Health officials in Columbus, Ohio, have long known that they're facing a health crisis. Ohio has the fourth-highest infant mortality rate in the country. In Franklin County, which includes Columbus, 150 infants a year -- almost three a week -- die before reaching their first birthdays.
As officials studied the issue more, they realized the best way to fix it is to understand and address the unique problems leading to infant mortality in each individual neighborhood.
Parts of the city are thriving, but there's a racial disparity in Columbus -- as in many other cities -- when it comes to infant mortalities. The infants that die before their first birthday in Columbus are twice as likely to be black.
These inequalities have struck Andrew Ginther, who was sworn in as mayor last month and previously served as city council president.
“I was at the newly-renovated Lincoln Theatre with my daughter, who had just turned 3," recalled Ginther. "It sort of hit me when we were leaving. I’m in a neighborhood with one of the highest infant mortality rates in the state and the country. After that, I knew I wanted to galvanize the city to put together some sort of task force."
In response to the task force's findings, the city created CelebrateOne, a partnership between the Columbus Public Health Department, the state Department of Medicaid and a number of other public and private entities. The initiative has a clear goal: to reduce the city’s infant mortality rate 40 percent by 2020 while cutting the health disparity gap.
Infant mortality rates vary throughout the United States -- from a high of nearly 10 deaths per 100,000 births in Mississippi to a low of 3.5 in Alaska. All told, the U.S. death rate of six babies per 100,000 is one of the highest in the developed world.
The most common causes of infant mortality in America are complications stemming from low birth weight, premature birth and unsafe sleep environments.
To achieve lasting results, the city’s health workers are attempting to address underlying social issues that have left some residents struggling.
"When we talk about high rates of infant mortality, we’re not just talking about access to medical care," said Liane Egle, director of CelebrateOne. "We're talking about a lack of stable housing and educational opportunity. We're talking about high crime and gun violence."
While attempting to address a range of issues, the program takes a targeted approach. CelebrateOne started working in three neighborhoods in 2015. Over time, it will cover a total of eight neighborhoods, with the intent of tailoring its program to each specific community.
“Our Near South neighborhood has a very active and engaged civic presence but lacks educational programs," said Erika Clark Jones, director of community strategies for CelebrateOne. "So we found a real desire to create some sort of hub for new moms, teen moms, grandmothers, fathers, whoever, to come learn more about keeping babies safe. A sort of resident-to-resident education program, which we’re now trying to get the infrastructure in place for.”
Columbus' neighborhood-by-neighborhood approach to this issue may be rare, but it's not the first to lead community-based efforts to curb infant mortality rates.
The Northern Manhattan Perinatal Partnership was founded in Harlem back in 1990 and was considered a trailblazer in leveraging community health assets to reduce infant mortality. Since its founding, infant mortality in the community has dropped 78 percent. In 2015, New York City reported its lowest infant mortality rate on record.
Since Baltimore began its B'more for Healthy Babies initiative in 2009, the city's infant mortality rate dropped 23 percent, while the rate of sleep-related deaths decreased 50 percent.
"The U.S. has traditionally been very medically-driven in its approach to health, and public health has always sort of taken a back seat," said Rebecca Dineen, co-leader of the Baltimore initiative. "I think cities are realizing that public health issues are indicators of what's happening throughout the society and that developing a long-term strategy [addressing] those underlying issues like trauma, stress and education is what really helps people."
In Columbus, not all of the efforts to address infant morality are being done on a strictly neighborhood level. The Central Ohio Hospital Council recently established standards to prevent women from having their babies early -- which can contribute to infant mortality -- unless medically necessary. There's also a citywide program to teach residents the “ABC’s of safe sleep”: alone, on their back and in a crib.
"The safe sleep ambassador training [program] teaches people those ABC's, and then they in turn are supposed to go out into the community and tell 20 more people," said Egle, the CelebrateOne director. "We've had everyone from social workers, soon-to-be grandmothers, children's advocacy organizations, even a men's fraternity take part."
Ginther, the new mayor of Columbus, is convinced it's an issue that demands a broad approach, carried out at the local level.
"The greatest contributors to health outcomes are tied to social determinants of health," Ginther said. "Cities need to be held accountable, because we are the ones who are best positioned to addressed them."