At the Intersection of Health, Health Care and Policy Cite this article as: Jessica Bylander The Best Chance At Life Health Affairs, 33, no.12 (2014):2188-2189 doi: 10.1377/hlthaff.2014.1218
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/12/2188.full.html
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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People
&
Places
Informing mothers: Tiffany Dorsey, Anita Brentley, Charlena Cleveland, Karlyn Wade Richardson, and Jill Frondorf and her daughter (left to right) represent the Best Babies Zone Cincinnati at the Price Hill Library’s ParentFest event on July 12, 2014, handing out information for mothers in the neighborhood. doi:
10.1377/hlthaff.2014.1218
The Best Chance At Life The Best Babies Zone Initiative aims to improve birth outcomes with concentrated efforts in neighborhoods in need. BY JESSICA BYLANDER
A
n oft-quoted proverb, the titular phrase of Hillary Rodham Clinton’s popular 1996 memoir, states that “it takes a village to raise a child.” Yet in some of the nation’s poorest and most vulnerable communities, it takes more than a village to ensure that a baby is born healthy with a fair shot at a long, successful life. It requires the complex interplay of social, behavioral, environmental, economic, and biological factors working together 2188
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to promote the health and well-being of communities and, by extension, mothers, babies, and families. This is the premise of the Best Babies Zone (BBZ) Initiative, a pilot program funded by the W.K. Kellogg Foundation aimed at improving birth outcomes for infants in communities in three cities: Cincinnati, Ohio; New Orleans, Louisiana; and Oakland, California. The BBZ team is driven by a recognition that even the most effective medical interventions and increased access to health care are
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not sufficient to improve birth outcomes. “Those of us in the health field have spent many decades trying to address infant mortality through clinical care, and we have not been successful,” says Cheri Pies, clinical professor at the University of California, Berkeley, and principal investigator for the BBZ Initiative. According to the March of Dimes, more than 450,000 babies were born prematurely in the United States in 2012, and rates of premature births are highest for blacks, American Indians, and Hispanics. Enter the BBZ Initiative, which delineates zones in a community where stakeholders across four sectors—health care, early care and education, economic development, and community services— come together to share resources, create programming, and empower community members in order to improve the health of mothers and babies in that area. The BBZ Initiative is what is known as a “place-based initiative,” which typically focus on the transformation or revitalization of a neighborhood or geographic area. Initially supported by a three-year, $2.75 million grant from Kellogg, the BBZ Initiative aims, in the long run, to reduce the racial disparities in premature births, infant mortality, and low birthweight seen in low-income communities across the country. The initiative is also positioned to achieve broader outcomes over ten years, including reductions in household poverty, economic inequities, and high school drop-out rates. “We can work with partners from multiple sectors to transform communities and increase resident power to make these communities healthier and less stressful places to live, so that women and children and families can grow up healthy and thriving,” Pies says. As its three-year pilot period wraps up in February 2015, the BBZ Initiative is in many ways still in its nascence. The BBZ team is actively engaged in its initial evaluation and looking to the years ahead to prove out the theory that Photograph by Best Babies Zone Initiative
Downloaded from content.healthaffairs.org by Health Affairs on June 16, 2015 at UNIV OF GEORGIA LIBRARIES
place-based efforts can achieve health improvements at birth and throughout the course of a person’s life. “We really do believe in this model,” Pies says. “A multisector approach means that ‘we are in this together,’ and each sector has a role to play. I’d like to see the proof in the pudding, and we’ll learn more from our evaluation, but I think this is the right approach to addressing preterm birth and infant mortality in a placebased way.”
