Michelle Chiezah
Appearances
Health Chatter
Infant Mortality
So those are deaths that have suddenly and unexpectedly from causes that are not immediately understood at the time of the death. So they require a sealed investigation, autopsy, review of the child's medical history to ascertain the cause and manner of the death. And so we have a project through the CDC where we'll be working with our communities directly to work on this issue with them.
Health Chatter
Infant Mortality
The American Indian population has the highest semen rate in our state. followed by the black population. And seaweed is also the leading cause of death in the American Indian population. So what this project intends to do is to sort of bring the community together and we'll have a steering committee made up of African-Americans and American Indians
Health Chatter
Infant Mortality
They will have listening sessions to kind of uncover some of the reasons that are driving the sewage rates, develop an action plans or develop action plans. There'll be a separate what we call community action team for the American Indian population. They'll have work plan and budget separate for the African-American population.
Health Chatter
Infant Mortality
They'll have their own work plan and budget, and they'll prioritize recommendations from this action plan to implement it. This is a five-year project. In addition, we have these infant mortality prevention grants, infant health and mortality prevention grants. Those are funds that came through the legislature last year through the Healthy Beginnings, Healthy Families Act.
Health Chatter
Infant Mortality
And that is intended to create opportunities across the state for addressing infant mortality in four areas. Prematurity, sudden unexpected deaths or sleep-related deaths. congenital malformations and the social determinants of health. And we issued 33 grants across the state. I believe it was like 55% of those grants went to the metro area and 45% went to greater Minnesota.
Health Chatter
Infant Mortality
So those grants went to tribes, nonprofit agencies, and local public health agencies.
Health Chatter
Infant Mortality
in total 33 grants went out so we also have other products that are working towards maternal morbidity and mortality you can think about the maternal mortality review committee which is quite robust and doing some amazing work to try and uncover the causes of maternal mortality in Minnesota they make recommendations there's also another project which they call Time On For Short.
Health Chatter
Infant Mortality
It's a five-year funded project, $5 million over five years. And that project is intended to strengthen implementation of innovative approaches, data-driven kind of community-led and driven strategies to improve outcomes in the Black American, Indian, and other populations of color, refugees and immigrants as well. And this is linked very closely to
Health Chatter
Infant Mortality
the Maternal Mortality Review Committee and other work that's going on with the Minnesota Perinatal Quality Collaborative as well. And so that project they'll develop, we're working on a perinatal health plan to implement to improve outcomes. And then there's also the Dignity in Pregnancy and Childbirth Act, which was passed by the Legislature in 2021 in maternal health care.
Health Chatter
Infant Mortality
And part of that is to develop access to a continuing education curriculum that address, that provides, it's a course that providers have to take. It focuses on anti-racism training and implicit bias. And I know the state worked or partnered with CARE, C-A-R-E-C, at the U of M to make this curriculum possible.
Health Chatter
Infant Mortality
So there's a lot of, and through this Dignity in Pregnancy and Childbirth Act II, there is resources online through a database called Help Me Connect for doulas.
Health Chatter
Infant Mortality
Anybody searching for doula, my colleague at the health department, Sarah Hill, she worked with Help Me Connect to create this fabulous area within that database so that people can search for doulas based on maybe geography or some other characteristics of interest to them. So there's also the sewage subcommittee.
Health Chatter
Infant Mortality
That's a review committee where we review certain unexpected infant deaths and then make recommendations for implementation. And so that work will also inform the project that we're doing funded through the CDC to address this issue. We also have grants through other agencies. some of which I mentioned that I didn't mention earlier. We work closely with the African American Babies Coalition.
Health Chatter
Infant Mortality
We work closely with Beck, of course, and Healthy Black Pregnancies. And we just do a lot of work with our partners out in the community to address this problem. So two different ways, whether it's sharing data and bringing awareness to the problem. And yeah, so sharing resources.
