Sacramento's Plan To Keep Black Children Alive Is Working — And LA Is Watching
In Los Angeles County, black babies are three times more likely to die before their first birthday than white babies.
Dire racial disparities in infant mortality have persisted for decades, and local officials have said turning those statistics around is a public health priority.
A robust, related initiative in Sacramento is showing promising results — and there are lessons L.A. can learn from their efforts.
L.A.'s action plan, formed in 2018, aims to close the gap in birth outcomes by 30 percent in five years. The plan focuses on raising awareness and averting chronic stressors (which affect birth outcomes).
Already, they've made some progress — forming action teams around the county and launching a website as part of a public awareness campaign. And in the near future, local groups will also be able to apply for a new pot of funding from the state to boost efforts like home visits from nurses, doula programs and group prenatal care.
Sacramento County's effort was launched in 2015. It's called the Black Child Legacy Campaign and its goal is to reduce preventable deaths of African American children under the age of 18 by 10 to 20 percent by 2020.
The results have surpassed expectations. Some of the rates were on the decline already, but the initiative ushered in a dramatic shift.
The people behind these community-driven efforts say other communities can use similar approaches to turn around these bleak and persistent trends. Here are five lessons they offer for L.A.:
1. FOCUS ON DATA
Twenty years of data got their attention. The Sacramento effort began in 2011 after the County Board of Supervisors saw a presentation from the county's Child Death Review Team, which studied the occurrence and causes of child deaths for decades. (L.A. has a similar group). Supervisor Phil Serna was shocked to learn about the persistent disparities.
"So I asked the question - what have we, the county, done about this in the past?" Serna recalled. "And it was crickets."
So Serna established a Blue Ribbon Commission composed of community groups, health professionals, clergy and more. In 2015, the county committed nearly $30 million to address the issue. The Black Child Legacy Campaign was born.
"That'd be the first advice: have the ability to document, report, and inform both elected leaders and the public about the nature of child deaths and where those disparities actually exist," said Serna.
2. NAME THE ENEMY
The committee identified four main causes of the deaths: sleep-related deaths or sudden unexplained deaths; child abuse and neglect by parents or caregivers; issues in pregnancy, like premature birth; and third-party homicide, like gun or gang violence.
They found seven Sacramento neighborhoods where these issues were the most pronounced. Danielle Lawrence, who runs a nonprofit in one of those neighborhoods, Arden Arcade, said the report was a turning point.
"You understand that there are disparities everywhere when you do this work, and yet and still, it wasn't until this report laid it out in black and white that we were like, 'Oh, this is deeper than we even thought,'" Lawrence said.
To turn this around, the lens of this work is focused not on individual circumstances but on the social determinants of health, the economic and social conditions that impact our wellbeing.
3. LET THE COMMUNITY OWN IT
Each neighborhood has a community incubator lead organization that serves as a hub for whatever families need. It's a one-stop shop for resources and programming. Some of the hubs have beefed up parenting classes and others created gang intervention task forces.
Kindra Montgomery-Block, who helms the Black Child Legacy Campaign work through the Sierra Health Foundation, says the key component is investing in and empowering individual neighborhoods and putting black people in charge.
"Block by block, who on that block is already a trusted messenger? Who on that block has opportunity to not just meet people where they're at, but to knock on their doors and go in their homes?" Montgomery-Black said. "What's been working in Sacramento is not a top-down approach. It is a bottom-up approach. That leads to great policy. That leads to great systems transformation."
Supervisor Serna has become a bit "evangelical" about this approach and has presented on their efforts before national organizations representing county governments. Another pro tip from him: "You can't expect this to reside with a single politician because politicians are fleeting. We come and we go. This is too important an issue to assign to any one office holder."
4. RECOGNIZE THE LARGER FORCES AT WORK
Of the four causes the campaign is targeting, all have shown progress except the perinatal category. Black women, regardless of income or socioeconomic status, are more likely to have a baby preterm. Prematurity is the leading cause of preventable death for infants.
Sacramento is making progress on sleep-related infant deaths, as hospitals provide more training and resources around safe sleep. But addressing perinatal deaths requires improving life for the moms and dealing with a variety of societal factors, from institutional racism in the health care system to chronic stress. And that's what L.A. County is focused on targeting.
"I think it's going to take all of us rolling up our sleeves and being able to look at the healthcare system through a different approach," said Montgomery-Block. "To be able to target African-American women in a way that lifts their voices but also understands: what is the social and environmental issues that play into having healthy birth outcomes for our families?"
She says they have a lot more work to do.
5. BE TARGETED, BUT UNIVERSAL
The programs in Sacramento were designed to serve black families in a culturally sensitive way.
"We understand that they must be targeted," said Lawrence. "We have to be unapologetic about driving this."
But the targeted work can also improve overall circumstances for neighborhoods and communities. In 2018, there were no juvenile homicides across the board in Sacramento. And that approach is inspiring change beyond just the seven neighborhoods.
A community resource center in North Sacramento has started offering a support program for black women called Sistah to Sistah. It's a model which originated in one of the Black Child Legacy neighborhoods.
Mason Taylor, a coordinator at the center, said that seeing the robust action of the Black Child Legacy Campaign and the early results was a wakeup call. The center hadn't previously offered targeting programming for and by black women.
"It's really easy for us to think about it when it's another language that needs to be served, like our Spanish-speaking population," said Taylor, who's white, "but it's hard sometimes for people to see that, yes, people who speak English may still be a part of other subcultures that need their cultural identities affirmed in different ways."
This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems.
This story also ran on the radio. Listen here.