Ma Magda Pe Peck ScD Founder and Principal , MP , MP3 H Heal alth th Gr Group Strategy. Le Leadership. Stories. When the Data Sing… Da Data Y You Ca Can U Use | | M May 30, y 30, 2018 2018
Powers of 3
“Urgency of Now. “
Solving Obesity?
Mind set. Knowledge set. Skill set.
De Determ rminants of Health and Health Inequities Appetite for COMPLEXITY... Commission on Social Determinants of Health. (2010). A conceptual framework for action on the social determinants of health . Geneva: World Health Organization.
Absence of Social Cohesion/Belonging Lead to ACEs and Diseases of Disconnection and despair
SE SEE AND SE SEIZ IZE “B “Brigh ght Sp Spots” s”
Le Leadership, through the effective use of data. Ci CityMatCH. CH.org “Data Use Institute”
Ci CityM tyMatCH tCH’s s “ Dat Data a Us Use Tri riangl angle ” ” Data – Research What we know… Community Strategies, Programs What we get Services others to do! What we do. Policy - Political Will
Dissatisfaction (D) = CHANGE IS NEEDED Vision (V) = IMAGINE BETTER FUTURE First Steps (F)= WORTHWHILE ACTIONS NOW Resistance (R) = natural and must be overcome D x V x F > R * Each of the elements must be present. If any of the elements = zero, resistance will not be overcome. 13
V
V
PO POWER TO CHA HANGE GE CHECKLIST ü Clearly defined and understandable? ü Of enough priority to engage other essential community partners? ü Amenable to change? ü Doable in the short term (some progress in the next 6-9 months)? ü Have baseline data that are available/accessible, reliable and timely? ü Have known solutions that can begin to yield measurable change? F ü Have defined, measurable results?
F
D Too many, too small, too soon…
D
D
D x V x F > R D > 0
DATA = spark D’s for CHANGE Vision (V) = IMAGINE BETTER FUTURE First Steps (F)= WORTHWHILE ACTIONS NOW Resistance (R) = natural and must be overcome D x V x F > R * Each of the elements must be present. 22 If any of the elements = zero, resistance will not be overcome.
Toward Equity: Eliminating Disparities
White: 20 25 10 15 0 5 1980 1981 10.9 1982 USA White and Black IMR: 1980-2011 1983 1984 1985 1986 Persistent disparity – >30 year lag… 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Black: 2007 NCHS 2008 11.42 2009 2010 2011
“Bright Sp “B Spot” Infant Mortality y (2015) in Omaha (Douglas County) y), NE Carol Gilbert, CityMatCH , David Busse, Douglas County Health Department
Infant Mortality Rate Trends, Douglas County 3-Year Rolling Averages 18.0 *2014 data is provisional 16.0 14.0 Deaths per 1,000 Live Births 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2007 2008 2009 2010 2011 2012 2013 2014 White, not Hispanic 5.7 5.0 4.4 3.7 4.4 4.1 4.9 4.9 Black, not Hispanic 14.5 16.2 15.7 15.1 13.1 12.0 10.0 8.7 Ratio Black/White 2.5 3.2 3.6 4.1 3.0 2.9 2.0 1.8
Decided to try PPOR* – 6 Stages * PERINATAL PERIODS OF RISK APPROACH 1. Assure Community and Analytic Readiness 2. Conduct Analytic Phases of PPOR 3. Develop Strategic Actions for Targeted Prevention 4. Strengthen Existing and/or Launch New Prevention Initiatives 5. Monitor and Evaluate Approach 6. Sustain Stakeholder Investment and Political Will Peck, Sappenfield et al, MCHJ, 2010.
Welcomed Communities as Full Partners § There is no substitute for lived experience, which can help us understand § Underlying problems and their causes § What solutions will work best § Make the data clear, comprehensible, compelling to most. Get READY to use the data.
PPOR DATA: Why include fetal deaths? 1. Fetal deaths are important to families 2. There may be as many or more fetal deaths as there are infant deaths 3. Fetal deaths may provide us with even more information about infant mortality in the community Standard infant mortality rates do not include fetal deaths. PPOR uses all of the available information to investigate infant mortality .