Health Chatter
Infant Mortality
I mentioned the family visiting area. They have a huge area that focuses on families, family health and their well-being. So that would be a really important and strategic area. We have other partners in other areas like the Eliminating Health Disparities Initiative. They're doing important work in the community to address infant mortality.
Health Chatter
Infant Mortality
We received funds from Title V, that's through the federal block grants, and those funds go out to local public health agencies, community health boards to address infant mortality through those community health boards. So that's also some of the other work that we're doing, and we also have awareness weeks There's just so much that touches on infant mortality.
Health Chatter
Infant Mortality
There's also work around prison, prison, doing work in jails and prisons with mothers and their babies. That's another project that's happening. That also was funded through the Healthy Beginnings, Healthy Families Act. There's just a whole lot of different initiatives, like the ones that I just mentioned. that are happening in the state. So the Title V funds come every year from the feds.
Health Chatter
Infant Mortality
They have to do a needs assessment every five years to make priorities. And they're about, in the state, I think, have started to do the needs assessments again. So that's where different topics are prioritized, including infant mortality. that we need to work on across the state. Last time around, last cycle infant mortality was one of the priority health topics. It makes sense.
Health Chatter
Infant Mortality
It's also a national priority, a priority that's listed in Healthy People 2020 and other federal strategic plans.
Health Chatter
Infant Mortality
That is a good question. Unfortunately, I don't have information, you know, any evaluation information of what those initiatives, how they impacted those rates. And it's sometimes hard to isolate, you know, one single intervention or two, because there's so many different interventions. interventions that are happening that could influence those outcomes, right?
Health Chatter
Infant Mortality
Prematurity, for example, we've seen an increase in prematurity, not just nationally, but in our state as well. And like I mentioned before, it's a major reason why we have such a poor infant mortality rate compared to other countries. industrialized societies. The March of Dimes every year comes up with a prematurely report card.
Health Chatter
Infant Mortality
I believe several years ago we had a B minus, now we're at a C plus, and the U.S. is at a D plus. So we're not doing too great in that area. Good question, though.
Health Chatter
Infant Mortality
I'm not aware of any such program, like maybe, no, I'm not aware of any program like the one you're talking about. Most of the programs that I'm aware of are for people who had babies.
Health Chatter
Infant Mortality
Yeah, so WIC, Women, Infants, and Children Nutritional Program, they're the ones who mostly handle, the work is divided up at the health department, and they're the ones who mostly address breastfeeding issues, nutrition issues in families, but through my work, I do promotion of breastfeeding because it's connected to infant mortality, and
Health Chatter
Infant Mortality
actually breastfeeding, breast, lack of breastfeeding is actually, or breast milk is actually a risk factor in what we call sudden infant death syndrome, which is a type of sudden unexpected infant deaths.
Health Chatter
Infant Mortality
So during infant safe sleep, sorry, during infant safe sleep week, which happens every November in this state, we do a promotional post that targets the American Indian population that looks at, basically focuses on the intersection of breastfeeding or breast milk, and it's important to reducing sewage seeds in that population. Again, that is the leading cause of death.
Health Chatter
Infant Mortality
So an unexpected infant that's in their population. So that's where my work intersects with that area. So we can partner in that way with the WIC program. They have a whole program and family-owned visiting. Maybe a good idea to bring them onto your program to maybe flesh that out more.
Health Chatter
Infant Mortality
That is a good question. So where my work touches on this topic is with abusive head trauma, shaken baby syndrome. So that's where I work on the prevention side. There's a law in the state or statutes and statute that hospitals must provide education to parents around this topic before they're discharged. And so the hospitals must show video to parents and educate them.
Health Chatter
Infant Mortality
And if they don't want to use the videos, or provided by the commissioner, then they have to submit one to the commissioner, which I act in place of the commissioner, review those for certain elements or we're looking for different things.
