Event Recap: Healthy Starts for Everyone

The United States infant mortality rate ranks with developing nations. How can health care and social support improve this? What can be done to ensure healthy starts for everyone? 

Featured Guest Opening Remarks:

Pat Baker: 

• There are many layers to this topic.
• The CT Health Foundation's mission is to improve health outcomes 
• Where can we make a difference? 

• Oral health for children and pregnant women
• Children's mental health
• Culturally competent car

• The issue for this state is disparities in health outcomes.  Why are there differences in health outcomes based on race? 
• There are major gaps in studies for Asian populations and Native American populations.
• If we can't ensure a healthy start, there is something fundamental in our culture that we need to look at.
• The US spends more money per capita than other countries in the world, yet we have the worst outcomes.
• So what are we going to do about it? 
• What are the drivers of health? 

• Where you live, play, learn, go to work (social determinants). 60% of your health has to do with this. You can even see differences in zip codes in Hartford. 
• Access. You need access to care. 20%of your health has to do with this.
• Quality. Are you getting the best practices? This is the final 20%

• We all have to take good care of ourselves, but does everyone have to opportunity to take good care of themselves?
• We rank 37th in infant mortality. CT can be seen as a very healthy state as opposed to other areas of the country. You need to break down the population to look at it differently. 
• Infant mortality in CT: (per 1,000 live births)

• 5.8: White
• 6.5: Hispanic
• 12.1: African American

• When you control income, education, insurance: there are health quality disparities being experienced by people of color. It is an important consideration. It can affect the trust of the system.
• What is the cause of infant mortality: 

• Pre-term births

• Right now there are significant increases in pre-term births. 
• The US was making progress in health disparities in the 1960s up to the 1980s, but then there were program cuts in the 1980s and an increase in health disparities occurs.
• African American disparities: 
• Given these outcomes, we ask, what is the cause of this? 
• The longer an African immigrant lives in the United States, the worse her health outcomes will be.
• Even if African American women have achieved higher education, wealth, and live in a nice neighborhood, they still have worse birth outcomes. 
• Stress due to racism is a major factor. When we live under stress all the time there will be an impact. How does the body recover? 
• Racism is a significant health risk. 
• We need to look at cultural humility and cultural competence. 
• What we need to look at now to make change
• How do we foster good behavior, how do we practice good nutrition.
• How do we build healthy community
• How do we create a health arena that practices cultural competency
• What are the system changes needed to make change.
• Health is in every policy. 
• The more education the better the health outcomes.

Grace Damio:

• Puerto Rican experiences in America are similar to that of African Americans. There is a commonality. 
• You can even break apart the Hispanic population and see differences.  
• In the 1980s there was recognition that infant mortality was high. Suggestions were that people were not getting prenatal care. Now in Hartford there is prenatal home care provided that came out of this issue. 
• What else can be happening?
• Fetal and infant mortality review: find out why each infant mortality was happening. 
• What are the risk factors that need to be solved before conception? How can we impact families lives to help prematurity, which is a major factor in infant mortality.
• What causes prematurity?
• Genetics
• Substance abuse
• Smoking
• Domestic violence
• Under nutrition
• Obesity
• Women may get health care when they are pregnant, but they do not always have insurance pre-conception. 
• Economics, access, quality, education, stresses are the big picture factors.
• The Hispanic Health Council was founded because of an infant mortality. A mother could not understand the instructions given to her from hospitals and doctors when she had a sick infant. The child eventually died of dehydration. In the United States, with all of the resources we have, should not have a situation where this is the reason why a child dies. 
• There are gaps in services because they are not there or they are not reaching the population accurately. 
• There has been very little research on the stresses on Latinas. When the Hispanic Health Council asked women their concerns, the major issues were: not enough food, education of children, safety in their neighborhoods. Required community members to commit to working on these issues. They have really followed up on food security. 
• HHC: Talked to community members to brainstorms that would help their communities. There are structural issues (like corn subsidies) that are bigger issues, but what can be done on a community level? Mobile farm stand was something to try in connection to the Regional Market (to bring prices down). 
• If you are on SNAP or WIC you can buy produce. But they are not fully available. These can now be used at the mobile farm stand created by the HHC. 
• Measured by sales, feedback, and sustainability. 
• People talk about barriers in health care institutions. Cross-cultural curriculum has been created by the HHC. Care providers have learned how to fill gaps. 
• Stereotypes are a major issue. 
• Having the courage to stand up around stereotyping, look at the discrimination that exists, and look at universal health care as an option. We need community based solutions.
• We need to raise the investment we make in health care. 
• We need to be allies around equity.

