1. REDUCING HEALTH INEQUITIES THROUGH THE IMPROVEMENT OF BIRTH OUTCOMES 9/13/2004

2. PRESENTOR SHIRLEY SHELTON CALIFORNIA BLACK INFANT HEALTH PROGRAM COORDINATOR

3. INSIGHTS CRITICAL KNOWLEDGE

4. PROGRESS  Life has improved for most racial and ethnic groups in California over the last 30 years, but not for all or on all dimensions.  Despite real progress in social, political, and economic equity, deep disparities persist.  On the whole, Whites and Asians are healthier, more educated, economically better off, and less likely to be victims of violent crime than AA’s and Hispanics.

5. POPULATION  California = 34 million people  California’s population is one of the world’s most diverse. 50.0% Female 50.3% non-Hispanic 30.8% Hispanic 11.5% Asian and P/I 6.8% African-American 0.6% American Indian

6. EDUCATION  The education gap between AA’s and Whites diminishing.  College initiation and completion rates remain lower for AA’s than for Whites.  U.S. born Hispanics have lower high school and college completion rates than do AA’s, Asians, and Whites.

7. ECONOMIC STATUS  Asian and White family incomes are substantially higher than those for AA’s and Hispanics. Lower income translates into higher poverty and public assistance rates for AA’s and Hispanics.

8. CRIME  African-Americans in California continue to experience the highest risk of arrest and incarcerations. African-Americans are also more likely than others to be victims of violence.  African-Americans along with Hispanics are more likely to be killed than Whites.

9. POVERTY  Poverty  Wealth  The pursuit of Happiness

10. HEALTH STATUS  Chronic health conditions increase with age.  African-Americans fare worse than other racial and ethnic groups in California.  Life expectancy for White males and females was 74 and 80 years respectively; 79 and 86 years for Hispanic; 80 and 86 years for Asian/Pacific Islander, and 67 and 74 years for Black males and females respectively.

11. HEALTH STATUS CONT.  Life expectancy is related to family income and having the means to adequately provide for and respond to the needs of the household.  People with lower income die younger.  Children from higher income families are more likely to have health insurance coverage.

12. PROBLEM STATEMENT  It’s a familiar but a disheartening story. Black women are not well and die younger and faster than their peers.  Likewise, African-American babies are twice or more likely to die during infancy as other babies.  African-American women experience the highest level of maternal mortality.

13. TROUBLING TRENDS  Obesity a nationwide epidemic with disproportionate rates in the African- American community.  Diabetes, the sixth leading cause of death and constitutes over 18 million cases in American and 2 million in California.  HIV/AIDS

14. TROUBLING TREND (cont.)  Preventive Health Behaviors/Poor Health Practices Mammography Pap Smear General Health Check-up

15. BARRIERS  Acknowledge and address barriers Barriers include more than lack of coverage Making end meet/survival (priorities) Different realities (the press of family issues) Transportation and child care Transience Lack of support (lack of partner or family support) Lack of knowledge/awareness of symptoms Trust Cultural inefficiencies (lack of reflective/like personnel and differential treatment) Discrimination

16. PATHWAYS  Initial steps Recognition Understanding Throne abandonment Seek real partnership w/target community Respect, Value, & Honor

17. PATHWAYS CONT.  Cultural Advisors expertise (what’s their thinking, what do they know that you need to know, what would they do)  Standardized state-of-the-art strategies Community awareness Linkage to appropriate and quality services Follow-up Other interventions (Social Support/Empowerment, Role of Men)  Assessment/Evaluation/Re-evaluation  Cultural Advisors buy-in

18. PROGRAM IMPROVEMENTS  Political/public will  Cultural and professional competence  Committed resources  Standardized strategies  Stabilized time investment  33 percent infant mortality decline

19. EQUITY  Respect, Value, and honor is vital! Willing! Doing!! Going!!! Acting!!!!