Health Chatter
Infant Mortality
So that's where my work intersects or addresses the abuse and the abuse issue is with chicken baby syndrome and the Indian violence prevention area keeps data on this topic. I haven't seen those statistics in a while, but it's not one of the leading causes of infant mortality. It doesn't show up as a leading cause, just to let you know.
Health Chatter
Infant Mortality
For family home visiting, they focus on abuse as well, because that's how it all started, through David Coles and his work and a number of other people. So that area focuses on that topic too.
Health Chatter
Infant Mortality
Yeah, that is a lot. Yeah, if you look at a map, CDC has a map of, you know, the states. You can look at their infant mortality rates. Luckily, Minnesota is just below that 5.0 target. And, you know, Minnesota's infant mortality rate has consistently been lower than the nation's rate overall and has always met the target. The problem, again, is those disparity gaps.
Health Chatter
Infant Mortality
That's the issue is those disparity gaps. But you're right, there are many states, especially in the south, that's where you see states with very high rates of infant mortality, like Mississippi, Alabama, West Virginia, those states have high infant mortality rates, historically.
Health Chatter
Infant Mortality
That is a very good question. So as I mentioned earlier, Mr. Jones had asked that question. Among 30-something developed countries that I looked at the data, OECD states, the US ranks did last. Finland and those countries, the Nordic countries, sometimes Singapore, Iceland, they compete for number one. They go back and forth.
Health Chatter
Infant Mortality
um i believe finland the latest data i saw finland had the best import mortality rate i believe it was like 1.7 per 100 per thousand life birds so um that's what do they do what is what are they doing right oh yeah they have paid currently we don't give extensive paper they provide more investments in their population right so you need health care i mean they pay a lot of taxes
Health Chatter
Infant Mortality
but they get their money's worth, right? So they have healthcare access, college, free college access. They just provide for their population, I think, a lot better than the U.S. does, including those extensive paid medical, I mean, parental leaves to both mothers and fathers, to birthing people, let's say.
Health Chatter
Infant Mortality
Yeah. May I just correct one thing? So actually, I'm looking at that today. It's Japan that has the lowest in 2021. All right.
Health Chatter
Infant Mortality
That's a very good question. So I'll give you a really good example. So like I mentioned, that CDC project, we have a number of different community committees, like the Maternal Mortality Review Committee that involves a lot of community input to review those maternal deaths. But then on the infant side, When we write plans, at least in the past, we've always involved community input.
Health Chatter
Infant Mortality
So too with Title V, communities were involved with prioritizing topics for the state or issues for the state to address. And with this new CDC grant that we have to address sudden unexpected infant deaths, it will be largely community-led. In fact, like I mentioned, the steering committee, the leadership team is made up of primarily African-American and American Indians.
Health Chatter
Infant Mortality
We have people with lived experience, both lived and professional experience in this space. And so they will be steering the project. We will hopefully do a very good job of listening to them, taking their ideas to guide and steer the project. Additionally, we provide information to the public, right? So that's part of our job as a state agency around different issues.
Health Chatter
Infant Mortality
infant health and mortality topics and engage them through social media and other ways. But having people sit on committees, being there, sharing power with them, centering and elevating their voices, that is one of the main purposes or goals of this project too. The CDC project is to do things a little bit differently
Health Chatter
Infant Mortality
where we have communities really being at the center of steering this project to make sure that, you know, their voices are heard, but that they have an input in setting the direction of this work and making sure that it benefits the community to the maximum. So their voices will be very important in this work. We can't do this work without communities.
Health Chatter
Infant Mortality
We can't sit back and make decisions and expect to see the changes that we want to see without the input or the voices of that does not make sense.
Health Chatter
Infant Mortality
And so if we want to see the changes that we really are desiring, then we really need to engage and involve communities in making decisions and helping to prioritize recommendations, identify what's really at the root of the problem and making sure that they're there and being at the center of this work.
Health Chatter
Infant Mortality
Mr. Jones, may I add that we used to have a fetal and infant mortality review. That's a community-led process where cases of infant deaths are reviewed by an interdisciplinary team of community members with expertise, lived experience, however you want to say it. We no longer have that in Minnesota.
