiting Legislation
Medicaid Policy
There are multiple programs through the Detroit Michigan Community, including WCHAP which is a private-public community health system that works to improve the quality and access of health care while also working together with community partnerships and making health care more affordable. Another program that is very beneficial to maternal mothers is Win Network which has three main goals that they work to reach. The first goal is to obtain 1500 at-risk maternal women and help link them to community programs such as United Way 2-1-1. Win Network reaches out to not only pregnant women but also women going through postpartum and new mothers who need help. Their second goal is to educate 500 healthcare workers such as physicians or nurses, and to also create new technology and products that will help engage the community to promote good health for pregnant women.
Michigan has many policies already in place to help reduce infant mortality in its state. The Home Visiting Legislation which was passed in 2012 mandates that home visits are tracked and outcomes are recorded to see if the home visits are having a positive effect on maternal mothers. The funding is based off evidence-based research and the state ensures that the results of the programs are beneficial to both participant and community. Another policy that is already in place is Michigan's Medicaid policy. Michigan contributes $20 million to their medical program and they also have a higher maximum income level for Medicaid coverage based of the Federal Poverty Level standards. There are only 8 other states with higher maximum income levels.
Richard C. Boothman is the chief risk officer for the University of Michigan’s health system and adjunct assistant professor at the University of Michigan Medical School. He holds degrees from the University of Michigan (AB) and the University of Detroit Mercy School of Law (JD). In 2001, he implemented what has become known as the Michigan Model for addressing patient injuries and claims, which has since been the subject of several journal articles, newspaper pieces, and media presentations. He collaborated with then Senators Clinton and Obama toward the introduction of the National MEDiC Act in 2005, testified before the U.S. Senate in 2006, and presently serves as a consultant on two of several Agency for Healthcare Research and Quality grants studying implementation of the Michigan Model in other settings.
The city of Detroit and Wayne State University launched Make Your Date campaign helping expectant mothers carry a healthy baby to full term. Make Your Date is a not-for-profit organization program working with other programs like the Perinatology Research Branch of Eunice Kennedy Shriver, National Institute od Child Health and Human Development, the National Institutes of Health at Wayne State University (WSU), and the Detroit Medical Center (DMC), the Women and Infants Network (WIN) led by Henry Ford Health Systems, and the Infant Mortality Project at St. John Hospital and Medical Center. The program helps babies of Detroit since Detroit has 18 percent of babies born prematurely. This is six percent higher then the state average. Studies show low birth weight accounts for the city’s infant mortality rate of 14/1000, which is twice the nations average. Expectant mothers who signs onto Make Your Date will have access to support and evidence-based medical services at no extra cost. They will receive prenatal care information, education preterm birth prevention classes, and regular ultrasounds. Ultrasounds help all pregnant women, especially women with a short cervix who will need an ultrasound to see a need for progesterone. Progesterone treatment help reduce the risk of preterm births by 45 percent. Meridian Health Plan offers progesterone on an immediate basis. Expectant mother will also receive group prenatal care already implemented by St. John Providence and the Detroit Medical Center. It has been proven to reduce preterm birth among African American women by more than 40 percent. The Mayor of Detroit elected Sonia Hassan MD associate dean for maternal, perinatal, and child health for Wayne State University School of Medicine, director Vernice Anthony from Detroit Public Health, and chief executive officer of Meridian Health Plan, David Cotton, MD.
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Policy Development & Facilitators
Education for Early Pregnancy Prevention
Enrollment in Medicaid &(re-enrollment)
Prenatal Care beginning 1st Trimester
Safe Delivery Act
Hutzel Women's Hospital
(Stakeholder)
There are many policies that are already in place for maternal women in the state of Michigan. To help control mortality rates, early pregnancy prevention, and increase safer deliveries, there are several programs needs. Programs such as MOMS, Medicaid Health Plan, Healthy Kids, and Medicaid Outreach, are just a few of the programs offered to the women of Michigan to assist them in getting medical coverage so they can get the proper care they need while pregnant. These programs tie into policies that help women receive the prenatal care they need during and after pregnancy. There are also programs that focus on educating women and their partners about adolescent intercourse, caring for ones self, and healthy baby practices. These programs are known are Plan First, Family Planning, Pregnant Women & Infants, and Michigan Healthy Baby. The Safe Delivery Act is through the department of Human Services in Michigan, and it allows a mother who gave birth to safely give up her child (abandonment) legally. The child must be given up within 72 hours of age, and must be given to a an employee that is on duty at a hospital, fire department, or police station. This Act helps protect an infant and will help find a loving home for the child.