Identifying Vulnerable Communities The seeds of the initiative were planted several years ago with a proposal from Michael Lu, now the associate administrator of maternal and child health at the Health Resources and Services Administration. Lu’s vision was built on the work of social activist and educator Geoffrey Canada, whose Harlem Children’s Zone aims to zero in on the difficult challenges facing children and families living in a finite (but gradually expanding) geographic area in New York City, from poor-quality housing to rampant drug use to chronic health problems. The zone approach allows organizations to tackle complex problems within a “manageable bite” of a community— potentially larger than a single neighborhood but less daunting than an entire city, explains Pies. In the BBZ Initiative, a “backbone organization” is chosen in each community to take the lead on identifying which groups to partner with across the health care, early care and education, economic development, and community services sectors. Setting up the zones has been a slow process of relationship building, notes Wendy Hussey, the BBZ Initiative’s program manager, particularly because some sectors, such as finance and education, never considered infant mortality as an issue under their purview. In Oakland the backbone organization is the Alameda County Public Health Department, which works with various organizations in the Castlemont area of the city, including Youth UpRising; Castlemont High School; Brighter Beginnings; and First 5 Alameda County, which funds early care and education for children from birth to age five years. In Castlemont, with about
5,000 residents, 13 percent of infants are born with low birthweight, 15 percent are born premature, and one in three children live in poverty. In the Hollygrove area of New Orleans, chosen because of its high rates of low birthweight, asthma among young children, poverty, and crime, the lead agencies are the New Orleans Health Department and the Louisiana State University Health Science Center’s School of Public Health, working with Healthy Start New Orleans, an organization that nurtures healthy pregnancies, babies, and families. In this zone one in five babies are born underweight, about 49 percent of children live in poverty, and about 18 percent of residents are unemployed. In the Price Hill neighborhood of Cincinnati, the Cincinnati Children’s Hospital Medical Center is taking the lead, working with community residents and leaders; local groups, including Santa Maria Community Services; and Every Child Succeeds, a home visiting program. In Price Hill about 40 percent of residents, including 56 percent of children, live in poverty. In 2010 half of the births there were to mothers who had not completed high school.
Tracking Success The specific work in each zone varies and is tailored to a zone’s unique resources and needs. In Cincinnati and New Orleans, projects include Moms Groups, which started as monthly meetings facilitated by a community member affiliated with the BBZ Initiative, where women would receive social support; health and financial education; and needed supplies, such as diapers and cribs. Some participants are now “block captains,” educating other women in their communities and serving as ambassadors for the initiative. In Oakland, among other innovative projects, the community created an Early Childhood Hub that hosts play groups and provides support for parents. “It’s become a place in the community where families know they can take their kids and get support,” Hussey says. “It also connects them with services they might be eligible for but are not receiving.” Other initiatives in the zones include efforts to help residents complete their high school education, to address urban
decay and make communities feel safe, and to provide small-business opportunities and training to residents. In some ways, the efforts look a lot like community organizing, but they should be considered on a broader and multisector scale, Pies and Hussey note. “We’re working at the community level…but we also have people on our team who have influence at the city level, or the federal level,” Hussey says. “The idea is to align the systems so that the systems at the federal, state, and city levels are responsive to and can be more nimble to support the needs of the community as they arise.” Such an effort requires persistence and patience. It could be another decade before the BBZ Initiative yields concrete epidemiological data reflecting its impact on birth outcomes. For now, however, BBZ teams have heard anecdotally that women who participated in activities such as the Moms Groups have carried their children to full term and then delivered healthy babies, Pies notes. The BBZ Initiative recently launched its first evaluation in the field: a survey for community members, on health, access to services, public safety, and experiences of racism, among other topics. In the short term, the BBZ team hopes to see increased community networks and civic engagement, increased access to reproductive services and to parenting education, and an emphasis on building and cultivating “resident power.” This year the team intends to publish a step-by-step guide to developing and implementing a Best Babies Zone. Five to seven years out, the team envisions more social supports for families, safer parks and neighborhoods, fewer experiences of racism and discrimination, more job training, access to medical homes, increased early prenatal care, and more parental involvement in child development. After a decade the initiative will be tracking—in addition to birth outcomes—financial stability, employment opportunities, health, and children’s academic success. “We want to give every baby born in a Best Babies Zone the best chance at life,” Pies says. ▪ Jessica Bylander ([email protected]) is a senior editor at Health Affairs, in Bethesda, Maryland.