Health Chatter
Infant Mortality
The statute expired over two decades ago and they've been trying to reinstate it, but data privacy laws get in the way, but that's the process that's used. across jurisdictions, across the U.S., in other states to really engage and involve communities. So hopefully we've been pushing hard to get the fetal and infant mortality reviews back in our state.
Health Chatter
Infant Mortality
And so hopefully one of these days we'll get it. So we can really understand the circumstances behind these deaths, what are driving them. It involves an arm of it is an interview, face-to-face interview with either the surviving mother or a family member
Health Chatter
Infant Mortality
And then, you know, recommendations are made if CHAP teams are formed, community action teams within communities to really implement strategies that are prioritized by the community to address problems within communities. So hopefully we can get a femur again to really help us with understanding the circumstances and then taking action in that way.
Health Chatter
Infant Mortality
Very good question. First, thank you so much for having me here. Mortality is the death of a live-born infant before the first birthday. And we measure infant mortality. We use a rate called the infant mortality rate, which is basically the number of infant deaths per thousand live births.
Health Chatter
Infant Mortality
We need that measure so we can do comparisons across populations, across geographies, across other types of deaths. variables of interest. And that variable in and of itself, that measure is very powerful in that it tells us a whole lot about a society and a whole lot about a community. It tells us about the quality of health care that's available, socioeconomic conditions.
Health Chatter
Infant Mortality
It tells us about medical care access. It tells us a whole lot. And I think, too, in my opinion, that it's also a measure of our values, who we value and what we value as a society.
Health Chatter
Infant Mortality
Unfortunately, even though the rates over time have declined in the US and in Minnesota, and we have data to show that even within racial and ethnic groups, the gaps, the disparity gaps between, let's say, the two groups with the highest rates, African American, American Indian, then other racial groups too, those haven't shrunk. The rates are declining, but those haven't shrunk.
Health Chatter
Infant Mortality
Still today, the disparity gap is about the same as it was two decades ago. Infants born to Black and American Indian mothers in the state and also nationwide are two to sometimes even three times as likely to die
Health Chatter
Infant Mortality
um before their first birthday as um maybe an infant born to a white mother and maybe compared to the state or national rates overall so that's what we're seeing and one of the reasons that gap is to me an opportunity gap it's a disparity gap but it tells us too there's a lot of things that we aren't addressing we've spent a number of years addressing health behaviors
Health Chatter
Infant Mortality
no smoking, no alcohol during pregnancy, get your prenatal care. Well, a lot of women are doing those things, but what's not being addressed are the systemic and structural issues, the drivers, those forces that are really having tremendous impacts on people's lives. For example, systemic racism is still an issue today. This talk about post-racial or whatever, that doesn't exist.
Health Chatter
Infant Mortality
Racism still exists in our institutions, in our healthcare system. Let's face it, we're not all treated the same in the healthcare system. Opportunities are not made available to all of us. And so we need people to have opportunities. We need to address housing issues. We need to address transportation access issues.
Health Chatter
Infant Mortality
We need to address medical care issues, expand medical care, treat people better, some of us better in the healthcare system. So there are a whole lot of issues that are being addressed. And until we address those and are truly intentional and make new efforts to do that, these gaps will still persist.
Health Chatter
Infant Mortality
When you compare the US's infant mortality rate to other industrialized societies, if you look at what we call OECD infant mortality rates, I can't remember what that acronym stands for, but Organization of Economic Something Development comes out of Europe. The US ranks dead last. Dead last? Yeah, among developed societies, yes.
Health Chatter
Infant Mortality
There's a statistic that's often been touted that even Cuba, a less developed country, has a better infant mortality rate than the U.S. So the U.S. is not doing very well. And it's because of prematurity and all that comes with those preterm births that we see a very high burden. a huge difference in this country.
