Academic journal article Cityscape

Healthy Start in Housing: A Case Study of a Public Health and Housing Partnership to Improve Birth Outcomes

Academic journal article Cityscape

Healthy Start in Housing: A Case Study of a Public Health and Housing Partnership to Improve Birth Outcomes

Article excerpt

Introduction

When public health officials measure the health status of a population, the two primary health indicators of interest are life expectancy and infant mortality. Infant mortality is considered a highly sensitive indicator of the health of a population. It reflects the direct causes of infant death and other factors that are likely to influence the health status of whole populations, such as their economic status, general living conditions, social well-being, rates of illness, and the quality of the environment (Reidpath and Allotey, 2003). Prematurity, defined as the birth of infants at less than 37 weeks gestation, and low birth weight (LBW), defined as the birth of infants weighing less than 2,500 grams, are associated with most infant deaths and are a major public health concern. The effects of prematurity and LBW can persist across the life course, placing children at elevated risk for cognitive and behavioral concerns (D'Agio et al, 2002; Hack et al, 2005; Klebanov, Brooks-Gunn, and McCormick, 1994; O'Shea et al, 1997). In the United States, societal costs of premature, LBW births exceed $26 billion a year (Institute of Medicine, 2006).

Despite an overall improvement in infant survival, Black infants in the United States continue to die at a rate twice that of White infants, a pattern that has persisted since the 1950s (Hogan et ah, 2012).1 The disparity in infant mortality is attributable to racial differences in LBW and premature births and explains approximately 80 percent of the observed Black-White gap in infant mortality (Bryant et al., 2010; MacDorman and Mathews, 2011).

To date, existing approaches, such as expanding access to prenatal care and case management, have not been successful in eradicating these disparities, even in communities such as Boston, the setting for this case study. Boston has a strong infrastructure of primary and specialty services, near universal access to health insurance, and comprehensive federally and locally funded perinatal support services, yet the rate of premature births among Black infants in Boston is 1.5 times that of White infants (BPHC, 2011b) and the rate of LBW for Black women is 59 percent higher than the rate for White women (BPHC, 2011b).2 Research supporting the link between early experiences with social inequality and adverse health outcomes (Barker, 1995; Felitti et al., 1998; Geronimus, 1996; Stein, Lu, and Gelberg, 2000) have forced public health leaders to reevaluate previous strategies and develop new program models that support women's health before conception and throughout their reproductive years. As a result of this greater appreciation of the importance of social determinants of health, stable housing has emerged as a critical factor in the lives of women at risk for poor birth outcomes.

The Affordable Care Act and the newly adopted National Prevention Strategy (ASTHO, 2013; NACCHO, 2013) have created opportunities to strengthen housing and health collaborations. The emergence of a new approach to policymaking and program development, Health in All Policies (HiAP), provides a framework for such collaborations. The HiAP approach integrates considerations of health, well-being, and equity during the development, implementation, and evaluation of programs and policies. This approach is being promoted by major public health organizations, including the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO). The U.S. Department of Housing and Urban Development (HUD) has integrated the HiAP framework into its 2010-2015 strategic plan. Its goal to "utilize housing as a platform for improving the quality of life" by "utilizing HUD assistance to improve health outcomes" is an example of this approach (Bostic et al., 2012: 2133). Despite a strong tradition of partnerships between housing authorities and public health agencies, to our knowledge none have focused specifically on pregnant women who have existing medical risks associated with poor birth outcomes and none have had the explicit goal of improving birth outcomes (Krieger and Higgins, 2002 ). …

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