Lessons learned in Memphis, Tennessee can help Southeastern, Wisconsin
A special series by Milwaukee Lifecourse Initiative for Healthy Families
Candles, cake and images of their child with smudged cake around the mouth and cheeks are joyful memories all parents want. However, far too many babies die before blowing out their first birthday candle. In Milwaukee, we are familiar with the problem and critically need to apply adequate resources and strategies to address the issue.
Memphis, Tennessee and surrounding Shelby County can perhaps provide Milwaukee guidance for curving infant mortality through a collaborative approach called “collective impact.” This model refers to a carefully crafted, multi-sectorial approach to realizing social change.
Once ranked as having the highest infant mortality rate in the nation, Memphis’ rate—which was 14.9 deaths per 1, 000 live births—has now declined by nearly a third of its original rate. In Shelby County in 2009, 187 babies died. But in 2011, 134 babies died, which meant 53 more babies lived to see their first birthday. The 2011 rate for infant mortality in Shelby County was 9.6 per 1,000 live births compared to the national rate of 6 per 1,000 live births.[i]
Tennessee’s infant mortality battle parallels that of Milwaukee as well as national trends.[ii] The number one cause of infant death in Tennessee is complications of prematurity, followed by congenital abnormalities[iii].
To combat the problem, Shelby County first established a common goal: saving babies. A series of newspaper articles amplified awareness of the problem and stirred public interest and support. “We have excellent birth outcomes in some communities and incredibly bad ones in certain [urban] communities,” said Yvonne Madlock, director of the Shelby County Health Department. Following the articles, “You had heightened awareness about infant mortality here in Shelby County across all sectors,” she said.
Shelby County employed professionals from national and community organizations, faith-based groups, businesses and the healthcare sector. Backed by a multidisciplinary leadership team, the sectors came together and implemented the collective impact model to slice the infant mortality rate drastically down by a third.
No one program was credited for the decline in infant deaths. There were multiple programs used to tackle the problem. Home visitation programs, early childhood education programs, and many other strategic approaches were taken, and partners across sectors were engaged in implementation.
“All this just kind of rippled out and created a tremendous amount of synergy and energy around addressing, not only infant mortality, but in general around improving the lives of women and children,” said Madlock.
Partnerships were one key element to the success seen in Shelby County. “It really is about building community partnerships,” said Dr. Michael Warren, MD MPH FAAP, director, Division of Family Health and Wellness, Tennessee Department of Health. “Public health can’t do this alone. The healthcare sector can’t do this alone. You really have to reach out and get others involved,” he said.
Reaching out and getting others involved proved to save lives. Seanella Barnes, 23, of Memphis is one of Shelby County’s success stories. Today her 15-month-old daughter, Mary Kaye Harrold, is doing well, but at one point doctors were fighting to keep her in Barnes’ womb. When Barnes found out she was pregnant she was working fulltime while also a fulltime student. Soon after, she lost her job, which led to a very stressful situation.
Barnes went into preterm labor twice during her pregnancy. The first time she was about 28 weeks pregnant. “I didn’t feel well, and my mom told me that I didn’t look good. When I went to the emergency room I had dilated three centimeters.” Barnes was treated with steroids to help the baby’s lungs develop along with other preventative treatments. She was placed on bed rest. Harrold was delivered at 36 weeks gestation, weighing seven pounds (full term is between 37 and 40 weeks gestation).
Without quality care, Barnes’ experience could have been much worse. And without organizations and sectors working through the lens of collective impact, the rates in Shelby County may not have drastically declined. As we acknowledge the tremendous efforts by a group of dedicated individuals across sectors in Tennessee, let us glean from the work that they have done.
The Milwaukee Lifecourse Initiative for Healthy Families (LIHF) Transition Team is currently supporting the Wisconsin Partnership Program in identifying a lead agency to coordinate the effort. Dr. Warren of the Tennessee Department of Health suggests several key steps to ensure that Milwaukee’s collective impact efforts are successful.
First, ensure a common mission among all of the partners. “Think about what the common mission is and work together towards that common purpose,” said Dr. Warren.
Second, urgency is needed. “Connect with your partners who have data to be able to tell that story,” said Dr. Warren. “We frequently talk about infant mortality rate, but what does that mean? What’s the actual number behind that rate? Well that’s 587 babies that died before reaching their first birthday. You could even go further and say that’s 29 empty kindergarten classrooms.”
“Tell the story that lights the fire,” he added. Sound the alarm Milwaukee. Enough is enough. Our babies are dying, so get involved.
Let’s stand for a community in which all families can buy candles and cake to celebrate first birthdays and beyond…regardless of where they live, work, learn and play.
If you are interested in the working towards achieving collective impact to improve birth outcomes in Milwaukee, please visit www.jumpatthesunllc.com/ LIHF or call 1-888-726- JUMP.
Collective impact involves the commitment of a group of important stakeholders from different sectors to a common agenda for solving a specific social problem. Unlike most collaborations, collective impact initiatives involve a centralized infrastructure, a dedicated staff, and a structured process that leads to a common agenda, shared measurement, continuous communication, and mutually reinforcing activities among all participants. (http://www.ssireview.org/articles/entry/collective_ impact). Examples of sectors include business, healthcare, nonprofit, faithbased, education and the like.
[i] Interview with Dr. Ramasubbareddy Dhanireddy, of the University of Tennessee Health Science Center (UTHSC) in Memphis, March 2013.
[ii] Milwaukee continues to experience significant racial disparities in infant mortality. The 2009-2011 3-year rolling average IMR for Milwaukee was 10.2 overall, 14.5 for blacks, and 5.0 for whites. The black: white ratio is nearly 3:1 in the latest 3-year rolling average. (Milwaukee Health Department 2012), and http://city.milwaukee. gov/Infant-Mortality
[iii] Interview with Dr. Ramasubbareddy Dhanireddy, of the University of Tennessee Health Science Center (UTHSC) in Memphis, March 2013.