Reducing Racial Disparities
addressing Extreme Prematurity
Eliminating Sleep-Related Deaths
September is Infant Mortality Awareness Month, a time for us to reflect on our community’s efforts to decrease the rate at which babies die during their first year of life. According to preliminary 2019 data, Cuyahoga County’s overall infant mortality rate (IMR) — the number of babies dying before they reach one year of age— was 8.61 per 1,000 live births. The IMR for white babies was 3.92, Hispanic babies 2.98, and the IMR for African American babies was 16.34 per 1,000 live births. Should these 2019 rates become finalized, Cuyahoga County will likely have IMRs that are lower than the national average — for white and Hispanic populations. Our overall IMR will be higher than the national average of 5.75 because our African American IMR is not only significantly higher than other groups here in Cuyahoga County, but is also significantly higher than the national African American IMR of 10.88 for 2017. This leaves our community with one of the highest African American infant mortality rates in the nation.
Each decade the United States Federal government releases a set of health outcome goals for our nation, including goals for infant deaths. These “Healthy People” goals and the most recent infant mortality goal states that by the end of the year 2030 no group shall experience an infant mortality rate greater than five deaths per 1,000 live births. Cuyahoga County has already achieved this goal for all groups except African Americans. As a matter of fact, in the four previous decades of Healthy People goals, the State of Ohio and Cuyahoga County have never achieved any infant mortality goal for African American babies. You read that right. In a community that provides some of the world's premier health care, African American babies in Cuyahoga County continue to die at embarrassingly high rates. For every white baby we lose, four African American babies die. In the City of Cleveland, it’s even worse, with seven African American babies dying for each white baby.
It is time for this trend to stop. At the beginning of a new decade for achieving Healthy People goals, it is time for our community to fully commit to finally achieving a Healthy People goal for African American babies. This means that, using the preliminary 2019 African American IMR of 16.34 as our baseline, we need to improve the Cuyahoga County African American IMR by 70 percent by the end of 2030. This means improving the African American IMR by seven percent year over year for the next ten years. It is a huge, and some would say almost impossible endeavor. As a matter of fact, some are so intimidated by the enormity of this challenge that they have retreated from achieving this goal before we have even begun to try.
Achieving an African American Infant Mortality Rate of 5.0 by the end of 2030 not only means significantly improving our provision of care for African American women during pregnancy, labor and delivery but, more significantly, it means substantially improving the quality of life for African Americans in Cuyahoga County. This will require dismantling the systemic racism that has resulted in African American communities struggling with poverty, unemployment, food and housing instability and high incarceration rates, and improving graduation rates and access to transportation. These major determinants of birth outcomes require urgent attention throughout Cuyahoga County. Without addressing these social determinants of health, we will not achieve the goal of no more than five African American infant deaths per 1,000 live African American births by the end of 2030. We, as a community, must join together and with one unifying voice commit to do all we can to save our babies. Because every baby deserves to celebrate his or her first birthday.
Friday, September 18, 2020
Written by Arthur James, MD, FACOG
Cuyahoga County has one of the highest rates of prenatal care in the state — yet, this area also has one of the worst infant mortality rates. And racial disparities contribute to this alarming statistic. In fact, the county’s 2018 infant mortality rate was nearly four times higher for black, non-Hispanic...
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