Population Health Blog

Population Health Blog

Why It Matters

Environmental Wordsmithing 101: Universal Tips For Advocates

The Sierra Club offered an informational handout, “Making Your Voice Heard” to participants at the “Clean Air Act Rulemaking and Permitting Training For EJ Communities,” April 25-26 in Detroit. Adapted from The Art of Commenting: How to Influence Environmental Decisionmaking With Effective Comments, by Elizabeth D. Mullin, the handout addresses a strategic aspect of advocacy: how to speak skillfully.

The advice is directed to advocates who are preparing for a public comment session in a permit or regulatory hearing. But this applies to any public comment, delivered orally or  in written form (example: a news commentary). Carefully-crafted public comments strengthen the position of advocates when trying to gain the attention and respect of regulators, as well as to counter claims by opponents. Preparation is the foundation to an effective comment:

  • Define your objectives.
  • Use clear organization, formatting, and language.
  • Make the strongest possible points.
  • Suggest specific language when possible and appropriate.
  • Use specific examples to illustrate concerns.
  • State what you support as well as what you disagree with.
  • Provide supplemental information, if needed.
  • Offer helpful solutions.

The guide offers good suggestions on how to take an incomplete or poorly-written comment and strengthening it with alternative words and word usage. You can get the pdf of the handout at http://eli-ocean.org/gulf/files/Making-Your-Voice-Heard.pdf.


Call the Midwife: Hope is a thing of extraordinary power

By Katie Moriarty

“Working as midwives in London’s East End we were no strangers to the first light or the half dark. When babies arrived we went to deliver them…it didn’t matter what the hour…”

The most recent episode  (season 3, episode 3) of Call the Midwife http://www.pbs.org/call-the-midwife/season-3/ really touched me. Sister Julienne showed immense compassion and perseverance as she helped Stella through her labor and birth within the prison system. She also helped advocate for her to begin anew and actualize a new direction to her life. It made me think back to my very first position as a certified nurse-midwife working in Detroit, Michigan at Hutzel Women’s Hospital. I attended a birth of a young woman while she was shackled to the bed with the prison guards outside of her hospital room. She labored alone in the room – I was her only support person present for this transitional and pivotal moment. I do not remember her name but I do remember her eyes as she looked at her newborn baby with love and I felt the heaviness of her sadness.

Pregnancy is such a time of transformation and an opportunity for change and growth. With adequate health care, evidence-based education, and compassionate support this moment in time can be one of the most teachable moments for a woman. They can really engage in lifestyle behavior changes to optimize their mind, body, and spirit. Experiencing a positive birth and assisting women to enhance attachment not only assists women but our communities and our society.

The United States has the highest incarceration rate in the world. This nation represents approximately 5 percent of the world’s population; however, it houses around 25 percent of the world’s prisoners, according to the U.S.  Department of Justice, World Prison Brief. The Bureau of Justice statistics, in 2010, reported that approximately 18 percent of the 7 million individuals under correctional jurisdiction or custody were women, 200,000 women are incarcerated in jails and prisons (Clarke & Adashi, 2011), 75 percent-85 percent of incarcerated women are mothers, and 6 percent of women in correctional custody are pregnant (Clarke & Adashi, 2011). Women are more likely to be in prison for alcohol, drug, and property offenses, while men are more likely to be in prison for violent offenses (Bureau of Justice Statistics). Males committed the vast majority of homicides in the United States, representing 90 percent of the total number of offenders (U.S. Department of Justice, 2010).

It is startling to realize that one in 25 women entering or admitted to state prison and one in 33 entering federal prisons are pregnant, according to the Federal Bureau of Justice Statistics. In 2008, the Federal Bureau of Prisons barred shackling pregnant inmates in all but the most extreme circumstances and many states have similar laws; however, some states still restrain women during labor and birth (Second Chance Act) https://www.govtrack.us/congress/bills/113/s1690/text. Many organizations have voiced their opposition to the use of restraints during labor and during the birth, including the American College of Nurse Midwives; American Medical Women’s Association; American Correctional Association; American College of Obstetricians and Gynecologists; Amnesty International; American Civil Liberties Union; Association of Women’s Health, Obstetric, and Neonatal Nurses; Rebecca Project for Human Rights; and National Organization of Women).

The majority of children born to incarcerated mothers are almost immediately separated from their mothers, according to the Women’s Prison Association, Institute on Women & Criminal Justice. It is evident that incarcerated women have many more challenges to overcome in dealing with their pregnancies and their birth experiences, developing into motherhood, and providing adequate parenting to their children. There are difficult decisions and limited choices as to what happens with the newborn child. There are some model programs which try to address issues such as adequate healthcare, counseling, parenting instruction, job skill education and even on-site nursery programs.

This episode has made me want to investigate the situation of incarcerated women in my local area of Detroit and Wayne County. I would like to know more of what is available for their health care. Do they have access to certified nurse-midwifery care? Can they have a doula present for their birth? Are there any residential parenting programs or prison nurseries? And what programs are in place to assist them to achieve short and long term goals to foster hope and success upon their release from jail?

Just like the Nonnatus House nuns and midwives – today’s modern day midwives continue to provide care for underserved women and families. We are in a position to advocate for practices and policies that facilitate optimal pregnancy outcomes, humane treatment, emotional well-being, maternal-infant attachment, and healthy parenting skills.

“Hope is the thing of extraordinary power—it feeds the soul, yet it can torment it. It can be dashed yet it can show the way. We learned this and more…we learned by justice and forbearance and friendship…and what it meant to help someone move from darkness into light.”