Health Chatter
Infant Mortality
Like I've said, the rates themselves have declined over time. It's the disparity gap. And that to me is also an opportunity for other interventions. And I think it's probably a combination of things, but that gap also says to me that we are addressing those structural and systemic issues that are really at the root cause of this problem, racism. Racism hasn't gone away, right?
Health Chatter
Infant Mortality
You think that you'd go to the healthcare system and be treated fairly and equally, but all people aren't treated the same in the healthcare system. There's research to back this up, dating to maybe two, three, even four decades ago, two decades ago. I can think of Michelle Van Ryn's research at the U of M, where she looked at this issue, the social
Health Chatter
Infant Mortality
economic differentials and how people are treated in the healthcare system. So getting at those structural issues, get systemic issues, social determinants of health, like inadequate housing or, you know, that's a problem. Housing problem. Housing is a problem. I'm sorry. We also have food insecurity. We have issues with the criminal justice system. People aren't treated fairly there.
Health Chatter
Infant Mortality
We need to expand health. It's just a whole lot of problems. whole lot of different issues. So I think when we think of infant mortality, we shouldn't just think about behaviors. If you think about what the determinants of health are, 40% of our health is determined by economic conditions, about 30% or so by health behavior. So it could be a combination of things.
Health Chatter
Infant Mortality
So when we think of infant mortality, we have to take a multifaceted approach to this complex problem. So not just tackle prenatal care, but we need to tackle all the other things that come around with it or are driving that problem.
Health Chatter
Infant Mortality
As I stated before, medical care is not available to everyone in this country. There are medical deserts, right? So that is why hospitals are closing. So people may have to travel longer to get access. And even when they're in the healthcare system, we're all not treated very the same, right?
Health Chatter
Infant Mortality
I think about based on our race, ethnicity, maybe based on a doctor's or provider's perception of who we are. So even though people may have some access health care may not be accessible in different ways. So the medical deserts issue the closing of hospitals, and that sort of thing contributes to some of these problems that we're seeing, the differentials that we're looking at.
Health Chatter
Infant Mortality
Access to transportation, that affects infant health outcomes too. Like I said, this is a very complex issue, and so there's so many different inputs into the problem, and we need to tackle as many of them as possible.
Health Chatter
Infant Mortality
Yeah, so in our state, the infant mortality rates vary by geography, of course, in the northwest part of the state, which I believe would include a county like Bemidji County, and they have the highest infant mortality rates, whereas the west central part of the state has the lowest infant mortality rate.
Health Chatter
Infant Mortality
When we look at, you know, greater Minnesota versus maybe the metro, what we see is that Ramsey County, currently has the highest infant mortality rate. This is looking at 2018 to 2022 data. And then Hennepin County, followed by, sorry, greater Minnesota, and then Hennepin County. And the suburbs have the lowest infant mortality rate in our state. So there's geographic disparity.
Health Chatter
Infant Mortality
And if you look at it nationally, too, the southern states have the worst infant mortality rates. And then, you know, the northeast, even the western corridor, you know, looking at Washington, California, Oregon, they have you know, more favorable rates in the northeastern part of the country too. So there's definitely a geographic disparity.
Health Chatter
Infant Mortality
Yeah, that is a very good question and a timely question at that. So in addition to the infant mortality initiative, which I manage, there's a whole lot of different activities that are happening that are, that benefit infant mortality. And I've been around for a long time.
Health Chatter
Infant Mortality
If you think about family home visiting, you can think about WIC, you know, eliminating health describing initiative, which was passed through the legislature in 2001, addressing hate, health areas, infant mortality is one of them and continues to be an important area that this grant focuses on. We also have some new initiatives.
Health Chatter
Infant Mortality
We recently received a grant from the CDC and we're looking at a specific cause of infant mortality now through the sudden death in the young case registry in the Indian violence prevention area of our state. We are partnering with them the maternal and child health section. And so this grant is intended to reduce infant mortality, basically sudden unexpected infant deaths.