Group Discussion

Why does where you live impact 60% of your health? 

• Is it safe? 
• What is the air quality?
• Is it a neighborhood where you have access to good food? 
• Do you have the capacity
• Can you exercise in your neighborhood? A group of women in New Haven applied for a grant to walk and improve their health, but they could not fulfill what they intended because it was not safe enough to walk in their neighborhood.

Do you have statistics available on your websites?

• We try not to duplicate. Kaiser has an incredible website that provides great information about health. 
• There is a challenge in getting good data
• There is a great publication that the Dept. of Public Health
• Profile of Latino Health in CT (publication by the HHC)

Are there disparities in health in other countries?

• In Canada, a new report came out that shows no disparities. They have one of the most promising systems
• The VA has taken on an aggressive effort and they have done tremendous work around addressing this issue. 
• The outcomes are not some high based on race

Does insurance have an impact?

• Studies have showed that if African Americans and white patientes who ask for certain treatment there is not difference in outcomes, the issue comes when African Americans are not even being offered the option for this treatment.
• There are still quality issues in intervention and outcome, even with insurance. 
• We need to think about policy. Health reform conversation is really important. We could increase coverage to over half of the uninsured in our state. 
• There are a number of conversations about structure, access, measurement and accountability.
• There is opportunity for change.
• Extreme change is needed. 

What could we do? 

• Have the courage to stand up to change health care.
• What should a minimum or living wage be? A minimum wage is not a living wage. The people who are at the bottom cannot live on what they earn.
• The election of 2012 is going to make a difference. More young adults are now insured today because of health reform. We need to continue to make changes. Who is elected in 2012 is going to determine where health care goes. The Supreme Court will also impact health.
• People are being kicked off of health care in CT. 
• We need to tie health and education in a much more profound way. Success in school and graduation will give kids a better shot. 
• How do we identify health issues earlier in children? Children of color are not getting mental health services until they enter juvenile justice system. This is not when they need to receive the care, it is way earlier. We need to provide better access. We need to help eliminate risky behavior.

Is there any data on whether or not African Americans are being sent home from emergency rooms earlier than they should be? 

• There is data that shows disparities in care for African Americans and Latinos in emergency rooms. Withholding pain medication is one issue here. 
• Re-hospitalization rates show that there must be an issue there. 

This is very disturbing. Has anyone taken legal action?

• A question that has come up is, how would you pursue action for discrimination in health care?
• There is a means of filing a complaint, but what happens is that most people don't know how to. 
• It's also hard to tell whether or not the doctor withheld. You often don't see the unequal treatment when it is happening. 
• People are also used to it or even grateful just to receive any care. 
• The statistics are not enough right now. 
• There has not been class action
• Is this a civil rights issue, what are the opportunities. 

What changes need to occur to make WIC more of a solution for infant health issues?

• There are certain issues that prevent certain places from accepting WIC.
• WIC is trying to give a better package of food to women who breastfeed. 
• WIC saves about $3 for every $1 spent. It does a lot of good.
• Bodegas have a major challenge, because you cannot be certified unless you carry all of the WIC options. 
• The monitoring becomes a major issue at the national level. 
• We need better supermarkets and stores in inner cities. 
• WIC is trying to broaden its package and it is making it more difficult
• We need better nutrition education

Are there any opportunities for working with public schools to impact this issue? 

• Nutrition education, healthy lifestyles, parenting, multiple languages. 
• HHC sends information home with parents, goes into schools to hold programs.
• Give someone a fish, feed them for a day; teach someone to fish, feed them for a lifetime...but we need to ensure that the river is clean, we have the right equipment, etc. 
• School lunches need to change. We could shift the barriers that exist. Many of the children are getting their major meals at school. 
• We also need to bring the adult population to a point where they can advocate for themselves, so there is adult education still needed.