Across the region, there's a big disparity in how long people live. Nearly 90 years, on average, in Indian Hill and Mason, but barely over 60 in Arlington Heights and Adams County. That's nearly 30 years of life, love, children, grandchildren, and memories that are lost. Why? Community health experts are looking at the larger forces that shape health and wellness. The places where we grow up, live, work, and age shape our lives and our opportunities to thrive. This is the fourth story in the series, Health Justice in Action, a year-long deep dive into the factors that people and neighborhoods need for long, healthful lives.You can read other stories in the series here.
Losing an infant is one of the most traumatic events anyone can experience. Not so long ago, babies in Greater Cincinnati were dying before their first birthdays at an unacceptably high rate. But a long-term, collective approach among hospitals, doctors, governments, foundations, and others brought infant deaths down to a level in line with the norm around the country.
Now the state of Ohio wants to replicate that success in other cities.
Using Cincinnati’s program as a model, the state is funding similar efforts in four of Ohio’s most populous counties.
“This investment will help four key counties lead the way to spreading and scaling this community-based model,” Ohio Department of Children and Youth Director Kara Wente said at an April 29 news conference.
Cradle Cincinnati, the Hamilton County organization that leads the local effort, will collaborate with hospitals and other community groups in Cuyahoga (Cleveland), Franklin (Columbus), Lucas, (Toledo) and Montgomery (Dayton) counties. “These are the counties where most Ohio babies are born and, tragically, where too many are lost,” Wente said.
Ohio recently hit its lowest rate of infant mortality in two decades, but more needs to be done, said Ohio Gov. Mike DeWine. “These are babies that die unnecessarily,” he said. “Now is not the time to take our foot off the gas.”
Cradle Cincinnati’s model brings together parents, caregivers, health care professionals, and community members to support mothers and babies. The effort has moved the needle on infant mortality rates in Hamilton County. In 2022, the county infant mortality rate was 8.7 deaths for every 1,000 live births. Since then, the number has dropped to 5.5 deaths per 1,000 live births – a decrease of more than 30%.
Going back further, Hamilton County’s infant death rate in 2007 was nearly 11 per 1,000, and was one of the highest rates in the country. Driving that awful number was the death rate among black babies, which was roughly twice as high as the rate among white babies.
In 2013, Dr. James Greenberg, a physician at Children’s Hospital Medical Center, and Dr. Elizabeth Kelly of University of Cincinnati’s College of Medicine, launched a collaborative effort to keep more newborns alive. They got public health departments on the same page to understand how bad the problem was. They convened more than two dozen organizations that were stakeholders in the infant health issue, secured funding, and analyzed data. They got the attention of government and health care leaders, who were able to get key organizations engaged to address the crisis in a methodical way.
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More babies are living to see their first birthdays in Cincinnati.That effort evolved into Cradle Cincinnati, which coordinates what has grown into a multi-faceted effort that is still working to save the lives of the youngest and most vulnerable.
The program began with community health workers collaborating with hospitals to identify and put into practice interventions to improve the chances of survival of at-risk infants. It grew to include a learning collaborative in which medical teams and any others who provide care to new moms and babies analyzed up-to-the-minute data, and shared what is working across the different hospital systems in the community.
“The world where people are communicating across systems and have common goals is exciting,” says Meredith Smith, executive director of Cradle Cincinnati.
About seven years ago, a program called
Queens Village was started. That program created a community of support for Black women to share connections, stories and information, in an effort to overcome some of the racial discrimination they have traditionally had to cope with.
Through the program, women can share information about prenatal services, mental health treatments, resources for maternity and infant supplies, and more. It’s meant to bridge the gaps between expecting mothers and the health care and community resources that may be available to them. It also provides a forum of emotional support.
“Queens Village is more than just a program, it’s a lifeline,” said LaTarsha Cook, a Queens Village board member who lost a baby when she was 5 months pregnant. “When Black women are heard, nurtured, and supported, our babies thrive, our families thrive, our communities thrive,” she said.
Although the Black infant death rate has dropped substantially since 2013, it’s still significantly higher than the rate for white babies, as Black infants are almost 2.5 times as likely to die as white infants in Hamilton County.
Cradle Cincinnati’s Smith says the reason can be linked to a history of racial discrimination. “Black people are paid less; they're treated differently in health care,” she says. “That has an impact on every aspect of their lives, such as housing and transportation.”
“We started listening to Black women and then doing what they asked us to do,” Smith says. “What we heard from them in the beginning was, ‘I don't feel heard, seen or valued.’ And so we got to work building this community to listen, to amplify voices and to respond to that.”
They also heard that Black women wanted better information about how hospitals are addressing racial inequities in birth outcomes. In response, Cradle Cincinnati and local birthing hospitals and Black mothers created a program called
Mama Certified in which birthing hospitals agree to publicly share data on the maternal equity-related efforts of local hospitals. The goal is to increase transparency into health care systems so Black families have the power to make informed decisions about their own care.
“It's so families can know what's going on behind the walls and can choose the right hospital for their birth experience,” Smith says.
Cradle Cincinnati has also tapped into the community resource of doulas, women who provide guidance, support, and information to new mothers. Access to doulas can be financially out of reach for many, so Cradle Cincinnati, using several community grants, offers a year of free doula care to Black mothers. The program also works with doula businesses to help them grow, and handle issues such as insurance and Medicaid reimbursement, as there is a high demand for doula services.
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Safe sleep: on the back, alone, in a cribIn-home visits from doulas can also help with one of the biggest reasons behind infant mortality – sleep related deaths. Nearly a quarter of all infant deaths in Hamilton County are sleep-related, and the rate is more than twice as high among Black families than white families. Cradle Cincinnati has embarked on a five-year plan to bring down the number of deaths from unsafe sleep. Infants should be laid to sleep on their backs, alone, in a crib, but cultural habits vary and exhausted mothers don’t always take the right precautions.
“We have to work on a larger conversation, a complex reality beyond just care,” Smith says. “The social determinants of health are interwoven into the work that we're doing. And at the same time, when you focus on Black infant mortality and Black maternal health, the rising tide lifts all boats, so you see the success for everyone, not just Black women.”
Cradle Cincinnati has not declared victory and continues working to reduce infant deaths, particularly among Black families, where the incidence remains high. Now, the change that has happened over the last 10 years through an all-hands-on-deck effort here will be studied and adapted in other urban areas around the state. “We are of the belief that together is better,” Smith says. “That's the hope for Ohio."
This series, Health Justice in Action, is made possible with support from Interact for Health. To learn more about Interact for Health's commitment to working with communities to advance health justice, please visit here.