Newsweek: A Wonderful Mystery

Black infant mortality has plummeted in one Wisconsin county. Why?

We wrote about this twice in recent months:

Apparent Disappearance of the Black-White Infant Mortality Gap --- Dane County, Wisconsin, 1990--2007

Health Care - The Real Story of Government Involvement: Saving Lives, Saving $Millions in Madison and Dane County

Here is, in part, what Eve Conant of Newsweek wrote last week:

Somehow, Dane County had achieved the holy grail—a reduction in the infant-mortality rate. But why? Another positive trend is almost certainly playing a role. "We're also seeing a big decline in the number of very early preterm births, which is unusual because nationally that rate is very stable and resistant to change," says Ferre. The Dane County decrease—from 2.8 percent to 1.1 percent—is dramatic, and no doubt related to the infant-mortality drop. Elsewhere in the U.S., the rate of preterm birth—a leading factor in infant mortality—has increased 36 percent over the past quarter century (to 12.7 percent), in part due to women having babies later in life and reproductive techniques that increase the chances of multiples, but also because black women across the country have a much higher risk of preterm delivery than whites...

... There is no quick or simple answer, not yet at least. But one area of interest is a former strip mall in a low-income part of Madison that, in the early '90s, was transformed from a bowling alley (and a cluster of jewelry and sub sandwich shops) into a hugely popular one-stop shopping zone for maternal care. Asked to name the facility, members of the community dubbed it South Madison Health & Family Center—Harambee, Swahili for "pulling together." Harambee, first created out of community grant funds and private donations, has developed and shifted over time, but is currently a collaboration of five different entities: three medical clinics, including county and city public-health clinics and Planned Parenthood; Head Start; and a public library. Some 600 patients a day visit the dozens of nurses and doctors at the clinics, or come for social programs, which range from parenting classes for soon-to-be fathers, breast-feeding seminars, and even bereavement groups for women who have lost infants or miscarried. Community volunteers, including elders, read to children in waiting rooms. "What is different in Dane County," says former Madison mayor Paul Soglin, who was instrumental in creating Harambee, "is that here a 19- or 25-year-old black woman finds a facility that is not the white man's institution—it's hers." As the center and the community around it began to grow, infant-mortality rates started to drop (though no data have yet proved that one caused the other). Does Ferre see a link? "Yes, I do. When you look at data from other one-stop centers, like in D.C. or Harlem, you'll see their infant-mortality rates have decreased too. I'm suspicious that this type of clinic—Harambee—could have affected the rate." (She points out that not all such one-stop clinics have these great rates, however, which warrants further investigation into what does and does not work in the one-stop-shopping plan for maternal care.) For his part, Schlenker doesn't think Harambee "is the whole answer by any means, but it is certainly part of the answer. It got agencies to work in a synergistic way, drew the community together, and made people feel valued."...

...Lorraine Lathen of the University of Wisconsin has been canvassing the women of Dane County for answers. "We're finding some non-health-related factors that actually seem to influence outcome," she says. Those factors involve a complex web of relationships between expectant parents and local medical care that Soglin (who is also investigating the Dane County results) describes simply as "access plus trust." Trust, in the words of many of the young black mothers Lathen interviewed, seems to translate into the absence of racial stereotypes...

...Other factors may have certainly played a role—including a system of devoted home nurses who work under Schlenker. There are some 60 public-health nurses in the county; at any given time a dozen are on duty for home visits before and after birth for high-risk pregnancies. But no one is exactly sure yet what did the trick. What they do know is that by 1996, says Schlenker, premature-birth rates in the area started to go down, and by 2002 the infant-mortality rate began to drop. Looking at a chart, Schlenker says, "The past six years have been a straight-down precipitous drop, like falling off a cliff." He still can't believe his own data. "It's shocking, for two reasons. One, you almost never see a graph like that in medicine. The second shock is that it's good news."

Comments

[John]

Don't forget the transportation aspect. Dane County has a very strong transportation system for human services (which is being threatened at the state level by switching to brokerage).

[Ty O'Mara]

No one knows how to respond to good news these days, it is such a rarity. Congratulations to those real people who treated other people as real people. "Way to go!"