Public Health Disparities

SESSION AUDIO:

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MODERATOR:
Brenda Henry, Ph.D., M.P.H.

PANELISTS:

Betty Bekemeier, Ph.D., M.P.H., M.S.N.

Local Public Health Delivery of Maternal Child Health Services: Do Specific MCH Services Impact Mortality Disparities?

Co-Investigators: D. Grembowski, Ph.D., M.A.

This study was conducted to identify which MCH services delivered by LHDs appear effective in mitigating health disparities by reducing mortality differences.  Existing data were analyzed, for 558 U.S. counties and multi-county districts.  Independent variables included the six MCH activities provided by LHDs and captured in the 1993 and 2005 NACCHO Profile of Local Public Health Departments.  MCH change variables were created to represent changes in specific activities from 1993 to 2005 (discontinuation, initiation, or maintenance). Control variables included selected LHD characteristics and county-level socioeconomics, demographics, and health provider resource data derived from the U.S. Census and Area Resource File.  Dependent variables included 1993 to 2005 absolute change in Black and White mortality rates and differences between these rates.  We used a time-trend design to investigate relationships between the change in MCH activities provided by LHDs in 1993 and 2005 and changes in 1993-2005 Black versus White disparities in mortality.  Among the six MCH activities examined, prenatal care had a significant beneficial relationship with Black all-age mortality change and with reducing the mortality “gap.”  WIC services indicated the most consistently beneficial relationship with both Black and White mortality change, whether the activity was maintained or discontinued.  The initiation of WIC by LHDs also had a significant relationship to reductions in the Black-White mortality gap.  The only significant relationships between infant mortality change and activity change were for Prenatal Care, in which Black infant mortality favorably improved among LHDs initiating Prenatal Care in communities where none existed.  Findings suggest that WIC and Prenatal Care have the most consistent relationships with improvements in mortality and reducing the Black-White mortality gap.  Implications of this study suggest support for the continuation of MCH services, particularly WIC and Prenatal Care in communities, be they through LHDs or discontinued by LHDs and transitioned to community providers.

Torrie Harris, Dr.P.H., M.P.H.

A Community’s Perspective: A Qualitative Study of the Social Determinants of Pregnancy Outcomes Among African Americans in Louisville, Kentucky

Kentucky suffers from a widening infant mortality health disparity. African Americans in the state have the highest mortality rate of 10.9/1,000 live births compared to Whites at 6.0/1,000 live births. Louisville, KY maintains over 44% of Kentucky’s African American population. This qualitative study was conducted by the Kentucky Office of Health Equity and the Louisville Center for Health Equity to understand the social and environmental influences that contribute to healthy or unhealthy pregnancies, which may lead to infant mortality health disparities among African Americans in a Louisville, KY community. Community readiness to address infant mortality was also evaluated through key informant interviews using the Community Readiness Assessment developed by the Tri-Ethnic Center for Prevention Research. Photovoice was used to assist facilitators in focus groups. To ensure interrator reliability, three research team members conducted data analysis. A codebook was developed to code themes in the focus group transcripts. Themes such as: healthcare access, safety, housing, marketing and product promotion were identified.  A total of (n = 131) community member’s participated in the focus groups. Four (n =4) community leaders participated in the key informant interviews. Focus group results indicated that the participants were most concerned about safety, neighborhood appearance, housing, and environmental hazards affecting healthy pregnancies. The key informants did not believe that their community and/or leaders were ready to address infant mortality, nor was the community aware that this issue is relevant. The results of this study have implications for future healthy equity policy to eliminate infant mortality health disparities.