Milwaukee sets goal to reduce rate to historic low by 2017
Editor’s Note: This article originally appeared in the Milwaukee Journal Sentinel. It is being reprinted as part of a partnership between the Community Journal and Journal Sentinel to help address a critical issue in our community.
In the face of perpetually poor birth outcomes, city officials Wednesday will announce a goal of reducing Milwaukee’s infant death rate to a historic low by 2017.
It is the first time city officials have set such a target for reducing the rate, aiming to improve the city’s status as one of the worst for infants in the nation.
The goal is to reduce the black infant mortality rate by 15%, and the city’s overall rate by 10%.
Mayor Tom Barrett and Commissioner of Health Bevan Baker say focusing on the death rate for black infants will help the city reduce an unacceptable racial disparity. That disparity, which a decade ago had black babies dying at 3.5 times the rate of white babies, is now at about 2.5, also one of the worst in the nation.
Meanwhile, a coalition that is coordinating community efforts to reduce Milwaukee’s infant deaths is about to set an even more ambitious goal: The Lifecourse Initiative for Healthy Families aims to completely eliminate the racial disparity by 2020.
“We agree with them100%,” Baker said of the coalition’s goal. “But there has to be an actionable and reachable step along that path.
“We’re just setting the first milestone. Zero disparity is what we all want. We’ll continue until the disparity is eliminated.” The Journal Sentinel has been reporting on the many facets of the city’s infant mortality crisis this year in its Empty Cradles series.
The infant mortality rate has never been below 13.5 deaths per 1, 000 live births among blacks – the threeyear average from 1990 to 1992, according to city officials. The city’s goal is to reduce the current black rate – a 2008 to 2010 average of 14.1 deaths per 1, 000 live births – to 12.0 by 2017.
Meanwhile, the city’s over- all rate has never been below the current 10.4 deaths per 1, 000 births; the goal would push the number down to 9.4 by 2017.
Current white and Hispanic infant death rates are 5.4 and 8.7, respectively. Specific goals were not set for those groups because the city is targeting “the toughest neighborhoods where the problem is worst,” Baker said. “We’re not going to leave anyone out, but we have to focus on where the problem is.” Baker said there still may be a “rolling disparity” if the infant death rates for whites and Hispanics also decline.
The Health Department analyzed 41 years of city data to come up with its goal, Baker said.
While the city’s goal may appear modest, those working on the issue say it is a realistic one.
“You try to achieve a balance,” said Veronica Gunn, medical director of community services at Children’s Hospital of Wisconsin. “You absolutely want to stretch. But with the complexity of this issue, you don’t want to establish something that is unattainable.
There is the risk of shooting too high and audacious, and failing. Then you get a sense of fatalism within the community to which this is directed. It is critical that, as a community, we’re all in this.”
While Gunn was chief medical officer for the Tennessee Department of Health, she helped lead efforts to reduce infant mortality in that state.
In a meeting with Journal Sentinel reporters and editors, Barrett said setting a goal allows the community to rally around something concrete.
He and others have pointed to successful communitywide efforts to reduce teen pregnancy – an approach that also began with a specific goal.
Barrett and Baker stressed that the whole community must be invested in improving the city’s infant mortality rate. They singled out health care providers, saying some systems are more invested than others.”It’s about a mission change for many of them,” said Baker. “Their historical mission is sick care.” Health care providers could go into the community with nurses and social workers to focus on prevention.
Hospitals could “adopt” specific ZIP codes to focus their efforts, they said.
“Hospitals are opinion leaders and resource providers,” Baker said. “The city is out front because it is our responsibility to lead. We need others to come with us.” Hospitals and doctors should not distance themselves from the problem if their health care systems are less aggressive or not involved, he said.
Said Barrett: “The positive reinforcement would be: ‘When we call, get on board.'” Maintaining a woman’s access to health care throughout life, and not just through pregnancy, is vital to the effort, Barrett and Baker said. They also said they are concerned about possible cuts to the state’s Medicaid program.
Collaboration The city is a member of the steering committee setting goals for the Lifecourse Initiative for Healthy Families, an effort in four Wisconsin cities with high infant death rates.
The three other cities are Beloit, Kenosha and Racine, and each city has its own steering committee.
The $10 million Lifecourse effort was launched in 2009 by the Wisconsin Partnership Program and the University of Wisconsin School of Medicine and Public Health. The funding comes from the conversion of Blue Cross & Blue Shield United of Wisconsin to a for-profit corporation.
The Life Course Model operates under the premise that health at each stage in life, including pregnancy, is shaped by the life stages that precede it. Thus, the healthier the mother, the better the chance her baby will be healthy.
United Way of Greater Milwaukee also has focused on reducing infant deaths in Milwaukee.
It announced an initial $200,000 grant this summer toward that goal, money being used to pay for an additional nurse-social worker pair to visit homes of women during and after pregnancy.
The Milwaukee Health Care Partnership invested in United Way this year, allowing the organization to leverage its dollars to help reduce infant deaths, said Nicole Angresano, the local United Way’s vice president of community impact.
“No one agency can do it alone,” she said. “It is imperative that our community work together to address this issue. This is the reason why the teen pregnancy efforts have been successful to date: collaboration and cooperation.” Successful programs addressing infant mortality must be brought to scale, and new models must be adopted, she said.
“The city’s goal is a goal to keep us on track and hold us accountable,” she said. “The goal is set at the current landscape and is academically informed.” Beyond the numbers The factors that drive infant death are complex and involve individual risks as well as socioeconomic factors.
Those who may think the city’s goal isn’t ambitious enough must look beyond the numbers at the difficulty of changing factors such as poverty, cultural barriers to breast-feeding and safe sleep practices, and the stress of racism, Gunn said.
From 1978 to 2006, the city’s black infant mortality rate went up and down from year to year but essentially was unchanged from the 16.4deaths per 1, 000 live births in 1978 to 16.3 in 2006, noted Geoffrey Swain, associate professor at the University of Wisconsin School of Medicine & Public Health and chief medical officer for the Milwaukee Health Department.
Considering the economy is worsening, the city’s goal is ambitious, but also realistic, Swain said.
“Is it more likely we can maintain a 3.5% drop annually, as we’ve been seeing the last four years, or is it more likely the 28 years of no movement is the underlying trend?” The city’s goal assumes an annual 2.3% decline in the rate from mid-2009 to mid-2016, Swain said.