Hutzel Women’s Hospital is in the metropolitan area of Detroit and is a huge stakeholder for these policies and the development of new polices. The reason this particular hospital is a good stakeholder, is because they specialize in the care for women and particularly, pregnancies. A medical facility such as Hutzel Women’s Hospital can either help or hinder the effectiveness of any developed policy or program. The hospital can either support, promote and credit certain programs, or choose to not promote or support programs. These types of stakeholders are extremely important to both the community, and the committees who develop these policies and programs.
Dazzo, O. (2012). State of Michigan: Infant mortality reduction plan. Retrieved from http://mchb.hrsa.gov/pdfs/michiganinfantmortalityreductionplan.pdf
http://www.cdc.gov/getsmart/program-planner/Step1.pdf
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Essential Services
Mobilize Community Partnerships
Inform, Educate, Empower
Develop Policies
· Teach first-time parents how to care for their new baby.
· Provide car seat education to new parents.
· Develop a network of community service for elderly people within the community
· Work with country board members to develop a policy for playground safety in local communities.
The head of the state health department is usually a medical doctor, appointed by the governor, who may carry the title of director, commissioner, or secretary. However, because of the political nature of the appointment, this individual may or may not have extensive experience in community or public health. Unfortunately, political influence sometimes reaches below the level of commissioner to assistant commissioners and division chiefs; it is the commissioner, assistant commissioners, and division chiefs who set policy and provide direction for the state health department. Middle and lower-level employees are usually hired through a merit system and may or may not be able to influence health department policy. These employees, who carry out the routine work of the state health department, are usually professionally trained health specialists such as microbiologist, engineers, sanitarians, epidemiologists, nurses, and health education specialist.
Most state health departments are organized into divisions or bureaus that provide certain standard services. Typical divisions include Administration, communicable Disease Prevention and Control, Chronic Disease Prevention and Control, vital and health statistics, Environmental health, health Education or promotion, health services, maternal and child health, mental health, occupation and industrial health, dental health etc.
The resources and expertise of the state health department are also at the disposal of local health departments. Once particular area where the state health departments can be helpful is laboratory services; many modern diagnostic tests are simply too expensive for local health departments. Another area is environmental health. Water and air pollution problems usually extend beyond local jurisdictions, and their detection and measurement often require equipment too expensive for local governments to afford. This equipment and expertise are often provided by the state health department.
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Enforce Laws & Regulation
Link People & Assure Provision
The Women Infant Children (WIC) program is a Special Supplement Nutrition Program (SSNP), which provides at risk and low-income maternal mothers and their children nutrition, education, and supplemental foods. WIC helps with prenatal care and reduces the frequency of low-birth weight infants. WIC program is also part of the Michigan Family Planning program authorized under Title X federal funds of the Public Health Service Act. Contraceptive services, reproductive healthcare are provided funding and support for comprehensive and voluntary family planning information and services to understand and utilize by low-income men and women. WIC was created by Congress in 1972 and administered by the United States Department of Agriculture (USDA). It helps low-income women, infants, and children up to the age of five who may be at nutritional risk. The WIC program in Michigan is part of the Bureau of Family, Maternal, and Child Health in the Michigan Department of Community Health (MDCH). There are 49 WIC agencies in Michigan who help maternal Michigan resident mothers pregnant or post-partum with their infant and or child up to the age of five. Family planning and WIC of Michigan provides epidemiological support to the MDCH, the Bureau of Disease Control, Prevention, and Epidemiology, and the Bureau of Family, Maternal, and Child Health through Title X which than provides important epidemiologic study design, statistical analysis, technical expertise, program evaluation, and policy and program development evident through data analysis of their WIC recipients according to Kendal, Peterson, Manning, Xu, Neville, and Hogue (2002). Wic offers cross-referral with Medicaid, but managed care organizations (MCO) and public sector programs as separate sites can