It is when a child misses 100 days of school because her asthma isn’t being managed properly.
It is when a toddler is diagnosed with elevated levels of lead in his blood when we know there are no safe levels of lead in children.
It is when a common cavity develops into full-blown sepsis and kills an 8-year-old when a quick trip to the dentist could have taken care of it.
It is when a new mother experiences a life-altering stroke because her high blood pressures at pregnancy end were not recognized and treated.
As an intensive care nurse and hospital administrator in an urban setting, I’ve seen way too many of these “its.” And it’s not for lack of caring and compassion. I’ve rarely met parents who didn’t want the best care for their children or themselves. The painful truth is that many families in our community are struggling just to keep a roof over their heads and food on the table. The prospect of taking an extra trip to the doctor and paying another medical bill can be overwhelming or just plain impossible.
Poverty, racism, stress and other factors are contributing to unmet health needs across our country. And it’s about time we, as healthcare providers and the communities we care for, come together to do something about it. We can’t simply continue to do what we’ve always done and expect things to change. And we can’t solve these problems in a vacuum. We need to work together. Collaboration is key in caring for our communities.
The numbers paint a bleak picture where I live and work in Cleveland’s Cuyahoga County. One measure is the infant mortality rate (babies dying before their first birthday). Here, our rate – 8.7 per 1,000 live births in 2016, according to the Ohio Department of Health – is 47 percent higher than the national average of 5.9, according to the Center for Disease Control and Prevention. That’s unacceptable.
But there’s hope. Competing hospitals, government leaders, local advocates and others in Cleveland have come together and are collaborating to create change. Together, we’ve formed an effort called First Year Cleveland (FYC), which I’m privileged to co-chair. FYC’s goal is to lower Cuyahoga County’s infant mortality rate to less than 6.0 deaths per 1,000 live births by 2020.
It’s a lofty goal. According to FYC data, three Cuyahoga County ZIP codes have a shocking infant mortality rate above 24. Furthermore, per FYC, the infant mortality rate for the county’s African-American babies is 16.27, more than seven times higher than the rate of 2.26 for white babies here. Also, recent national research from the Healthcare Cost and Utilization Project tells us that the rate of severe maternal morbidity – life-threatening conditions for mothers during delivery – is 112-115 percent higher for black women than for white women. We could never achieve our goal without first addressing these disparities, which includes acknowledging and addressing the impacts of systemic racism.
Moving the needle on healthcare equity in our communities requires collaboration. Where I work at University Hospitals (UH) Rainbow Babies & Children’s and MacDonald Women’s hospitals, we have convened a community advisory board that brings together more than 70 stakeholders representing 35 different organizations, as well as neighborhood residents and our patients and their families. We are working together to develop community-centered care that addresses not only clinical factors that influence health, but also social and environmental factors that are all too often ignored. To achieve health equity, we must acknowledge the importance of these factors, and design solutions in true partnership with our community stakeholders and the patients we serve.
The UH Rainbow Center for Women & Children, which opened July 9, is a direct result of collaborative, community-centered design. Yes, we’ve got the medical basics covered there, but what most excites me is that the center is a reflection of the neighborhood and families it serves. It’s warm. It’s welcoming. Nearly every detail – including the artwork on the walls – is inspired or recommended by the patients who pass through its doors every day. And with dieticians, eye doctors, dentists and social services on site, it’s a one-stop shop for care that welcomes and honors the rich diversity of patients and families we serve – from many walks of life, from Cleveland and across the region.
Collaborating with community partners, patients, and families is one way we’re working to achieve health equity. Another way is by looking beyond our borders to see what’s working elsewhere.
An example of that is something we did in 2010. That’s when we adopted a model from the Boston-based Centering Healthcare Institute to help address the needs of pregnant women here in Cleveland. CenteringPregnancy provides added support and education for at-risk expectant mothers. And it’s working. We’ve seen the overall preterm birth rates for those in the program decline from 11 percent in 2011 to just 3.8 percent last year. That’s substantially lower than Cleveland’s overall preterm birth rate of 14.9 percent (according to the March of Dimes 2017 Premature Birth Report Card). We have greatly expanded our ability to care for more women using this model within our new UH Rainbow Center.
As we continue on this journey in Cleveland, we intend to share what we learn with our peers not only here, but throughout the country. We want you to call us and we want to call on you. By collaborating to care for our community, we can make it about every child growing into adulthood. We can make it about every mother having a healthy pregnancy. We can make it about every family thriving.
It’s inspiring. It’s fulfilling. It’s life-saving. It’s what drives me every day.
Patti DePompei is president of UH Rainbow Babies & Children’s and UH MacDonald Women’s hospitals.
