Social Justice in Maternal and Child Health Practice ~ the View from a FIMR Project

1. Social Justice in Maternal and Child Health Practice ~the View from a FIMR Project Mary Ostrem, DrPH Boston Public Health Commission January 20, 2005

2. Orientation to This Presentation • Goal • A common framework • BPHC Social Justice Work • The Boston FIMR as a Case in Point

3. Boston: the Disparities Scene INDICATOR BLACK WHITE__ Asthma Hospitalization Rate (< 5 y/o)* 10.7 2.9 Very Low Birthweight 3.6% 1.2% Overweight 64.0% 44.3% Overall Mortality** 1,054.9 892.6 Diabetes Mortality** 48.3 23.4 Lack of Health Insurance 12.8% 6.3% Heart Disease Mortality** 220.7 205.4 High Blood Pressure 30.0% 17.0% HIV/AIDS Mortality** 33.2 8.1 Homicide** 27.0 3.4 Infant Mortality* 12.4 4.6 Hospitalization Rate (all ages)* 163.0 107.5 Prostate Cancer Mortality** 68.7 30.0 Smoking During Pregnancy 6.3% 5.1% Teen Birth Rate*** 14.1 6.0 *Per 1,000 **Per 100, 000 ***Per 1,000 15-17 year-old females

4. How Did Social Justice Gain Prominence? • Inadequacy of biological, genetic, individual behavioral explanations for disparities • Clear evidence of socioconomic and systemic impact • Consistency with historic public health principles

5. One Angle on Social Justice: The Health Impact of Racism • Socioeconomic status and environmental conditions • Exposure to stressors • Access to health care services • Treatment by the health care system • Health-related behavior

6. BPHC Action • Programs • Existing and new • Mayoral priority initiatives • Task Force • Hospital Working Group • Policies • Priority in mission • Integrated into collaborations • Modeled through training and internal activities

7. Programs • Boston Fetal and Infant Mortality Review • Boston Healthy Start Initiative • Cherishing Our Hearts & Souls Coalition • REACH 2010 Breast and Cervical Cancer • REACH 2010 Boston Elders • REACH 2010 Metro Boston Haitian HIV/AIDS Coalition • Steps to Cultural Competence

8. Programs • Sister Talk II local TV series • State Legislature hearings • Advocacy for and staffing of new State Commission on Disparities • Communication and support • Conferences • Community meetings • Summit and action plan • Funding • Upcoming projects: increasing workforce diversity, monitoring to ensure equitable health practices, and support of grassroots efforts

9. Mayoral Priority Initiatives • The Mayor’s Hospital Working Group • The Mayor’s Blue Ribbon Task Force on Eliminating Racial & Ethnic Health Disparities

10. Policies • Mission priority • Staff training • “Undoing racism” • Discrimination and harassment • Cultural competency assessment and development • Grants office role

11. Elimination of Disparities in Maternal and Child Health • The Health of Women and Infants Working Group • Women’s Health Demonstration Project • BHSI and Healthy Baby/Healthy Child • Cultural Competence • FIMR • Adolescent Health • Common Thread: Surveillance of women’s health • Common Tool: Women’s Health Questionnaire • Common Approach: Collaboration

12. 4 FIMR Partners • Boston Public Health Commission • Healthy Baby/Healthy Child • Executive Office • Research Office • Massachusetts for SIDS • March of Dimes • Health of Women and Infants Working Group

13. 6 A New Model • Why? • IMR findings • Learning from collaboratives and programs • Key Elements • Bereavement support • Women’s health assessment • Data analysis for public health programming and policy

14. Women’s Health Focus • Economic, social, other aspects of health • Preconceptional/interconceptional but not solely reproductive focus • Attention to relationship with health system, barriers • Women’s perceptions for data

15. Conclusions • Social justice and the Boston FIMR • Findings and impact • Expectations