Developing and monitoring system change around social determinants of health: Lessons learned from a successful infant mortality reduction program

Health disparities are rooted in fundamental social inequalities, but many communities are challenged with addressing the social and structural components of health problems. The Genesee County REACH 2010 partnership developed and implemented a community action plan which contributed significantly to an historic low rate of African American and overall infant mortality in the county. Central to the partnership's success was a multi-sector commitment to addressing historical, cultural, and structural aspects of racism as a focus of community planning and intervention activities. Over a period of seven years (and ongoing), the REACH 2010 partnership supported education, community mobilization, and healthcare advocacy to reduce the harmful impact of racial inequities within social, educational, and healthcare institutions. The ongoing input of community partners was essential to framing the community planning process around racism and designing a community survey that monitored perceptions of racism at the community and individual levels. An evaluation of the partnership documented improvements in community capacity, racial attitudes, cultural competence in healthcare, institutional prenatal assessment tools, professional education, and other system changes that benefited infant health. This success is being modeled to assist regional communities to redress infant mortality disparities. This presentation will: a) discuss the challenges and opportunities of developing a community health planning approach with a social determinants emphasis; and b) report evaluation results that examined how the partnership fostered system changes to enhance success. The experiences of this partnership reinforce the value of structural approaches to redress infant mortality disparities in communities beyond borders.