Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic's best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how government and grassroots efforts are fighting infant mortality in Cleveland.
Are Babies Healthier in North Korea or Northeast Ohio?” asked one local newspaper headline in 2013. The question, which raised more than a few eyebrows, didn’t come as a surprise to the physicians and medical workers of the Ohio Collaborative to Prevent Infant Mortality. In 2011, Cleveland claimed the infamous record of being the nation’s “infant mortality capital.” In 2013, Cleveland had 13 deaths per 1,000 babies—one of the highest infant mortality rates in the country and a rate higher than in many developing countries.
Cities are now emerging as some of the most dangerous places in the world to be mothers and babies. At the same time, experts agree that high rates of infant mortality--long considered a telling indicator of a community’s overall well-being--are often preventable
Since 2010, the Ohio Collaborative to Prevent Infant Mortality—an interdisciplinary task force of more than 50 organizations, including University Hospitals’ MacDonald Women's Hospital and UH Rainbow Babies & Children’s Hospital—has been working to reverse the negative trend, and advocates are finally beginning to see promising results.
Studies indicate that access and use of healthcare services represent only about 20 percent of a patient’s overall well-being. Other deciding factors include diet, nutrition, physical activity, as well as socioeconomic factors that can translate into “social determinants” of health, such as access to good food and shelter. The same is true of babies: Their chances of survival are overwhelmingly determined by the social determinants that impact their mothers, fathers, extended family, and community.
These many variables make the challenge of reducing infant mortality rates particularly complex. Solutions must be found not only in hospitals but also in coordination with the many organizations, from local government to nonprofits, that help improve population health in a community.
One of the primary risk factors driving premature births—and, by extension, infant mortality—is poverty. There are some 16,000 births a year in Cuyahoga County, many of them in UH facilities. Of those, a substantial majority are insured through the federal Medicaid program. Many low-income women, however, aren’t aware that they could qualify for Medicaid and receive prenatal care.
That’s why government and grassroots efforts, such as the Ohio Collaborative to Prevent Infant Mortality, have proved crucial for population health management in inner-city Cleveland, where one in three residents, and more than half of all city children, live in poverty.
All too often, the problem is clearing practical hurdles that discourage these new mothers from going to their doctor’s appointments. But it’s a task that’s far from simple when expectant mothers are dealing with violence in their community, or making decisions between having the heat turned or having food for their family.
A partnering program championed by Rainbow Babies & Children’s Hospital sends health workers out to the community to identify low-income women and inform them that that their Medicaid benefits include preventive care for chronic conditions and care specific to pregnancy, and that they’re entitled to receive free care under the Affordable Care Act. The program also helps ensure that low-income women make it to their prenatal checkups. If, for example, a patient misses her visit because it’s a choice between transportation and paying the electric bill, or a matter of child care at home, the program will come up with solutions.
Population health management initiatives like these show the power that collaborative efforts have to end infant mortality. By working together with other hospitals, grassroots organizations, government officials, and health advocates, Cleveland has emerged as a leader in the fight.