slow offered service to some clients. Detroit has poor overall pregnancy outcomes and infant immunization rates therefore the WIC program has been evaluated in a quasi-experimental approach as a beneficial impact to the maternal and child mortality problems of Detroit. Data was collected from African American infants enrolled in Medicaid and WIC which was about 90% of the 6548 WiC infants receiving Medicaid. Like in my state of Illinois, WIC recipient mothers must come in for an appointment to pick up food vouchers as well as receive nutrition educational support. The Detroit Health Department also require the infants at 6 to 12 months to come in for assessment and monitoring. WIC data system tracked immunizations and vaccinations. In order for WIC to be updated at certain collocated MCO,12 to 14 month old babies needed vaccinations completed for diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophihis influenzae B, measles, mumps, and rubella. Managed Care Organizations still lack collocating with WIC and Medicaid programs which can improve epidemiological data for future maternal and child care of Detroit clients. Unfortunately not all MCO intervention groups observed on the WIC and Medicaid program had a benchmark approach, which was universal. This reminded of the ACA and its differing state implementations with essential health care services.
Kendal, A., Peterson, A., Manning, C., Xu, F., Neville, L., and Hogue, C. (2002). Improving the health of infants on Medicaid by collocating special supplemental nutrition clinics with managed care provider sites. American Journal of Public Health. Vol. 92. No. 3. PP. 399-403.
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Assure Competent Workforce
Effectiveness, Accessibility, Quality
Five principles that characterize the population-based approach are (a) a community perspective, (b) a clinical epidemiology perspective (using population-based data), (c) evidence-based practice, (d) an emphasis on effective outcomes, and (e) an emphasis on primary prevention (Ibrahim, Savitz, Carey, & Wagner, 2001)
The quality of personal health services is not the issue in Detroit, rather it is the accessibility. People who have access tend to receive decent healthcare but for the uninsured, just getting proper pre and post natal care has been difficult. Fortunately, Detroit has several initiatives to address maternal and child health through community programs. Population-based health services focus on wellness and preventative care for the community. The Wayne Children’s Healthcare Access Program places emphasis on health education that is essential in early development. They offer an array of resources and referrals and boast a high quality rating. The Women-Inspired Network (WIN) is an easily accessible and successful organization that has proven effective for pre-natal, new mothers, and those afflicted with post-partum depression. Although they are centered in Detroit they have outreach programs throughout the state of Michigan. In June of 2014, Wayne University started the Make Your Date campaign which works to reduce the city’s infant mortality rate. Although too soon to tell, the campaign has significantly raised awareness to the issue and emphasizes pre natal care to promote live births.
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Conclusion
Synopsis
Research is imperative in assessing a health concern, developing programs/policies and researching new innovative health solutions
The 10th Essential service (research for new insight and innovations) plays a vital role in all three public health organizational functions. In order to assess a health concern, research is needed to determine if there is a need for a concern to be addresses. Once it is determined that indeed a community has a health concern that needs to be addressed, policies can be put into place. Developing policies require some extensive research as well. With the legal and ethical concerns of public health, policies must be developed is an appropriate way. Researching the community that will be influenced along with their needs, values, and ideas must all be considered. Implementing programs and policies will only work if they are presented in a way that the community will positively receive and understand. As for Maternal and child health, this health concern is very serious but can also become very hard to address due to the individuals involves. Lifestyles, financial means, and ethnicity must all be researched and taken into account when implementing any policies or programs. After programs are in place, research and evaluation are imperative in order to understand the effectiveness of the programs and policies. Programs such and Medicaid, WIC, MIHP, are all programs that have been implemented and are showing high levels of effectiveness in the community. New innovative health methods and research should continue to aid in overall improvement of the maternal health situation. Setting goals to reduce mortality rates such be taken into account when looking into new innovative programs for improving the maternal and child health of women of Michigan.
