striking the root
Columbus has infant mortality rates worse than those in bigger, poorer cities. Can a new approach reverse the trend? In […]
Columbus has infant mortality rates worse than those in bigger, poorer cities. Can a new approach reverse the trend?
In the photos, little Will Hurd smiles, toothless and wide-eyed, at the person behind the lens. He sleeps, his little fists bundled close to his head in the victory pose babies seem to find so often. He cries, the effort crinkling his eyes. He has irresistible little rolls of baby fat. He is happy, healthy, surrounded by his parents, his brothers and his extended family. But Will died in July 2009, only 82 days old, of Sudden Infant Death Syndrome, or SIDS. Grieving parents Nathan and Michelle Hurd almost immediately started researching SIDS, seeking answers: How? Why?
Four years later, the Hurds, who live in Grove City, are still asking questions, and they are financing some of the answers through a nonprofit foundation they established in Will’s memory. It’s called, simply, BabyWill.org. The foundation’s mission: to raise awareness about SIDS. “Every time you lose a kid, you lose the potential of what that kid could contribute to the world. That’s the part that’s so sad,” Nathan says. “You see the pictures, and you’re like, ‘What could he have become? What contributions has the world already lost?’”
Nathan is one member of a new task force that draws from the city’s medical, philanthropic, education, business, public health and even religious sectors to address an alarming yet little-known problem: On average, three to four babies die each week in Franklin County. The infant mortality rate in some ZIP codes in Columbus is even higher—comparable, officials say, to rates in third-world countries. For every 1,000 babies born in Franklin County, 10 will die before their first birthday. For comparison, the national infant mortality rate in 2011 was 6.15 deaths per 1,000 births. Additionally, there is a disparity between the rate among white babies and black babies, who are two and a half times more likely to die before turning 1 in Franklin County. (Nationally, the infant mortality rate in the black population is 2.2 times that of the white population.) “It’s a stain on this community’s reputation,” says Columbus City Council president Andy Ginther. A new father—his daughter turned 3 last year—Ginther has been researching infant mortality in Franklin County for the last year and a half. He became convinced that the only way to start solving the problem is to address the complex “social determinants” of infant mortality. He created the task force with a stated goal to reduce the infant mortality rate by half within 10 years. When Nathan got the invitation from Ginther to join the task force, his immediate response was, yes, whatever you need, whatever I can do.
“It’s really simple,” Nathan says. “What I hope for the task force is that we reduce our infant mortality rate by half. In Columbus, that means over 70 families that don’t have to go through this every year.”
In Franklin County, as elsewhere, the most common cause of infant death is prematurity and low birth weight. The second and third most common causes are birth defects (such as chromosomal or organ defects) and sleep-related causes (like SIDS), says Dr. Kelly Kelleher, vice president for community health at Nationwide Children’s Hospital. A fourth category, the smallest, includes deaths by child abuse, crashes, fires and other rare events. Infant deaths are a measure of community health, not just the health of the babies who fall victim, Kelleher says. “In the last decade, most scientists have agreed that infant mortality is probably the best measure of community health. What is a better measure? Heart attacks? Cancer? Those are things that are probably set in childhood. Most mental illnesses, even heart disease, start in childhood. That doesn’t mean you can’t change some of that later,” he says, but the point is that a low infant mortality rate is an indicator of adult health—and all the services and habits that lead to it—in a given neighborhood.
In ways big and small, many of the parties that comprise the new task force have found ways to stem the problem on their own. Public health officials and doctors work on education and prevention. People like the Hurds raise awareness and money (they host a 5K, poker tournament and golf outing annually) and donate proceeds to researchers and doctors. Researchers dig deeply into medical aspects of these deaths. Individual hospitals and health systems run outreach programs. Until now, these efforts have acted as independent silos. The task force is supposed to weave these individual efforts together to form a better defense. “We have understood for one of the first times in the medical world that we are desperate for the help. If this involved just needing a better operating room or better doctors, we don’t want help, but for these problems that have social determinants, we do,” Kelleher says. “If we do this well, we’re not just going to change infant mortality. We’re going to change asthma. We’re going to prevent kids from dropping out eventually. And eventually we’re going to have a more engaged workforce and a better community. This is everybody’s problem.”
One program that has had measurable success in reducing infant deaths is OhioHealth’s Wellness on Wheels, a semi-truck trailer converted into a mobile prenatal clinic. In 20 years of working with families, the clinic has achieved an infant mortality rate of 5.5 deaths per 1,000 births, as opposed to 10 in 1,000 births in the county at large. The approach is not strictly medical: Obstetricians, clinical nurses, a social worker and a dietician work at the clinic—not the typical storefront medical staff. The trailer makes five stops every week at four public high schools. (It does serve students, but it uses the high school lots mostly for convenience of location.) “One of the things we have seen as a problem for these mothers is the ability to navigate various community services,” says Shawna Davis, system vice president of community and government relations for OhioHealth. Hence the social worker, who can connect expectant moms with social-service agencies in and around Columbus. “There really are a lot of people doing a lot of great things—it’s just knowing how to access them.”
Wellness on Wheels focuses on prenatal health of the baby and the mom—increasing the chances the baby will be carried to full term, which is ideal for the baby’s health. In these ways, the clinic is addressing the most common cause of infant mortality. Doctors also teach good sleep habits for babies, which can help prevent SIDS. Wellness on Wheels isn’t as intensely involved with moms after babies are born, but clinicians do post-partum visits and point new moms to other resources in and around Columbus. The causes of infant mortality are, roughly: access to health care, environment (including nutrition), behavior in the home and genetics. The highest infant mortality rates happen in neighborhoods where these risks accrue, Kelleher explains.
“Forty percent of our kids have none of the risk factors. Forty percent have one or two. Twenty percent of the population in 10 or so ZIP codes around the city have three or more,” he says. “Kids have trouble struggling against that kind of pressure.”
If you were to map gun incidents involving children, then map cases of childhood asthma, then map infant mortality across the city and lay those maps on top of one another, the neighborhoods highlighted would be the same. “The concentration is striking,” Kelleher says. Ginther says the task force is spending the next few months consulting national experts and drawing up a strategic plan, which could be unveiled in May or June. Once action is taken, Kelleher says, some results could be seen quickly.
“If we were effective at mobilizing and educating people, we might see sleep-related deaths move from 30 a year to 20 a year. Every single baby matters. To think about that, that fewer babies would die, and it would help overall for our community to be more aware,” Kelleher says. Reducing rates of prematurity could take longer, and some neighborhood changes could take a decade, he says. Maryland, New York City and Milwaukee all have improved infant mortality rates through comprehensive approaches that include medical care, social services, education and intensive neighborhood-based intervention. “We actually didn’t know people could make a difference for a long time,” Kelleher says. “This idea of changing the medical side but also changing the social side is a big step for people to get their arms around.”