Look at fetal and infant deaths and rates through PPOR ‘Mapping’ Age at Death Neonatal Post- neonatal Fetal Death 0-27 days 28-364 days >=24 weeks Birthweight Maternal Health/ 500-1499 g Prematurity Maternal Newborn Infant 1500+ g Care Care Health
Fi First P t Per erinatal Pe Periods of Risk “Ma Map” p” Do Douglas County (Omaha), NE, NE, All Races Fetal-Infant Rate= 10.0 Fetal-Infant 4.1 Rate= Fetal-Infant 2.2 1.7 2.0 Rate= 1999-2002 Fetal-Infant Rate= 2003-2006 2007-2010 2011-2014
Perinatal Periods of Risk (PPOR) Approach Helps Narrow the Choices of Action Pre conception Health Maternal Toxic Stress , Other Exposures Health / Behaviors before pregnancy Mental Health Prematurity Prenatal Care Access and Quality Maternal High Risk Referral Obstetrical Care Care Quality of Caring, Doulas Perinatal Management Newborn Neonatal Care Pediatric Surgery Care Home Visitation Sleep Position Infant Smoking Injury Prevention Health Child Care Quality
GAPS: Comparing Different Subpopulations Black Fetal-Infant White Fetal-Infant Rate =17.6 Rate = 8.6 3.1 8.8 2.0 1.9 1.6 2.4 2.4 4.0 White non-Hispanic Black non-Hispanic
PPOR also asks: How man y deaths might have been prevented? Compare, using a Reference Group ●If one population group already can have very low mortality, other groups can reach that goal. ●Instead of comparing racial/ethnic groups, we compare all groups to this agreed-upon reference group. …A matter of health equity. ● Community helps decides who is compared to whom.
Calculating Excess Rates (US 2000-2002 Reference Group) Urban Cty Maternal Maternal Newborn Infant Fetal-Infant Health/ Care Care Mortality Health Prematurity ALL 4.2 2.1 1.9 2.0 10.1 _ US 2.2 1.5 1.1 0.9 5.7 Reference Group Excess 2.0 0.6 0.8 1.1 4.4 Mortality Rates
Estimated Excess Number of Deaths (US 2000-2002 Reference Group ) Racial- Maternal Maternal Newborn Infant Fetal-Infant Ethnic Health/ Care Care Health Mortality Groups Prematurity White, non- 14 8 13 11 47 Hispanic Black, non- 22 3 4 10 39 Hispanic Other 9 2 1 6 18 Races 46 13 18 26 103 All
Perinatal Periods of Risk (PPOR) Approach Helps Narrow the Choices of Action Pre conception Health Maternal Toxic Stress , Other Exposures Health / Behaviors before pregnancy Mental Health Prematurity Prenatal Care Access and Quality Maternal High Risk Referral Obstetrical Care Care Quality of Caring, Doulas Perinatal Management Newborn Neonatal Care Pediatric Surgery Care Home Visitation Sleep Position Infant Smoking Injury Prevention Health Child Care Quality
Pe Perinatal Pe Periods of Risk “Maps” 1999-2014 2014 Do Douglas Co County (Omaha), , NE, NE, All Races Fetal-Infant Rate= 10.0 Fetal-Infant 4.1 Rate= 8.2 Fetal-Infant 2.2 1.7 2.0 3.4 Rate= 8.3 Fetal-Infant 1999-2002 1.8 1.2 1.8 3.7 Rate= 6.3 2003-2006 2.2 1.2 1.2 2.4 2007-2010 1.0 1.5 1.3 2011-2014
Av Average PPO PPOR Ra Rates ( (Fe Feta tal+Infant De Death ths) Douglas County, NE 1995-2014* 4.5 MH/P 4 MC 3.5 NC 3 IH 2.5 2 1.5 1 0.5 0 95- 96- 97- 98- 99- 00- 01- 02- 03- 04- 05- 06- 07- 08- 09- 10- 11- 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 *2014 data is provisional
3 more things…
Th Thelma’ elma’s Box 1. 1. U University o ty of P Pennsyl ylvania 1948 ( 1948 (MSW) M Masters T Thesis 2. 2. U University o ty of Ca California - Ber Berkel eley M y Master ers i in Di Divinity ty, 2000 G 2000 Graduati tion H Hood 3. …………..
And the Bikini? Persistent Fierce Optimism
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