American Civil Liberties Union. Federal Appeals Court condemns shackling of pregnant prisoners in labor. New York, NY: American Civil Liberties Union; 2009. http://www.aclu.org/prisoners-rights_reproductive-freedom/federal-appeals-court-condemns-shackling-pregnant-prisoners-la Accessed 4/14/14

Amnesty International. Pregnant and imprisoned in the United States. Birth 2000; 27:266.

Bureau of Justice Statistics: Federal Bureau of Justice. http://www.bjs.gov/content/pub/pdf/wo.pdf – 268k – 2009-09-01 Accessed 4/14/14

Clarke, J.G. & Adashi, E.Y. (2011). Perinatal care for incarcerated patients: a 25 year-old woman pregnant in jail. JAMA, 305(9), 923-929.

Guerino P., Harrison, P.M., & Sabol, W.J. Prisoners in 2010. (2011). Washington, DC: Bureau of Justice Statistics.http://bjs.ojp.usdoj.gov/content/pub/pdf/p10.pdf

Barbara A. Hotelling (2008). Perinatal Needs of Pregnant, Incarcerated Women. The Journal of Perinatal Education, 17(2), 37-44.

Maruschak, L. (2008). Medical problems of prisoners. Washington, D.C.: Bureau of Justice Statistics.

National Women’s Law Center. Mothers behind bars: a state by state report card and analysis of federal policies on conditions of confinement for pregnant and parenting women and the effect on their children. Washington, DC:

National Women’s Law Center; 2010. http://www.nwlc.org/resource/mothers-behind-bars-state-state-report-card-and-analysis-federal-policies-conditions-confin Accessed 4/14//14

“Prison Brief – Highest to Lowest Rates”. World Prison Brief. London: King’s College London School of Law. http://www.prisonstudies.org/

Second Chance Act of 2007: Community Safety Through Recidivism Prevention. Vol 42 USC 17501; 2008.http://www.law.cornell.edu/uscode/text/42/17501 Accessed 4/14/14

Thistle Farms http://www.thistlefarms.org/index.php/about-magdalene

Women’s Prison Association, Institute on Women & Criminal Justice. (2011). Shackling brief. New York, NY: Women’s Prison Association.

Women’s Prison Association, Institute on Women & Criminal Justice. (2009). Mothers, infants and imprisonment: A national look at prison nurseries and community-based alternatives. New York, NY: Women’s Prison Association

Katie Moriarty, PhD, CNM, RN, CAFCI is director of the Nurse-Family Partnership at the Detroit Wayne County Health Authority and a practicing midwife.  She is a regular contributor to the blog, Modern Day Midwives, which offers commentary on the PBS series “Call the Midwife.” http://moderndaymidwives.wordpress.com/2014/04/16/hope-is-a-thing-of-extraordinary-power/

‘Detroit Future City’ seen through a health lens


By Loretta Davis and john a. powell

Last year, “Detroit Future City,” the Detroit Strategic Framework, was released and presented throughout the city.  The plan offers a reasoned approach to redesigning a smaller city, specifically as it addresses the need to promote sustainable residential neighborhoods and quality of life. The underlying cohesion is the health of the population: An economically viable Detroit begins with healthy neighborhoods.

The Detroit Strategic Framework recommends that neighborhoods be measured by 13 quality of life indicators: safety, education, housing, environmental quality, prosperity and income, sense of community, physical condition of the built and natural environment, personal mobility, recreation, culture, retail services, and “health,” among others. However, all of these are integral to what we refer to as “population health.”

Population health is a discipline that links traditional public health services with many aspects of life not normally associated with health, such as public safety, transportation, and housing. However, one’s health is strongly influenced by “social determinants,” and if you live in a vulnerable community, those determinants may be overwhelmingly detrimental to your health.

As the  2013 Robert Wood Johnson Foundation County Health Rankings www.countyhealthrankings.org/app indicate, Wayne County ranks lowest on most health indicators, largely a reflection of the health status of Detroiters. While the methodology may be challenged, the fact is the health of our community is severely distressed, which reflects in health care costs, educational performance, and productivity. Wayne County ranks 81st and 82nd in Michigan for mortality and morbidity. After taking into account the health indicators, most social, economic, and physical environment indicators are well below national benchmarks.

Arguably, the first order of business in restoring the economic vitality of Detroit should be restoring the health of its population.

The Population Health Council, sponsored by the Detroit Wayne County Health Authority, works with stakeholders in all areas that impact the health of the community, as well as the well-being of specific vulnerable populations. While the heart of our work expands and supports traditional public health, we integrate other stakeholders to achieve a more comprehensive analysis and approach to health improvement.

We welcome the support of  public health representatives from Oakland and Macomb counties, representatives from the State of Michigan Department of Community Health, local health and environmental advocates, public safety, housing, economic, and academic scholars – all of whom share a commitment to Detroit, Wayne County, and the Southeast Michigan region. The health challenges of Detroiters, complex and serious as they are, can be reflected in other Michigan communities and the overall quality of life in our state.

The national “Place Matters” program articulates the notion that racial and ethnic health inequities result in higher rates of infant mortality, chronic and infectious diseases, disability, and premature mortality among many minority groups relative to national averages. The root cause, according to a growing body of research, is the place in which people live and work.

While we look at health disparities and the social determinants of health, our goal is improving the health of the entire population, not just achieving equity for disenfranchised groups who may live in less desirable areas.

The fate of Detroit Future City is linked to the future Southeast Michigan. The air, water, and soil are shared by all. Conditions like obesity, diabetes, and heart disease cross all demographics.

We need to apply a health lens to sharpen our economic vision. Simply put, a healthy citizen is a productive citizen.

Loretta Davis is president of the Institute for Population Health, Detroit, and former co-chair of the Population Health Council

 john a. powell is executive director of the Haas Center for Diversity and Inclusion at the University of California – Berkeley and co-chair of the Population Health Council