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The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/12/2188.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 16, 2015 at UNIV OF GEORGIA LIBRARIES
People
&
Places
Informing mothers: Tiffany Dorsey, Anita Brentley, Charlena Cleveland, Karlyn Wade Richardson, and Jill Frondorf and her daughter (left to right) represent the Best Babies Zone Cincinnati at the Price Hill Library’s ParentFest event on July 12, 2014, handing out information for mothers in the neighborhood. doi:
10.1377/hlthaff.2014.1218
The Best Chance At Life The Best Babies Zone Initiative aims to improve birth outcomes with concentrated efforts in neighborhoods in need. BY JESSICA BYLANDER
A
n oft-quoted proverb, the titular phrase of Hillary Rodham Clinton’s popular 1996 memoir, states that “it takes a village to raise a child.” Yet in some of the nation’s poorest and most vulnerable communities, it takes more than a village to ensure that a baby is born healthy with a fair shot at a long, successful life. It requires the complex interplay of social, behavioral, environmental, economic, and biological factors working together 2188
H e a lt h A f fai r s
to promote the health and well-being of communities and, by extension, mothers, babies, and families. This is the premise of the Best Babies Zone (BBZ) Initiative, a pilot program funded by the W.K. Kellogg Foundation aimed at improving birth outcomes for infants in communities in three cities: Cincinnati, Ohio; New Orleans, Louisiana; and Oakland, California. The BBZ team is driven by a recognition that even the most effective medical interventions and increased access to health care are
D e c em b e r 2 0 1 4
33:12
not sufficient to improve birth outcomes. “Those of us in the health field have spent many decades trying to address infant mortality through clinical care, and we have not been successful,” says Cheri Pies, clinical professor at the University of California, Berkeley, and principal investigator for the BBZ Initiative. According to the March of Dimes, more than 450,000 babies were born prematurely in the United States in 2012, and rates of premature births are highest for blacks, American Indians, and Hispanics. Enter the BBZ Initiative, which delineates zones in a community where stakeholders across four sectors—health care, early care and education, economic development, and community services— come together to share resources, create programming, and empower community members in order to improve the health of mothers and babies in that area. The BBZ Initiative is what is known as a “place-based initiative,” which typically focus on the transformation or revitalization of a neighborhood or geographic area. Initially supported by a three-year, $2.75 million grant from Kellogg, the BBZ Initiative aims, in the long run, to reduce the racial disparities in premature births, infant mortality, and low birthweight seen in low-income communities across the country. The initiative is also positioned to achieve broader outcomes over ten years, including reductions in household poverty, economic inequities, and high school drop-out rates. “We can work with partners from multiple sectors to transform communities and increase resident power to make these communities healthier and less stressful places to live, so that women and children and families can grow up healthy and thriving,” Pies says. As its three-year pilot period wraps up in February 2015, the BBZ Initiative is in many ways still in its nascence. The BBZ team is actively engaged in its initial evaluation and looking to the years ahead to prove out the theory that Photograph by Best Babies Zone Initiative
Downloaded from content.healthaffairs.org by Health Affairs on June 16, 2015 at UNIV OF GEORGIA LIBRARIES
place-based efforts can achieve health improvements at birth and throughout the course of a person’s life. “We really do believe in this model,” Pies says. “A multisector approach means that ‘we are in this together,’ and each sector has a role to play. I’d like to see the proof in the pudding, and we’ll learn more from our evaluation, but I think this is the right approach to addressing preterm birth and infant mortality in a placebased way.”
