Population Health Blog

Population Health Blog

Why It Matters

Water Affordability Should Be a Matter of Means

By Ashley Edwards

This summer’s heat has drawn attention to the essential role that water plays in our lives. Access and quality of water is an environmental and social determinant of health. According to the World Health Organization (WHO) “hundreds of millions of people have no access to soap and water to wash their hands, preventing a basic act that would empower them to block the spread of disease.” One would think that WHO is concerned about people in developing nations. However, many in the City of Detroit face that dilemma.

That is why the Population Health Council has consistently advocated on behalf of a water affordability policy based on the citizen’s ability to pay. This summer, the Council renewed this commitment by creating a statement urging the City of Detroit Water and Sewerage Department to make exceptions to water shutoffs for vulnerable populations. Vulnerable populations included are:

  • Infants and children under the age of 18
  • Seniors age 62 and above
  • Persons with mental illness
  • Persons with disabilities
  • Expectant and/or breastfeeding mothers
  • Persons dealing with chronic disease or otherwise in need of critical and/ or medical care

In addition the Council recommended a health impact assessment be conducted for the vulnerable populations, and that the public health exceptions to water shutoffs statement be widely distributed.

For more information about the statement or the Council,please visit authorityhealth.org. or connect with Authority Health on social media at Facebook.

Ashley Edwards is the 2016-17 W.K. Kellogg Population Health Fellow.

The Nation’s Health Features Wayne County Department of Health, Veterans and Community Wellness

By Ashley Edwards

Recently, The Nations’ Health, a publication of the American Public Health Association, featured Dr. Mouhanad Hammami in an article written by Kim Krisberg titled “Shift toward social determinants transforming public health work: Targeting causes of health disparities.” Below is an insert of the article.

“We wanted to focus on education, employment, social isolation, structural racism — all those factors combined correlate to an unfavorable birth outcome and the chances of a child not celebrating his or her first birthday,” Dr. Hammami, a member of the APHA and director of the Wayne County Department of Health, Veterans and Community Wellness, told The Nation’s Health. “What happens from the time a girl is born to the time she has a child?” Dr. Hammami also serves as co-chair of the Population Health Council, and the Detroit Regional Health Collaborative.

The Wayne County approach is complex, slow moving and requires buy-in from multiple sectors, but Dr. Hammami said public health “cannot continue to do business as usual.” Among the first steps, he said, was reaching across sectors to educate public officials about their role in health. For instance, when Dr. Hammami first asked local transportation authorities for help in reducing infant mortality, he said “they laughed — they said ‘we’re not a health department.’” But he persisted, explaining that for many women, transportation was a major barrier to prenatal care. Now, health and transportation officials work together to make women aware of their transportation options, such as shuttles that can be scheduled in advance.

The prenatal transportation initiative was just the beginning. This year, the health department has begun to integrate the social determinants of health in all of its programs. Dr. Hammami called the new working philosophy “no wrong door.” In other words, regardless of why people visit the health department, staff can assess their social needs and help them access services, such as Head Start or housing assistance. The agency also has a newly established a Social Wellness Program, which is charged with creating a delivery model that acknowledges and confronts the health impacts of racism and discrimination.

“We can’t approach a person in sections and silos,” Dr. Hammami told The Nation’s Health. “We’ve become so overspecialized…we’ve lost the authority to be truly what we should be: the guardians of people’s health. Our plan is to reclaim that authority.”

For more information and to read the entire article please visit http://thenationshealth.aphapublications.org/content/46/5/1.3.full

Ashley Edwards is the 2016-17 W.K. Kellogg Population Health Fellow.

 

Looking to what happens after birth to understand infant mortality rates

By Esperanza Cantu

In the New York Times article “The U.S. Is Failing in Infant Mortality, Starting at One Month Old,” written by Aaron E. Carroll, the author breaks down the science behind infant death in the United States. Noting the disparity in infant mortality rates, between the United States and other industrialized nations, he delves deeply into the complications that contribute to infant death. He focuses on evidence that suggests it may be after birth, and not before, that may be strongly contribute toward the high infant mortality we experience in the United States.

As an evidence-based physician and enthusiast, Carroll discusses large bodies of research that direct the attention away from inferior prenatal care as the number one contributor to premature birth and infant mortality. Recent research shows that the disparity in infant mortality may be due to postneonatal mortality (death between one and 12 months of age); importantly, deaths within the post-neonatal period are due largely to sudden infant death syndrome (SIDS), sudden death, and accidents, and they appear to occur disproportionately in poorer women.The study estimated that, compared to European countries, it would make sense to spend up to $7,000 per infant to decrease post-neonatal mortality in the United States. Home-visiting nursing programs were recommended to reduce the incidence of SIDS and accidents.

Naturally, Nurse-Family Partnership (NFP) comes to mind. Founded in 1970, the organization arranges for home visits from registered nurses to low-income first-time mothers, and the visits continue during pregnancy until two years following birth.Nurse-Family Partnership, which has been estimated to cost $4,100 per family per year in 2011 dollars, or close to $4,300 in 2016 dollars, is a strong solution toward reducing infant mortality. Evaluated in six randomized trials and more operational analyses, the NFP National Service Office predicts that “enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 pre-term births, 13,000 dangerous closely spaced second births, 4,700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse.”

For communities like Detroit, NFP offers great promise. Infant mortality in Detroit is one of the highest in the country, and was last reported at 11.8 per 1,000 births in 2014. Broken down by race, the infant mortality rate for Whites has increased from 7.5 per 1,000 (2003-05) to 10.4 per 1,000 (2012-14), and decreased from 17.9 per 1,000 (2003-05) to 14.5 per 1,000 (2012-14). Although the disparity has narrowed between Blacks and Whites for infant mortality, it is important to note both an increase in infant mortality in Whites, as well as a decrease in infant mortality in Blacks, have comprised of the narrowing health disparity.

Check out Aaron E. Carroll’s piece here: http://www.nytimes.com/2016/06/07/upshot/the-us-is-failing-in-infant-mortality-starting-at-one-month-old.html.

Nurse-Family Partnership – Detroit and its Nurse-Family Partnership Implementing Agency (Detroit Wayne County Health Authority) have been serving the community since 2013. NFP-Detroit currently sees 184 Detroit moms, and will have successfully graduated 61 mothers after its upcoming graduation ceremony on July 22, 2016.

Source: 2003-2013 Geocoded Michigan Death Certificate Registries; 2014 Michigan Death Certificate Registry. 2003-2014 Geocoded Michigan Birth Certificate Registries. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Table created: 4/22/2016. Graph created: 06/08/2016.

Links: http://www.mdch.state.mi.us/pha/osr/InDxMain/Tab4.asp;

http://www.mdch.state.mi.us/pha/osr/InDxMain/BlackCityTbl.asp;

http://www.mdch.state.mi.us/pha/osr/InDxMain/WhiteCityTbl.asp.

Esperanza Cantu is manager of Health Equity and Community Engagement at Authority Health.