In 2011, the Georgia Department of Public Health (DPH) reported that the state’s infant mortality rate had dropped to 6.8 deaths for every 1,000 live births. Just five years earlier, Georgia’s infant mortality rate of 8.4 was 20 percent higher than the national average, with some areas of the state reporting rates as high as 17.5 deaths per 1,000 births.
Why the turnaround? DPH focused on leveraging unique partnerships with local health departments, birthing hospitals, health care professionals and nonprofit organizations across Georgia, an effort highlighted by the Association of State and Territorial Health Officials (ASTHO) in its annual President’s Challenge.
ASTHO President Jose Montero, M.D., challenged states to focus on advancing the reintegration of public health and health care, emphasizing the power of partnerships in improving the quality of health care, decreasing costs and bettering the overall health of the population.
“To prepare ourselves for the future, we need to be able to look at public health and health delivery systems and integrate them philosophically. We need to capture examples, decode them and see what works and what doesn’t and how to use which in different parts of the country,” Montero said in an interview with the Robert Wood Johnson Foundation.
For DPH, a vibrant partnership between public health and health care organizations is a priority.
“Our work is only as good as our collaborations,” said Seema Csukas, M.D., director of Maternal and Child Health at DPH.
To improve Georgia’s infant mortality rate, DPH used an innovative strategy to identify geographical clusters of infant deaths and discovered most of the deaths were linked to premature birth and low birthweight. With the help of its health care partners, DPH staged interventions in those regions, focusing on early elective deliveries, breastfeeding in hospitals and a home-visiting program.
DPH and local health departments collaborated with hospitals and state medical societies to reduce early elective deliveries (non-medically indicated C-sections and inductions that occur before 39 weeks). A physician champion in each birthing hospital gathered support for policies to reduce early elective deliveries. The state Medicaid program stopped paying for early elective deliveries. By 2013, elective deliveries at 37 and 38 weeks declined by more than 50 percent.
DPH also enlisted its partners to promote breastfeeding, helping new mothers to begin the practice from the first hours of their babies’ lives. DPH launched the 5-Star Hospital Recognition Program, awarding hospitals five-star status for taking steps to promote breastfeeding among all new mothers.
Research has shown that breastfeeding is one of the most effective ways to reduce infant mortality.
“The Academy of Pediatrics recognizes breast milk as the optimal nutrition for most infants and encourages mothers to breastfeed exclusively for six months,” said Arlene Toole, EPIC breastfeeding director at the Georgia chapter of the American Academy of Pediatrics. “Our Georgia 5-Star Hospitals are leading the way in assisting mothers to meet these goals by providing evidence –based maternity care practices to improve health outcomes for Georgia’s moms and babies.”
Nine hospitals in the state, most in areas with the highest rates of infant mortality, participated in the program. Collaboratively, all nine hospitals made significant improvements over the course of the first year. Skin-to-skin contact rates increased from 32 percent to 50.2 percent; breastfeeding support within six hours increased from 12 percent to 53.6 percent; and the number of mothers and babies staying in the same hospital room improved from 29.4 percent to 53.3 percent. Seven more hospitals will participate in the 5-Star Hospital initiative beginning later this year.
DPH Commissioner Brenda Fitzgerald, M.D., said the improvement in Georgia’s infant mortality rates shows how partnerships between health care and public health can move the state forward in other areas as well.
“When you know what the problem is, and you work collectively, together you can make an impact. Collaboration is vital to the work that we do, so building these strong connections with our health care partners will continue to be a priority for DPH,” she said.