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References
About | WCHAP. (n.d.). Retrieved from http://wchap.org/about/
Aday, L. A. (2005). Reinventing public health: policies and practices for a healthy nation. San Francisco, CA: Jossey-Bass.
Bledsoe, C. (2014, July 10). Maternal Death Rates in Detroit Triple the National Average | Wyandotte, MI Patch. Retrieved from http://patch.com/michigan/wyandotte/maternal-death-rates-in- detroit-triple- the-national-average
Detroit (city) QuickFacts from the US Census Bureau.(2015, March 24). Retrieved March 27, 2015, from http://quickfacts.census.gov/qfd/states/26/2622000.html
Detroit Has Highest Maternal Mortality Rate - Birth Injury Guide.(2014, August 22). Retrieved from http://www.birthinjuryguide.org/2014/08/detroit-highest-maternal- mortality-rate/
Friis, R. H., Bell, N. M., & Philibert, B.(2013).Community and Public Health. San Diego, CA: Bridgepoint Education, Inc.
Harambee Care MIHP.(n.d.). Retrieved from http://www.harambeecare.org/#!about/cjn9
Harrell, J. A., & Baker, E. L. (1994). The essential services of public health. Leadership in Public Health, 3(3), 27-31.
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References(Continued)
HealthyPeople.gov (2014). Maternal, Infant, and Child Health. Retrieved on March 28, 2015 from http://www.healthypeople.gov/2020/topicsobjectives/top ic/maternal- infant-and-child-health/objectives
Ibrahim, M., Savitz, L., Carey, T., & Wagner, E. (2001). Population-Based Health Principles in Medical and Public Health Practice. Journal of Public Health Management, 7(3), 75-81.
Kogan, M., Ghandour, R., & Schempf, A. (2012, May 2). Introduction to the Special Issue of Articles from the 2007 National Survey of Children's Health.
Learn about our work. (2015). Retrieved from http://www.starfishonline.org/learn.html
Lipson, D., Birnbaum, M., Moon, M., Norton, S., & Wallin, S. (1997, November 1). Health Policy for Low-Income People in Michigan. Retrieved from http://www.urban.org/publications/307321.html#sett
Maternal & Child Health Journal. pp. 1-5. doi:10.1007/s10995-012-1007-x.
Maternal Infant Health Program - Policy. (2015). Retrieved from http://www.michigan.gov/mihp/0,5421,7-311-66379_66393---,00.html
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References(Continued)
Maternal, Newborn, Child, and Adolescent Health (2015). Retrieved on April 2 from http://www.who.int/maternal_child_adolescent/about /en/
Michigan Citizen. (2014). Program begins to help expectant moms. Vol. 36. Issue 29. P.A3-A3.
Milbank Quarterly. (2012). Notes on contributors. Vol. 90. Issue 4. P.791-796.
National Institute of Health (2006).Women of Color Health Data Book 2006. National Institute of Health
Pregnant woman (2014). [image]. Retrieved from http:// www.medicaldaily.com/detroits- soaring-infant-mortality-rate-make-your-date-campaign-aimed-decreasing-baby- deaths-city
Shaefer, S., Herman, S., Frank, S., Adkins, M., and Terhaar, M. (2010). Translating Infant Safe Sleep Evidence Into Nursing Practice Shaefer, S. J. M., Herman, S. E., Frank S. J., Adkins, M. and Terhaar, M. Translating Infant Safe Sleep Evidence Into Nursing Practice. Journal of Obstetric, Gynecologic & Neonatal Nursing. Vol. 39. Issue 6. PP 618-626.
State of Michigan 2012 Infant Mortality Reduction Plan (2012,August). Retrieved on April 2, 2015 from http://mchb.hrsa.gov/pdfs/michiganinfantmortalityr eductionplan.pdf
References(Continued)
Taylor, Y., & Nies, M. (2013). Measuring the Impact and Outcomes of Maternal Child Health Federal Programs. Maternal & Child Health Journal, 17(5), 886-896. doi:10.1007/s10995-012-1067-y
WIN Network | Project Goal. (2015). Retrieved from http://www.winnetworkdetroit.org/about-us/project-goal/