Identifying Vulnerable Communities The seeds of the initiative were planted several years ago with a proposal from Michael Lu, now the associate administrator of maternal and child health at the Health Resources and Services Administration. Lu’s vision was built on the work of social activist and educator Geoffrey Canada, whose Harlem Children’s Zone aims to zero in on the difficult challenges facing children and families living in a finite (but gradually expanding) geographic area in New York City, from poor-quality housing to rampant drug use to chronic health problems. The zone approach allows organizations to tackle complex problems within a “manageable bite” of a community— potentially larger than a single neighborhood but less daunting than an entire city, explains Pies. In the BBZ Initiative, a “backbone organization” is chosen in each community to take the lead on identifying which groups to partner with across the health care, early care and education, economic development, and community services sectors. Setting up the zones has been a slow process of relationship building, notes Wendy Hussey, the BBZ Initiative’s program manager, particularly because some sectors, such as finance and education, never considered infant mortality as an issue under their purview. In Oakland the backbone organization is the Alameda County Public Health Department, which works with various organizations in the Castlemont area of the city, including Youth UpRising; Castlemont High School; Brighter Beginnings; and First 5 Alameda County, which funds early care and education for children from birth to age five years. In Castlemont, with about
5,000 residents, 13 percent of infants are born with low birthweight, 15 percent are born premature, and one in three children live in poverty. In the Hollygrove area of New Orleans, chosen because of its high rates of low birthweight, asthma among young children, poverty, and crime, the lead agencies are the New Orleans Health Department and the Louisiana State University Health Science Center’s School of Public Health, working with Healthy Start New Orleans, an organization that nurtures healthy pregnancies, babies, and families. In this zone one in five babies are born underweight, about 49 percent of children live in poverty, and about 18 percent of residents are unemployed. In the Price Hill neighborhood of Cincinnati, the Cincinnati Children’s Hospital Medical Center is taking the lead, working with community residents and leaders; local groups, including Santa Maria Community Services; and Every Child Succeeds, a home visiting program. In Price Hill about 40 percent of residents, including 56 percent of children, live in poverty. In 2010 half of the births there were to mothers who had not completed high school.
Tracking Success The specific work in each zone varies and is tailored to a zone’s unique resources and needs. In Cincinnati and New Orleans, projects include Moms Groups, which started as monthly meetings facilitated by a community member affiliated with the BBZ Initiative, where women would receive social support; health and financial education; and needed supplies, such as diapers and cribs. Some participants are now “block captains,” educating other women in their communities and serving as ambassadors for the initiative. In Oakland, among other innovative projects, the community created an Early Childhood Hub that hosts play groups and provides support for parents. “It’s become a place in the community where families know they can take their kids and get support,” Hussey says. “It also connects them with services they might be eligible for but are not receiving.” Other initiatives in the zones include efforts to help residents complete their high school education, to address urban
decay and make communities feel safe, and to provide small-business opportunities and training to residents. In some ways, the efforts look a lot like community organizing, but they should be considered on a broader and multisector scale, Pies and Hussey note. “We’re working at the community level…but we also have people on our team who have influence at the city level, or the federal level,” Hussey says. “The idea is to align the systems so that the systems at the federal, state, and city levels are responsive to and can be more nimble to support the needs of the community as they arise.” Such an effort requires persistence and patience. It could be another decade before the BBZ Initiative yields concrete epidemiological data reflecting its impact on birth outcomes. For now, however, BBZ teams have heard anecdotally that women who participated in activities such as the Moms Groups have carried their children to full term and then delivered healthy babies, Pies notes. The BBZ Initiative recently launched its first evaluation in the field: a survey for community members, on health, access to services, public safety, and experiences of racism, among other topics. In the short term, the BBZ team hopes to see increased community networks and civic engagement, increased access to reproductive services and to parenting education, and an emphasis on building and cultivating “resident power.” This year the team intends to publish a step-by-step guide to developing and implementing a Best Babies Zone. Five to seven years out, the team envisions more social supports for families, safer parks and neighborhoods, fewer experiences of racism and discrimination, more job training, access to medical homes, increased early prenatal care, and more parental involvement in child development. After a decade the initiative will be tracking—in addition to birth outcomes—financial stability, employment opportunities, health, and children’s academic success. “We want to give every baby born in a Best Babies Zone the best chance at life,” Pies says. ▪ Jessica Bylander ([email protected]) is a senior editor at Health Affairs, in Bethesda, Maryland.
December 2 014
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