This is a public collection of knowledge funded and/or published by the W.K. Kellogg Foundation (WKKF). Views, opinions, findings, conclusions or recommendations expressed in these publications are those of the authors and their respective organizations. They do not necessarily reflect the views, policies or positions of WKKF.

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Reforming National and State Policies to Reduce Inequity of Safely Managed Sanitation in the United States

February 27, 2023

The Decentralized Wastewater Innovation (DWI) Cohort is a nationwide community-driven research initiative by DigDeep Right to Water Project elevating decentralized wastewater challenges, solutions, and policy opportunities. Given the unique intersection of (1) unprecedented federal funding for decentralized and alternative wastewater solutions, (2) the complex landscape of residential infrastructure needs, and (3) the diverse, comprehensive expertise of the DWI Cohort, the Cohort recommends the following policy opportunities for federal agency consideration:1. Develop an accurate count and map of decentralized wastewater system deficiencies in the US; use this improved data to drive resource allocation to increase the efficiency and impact of federal and state programming.2. Expand and improve outreach programs to impacted communities and households to reduce access barriers to funding mechanisms.3. Prioritize regulatory support and funding for alternative technologies to improve access to affordable and effective decentralized wastewater systems.4. Invest in long-term relationships with impacted communities and households to improve compliance, ensure longevity, deepen cultural integration, and improve public health outcomes.

Health Equity

Advancing Racial Equity in Maternal-Child Health and Addressing Disparities through a Reproductive and Birth Justice Lens - Report Summary

June 24, 2022

This report expands upon earlier healthy birth and early development work by critically examining how local community-based organizations are addressing maternal-child health-racial inequities and disparities. While home visiting, breastfeeding, doulas and baby-friendly hospitals are essential strategies for improving maternal-child health, a health gap still exists for women and families of color, as evidenced by high infant and maternal mortality rates and low infant birth weight rates in New Mexico, particularly for women of color. While the maternal-child health strategies may improve access to care for women and families of color, they do not necessarily translate to quality of care. "Evidence-based" practices will not lead to changed outcomes for W.K. Kellogg Foundation (WKKF) target populations if racial equity is not addressed and foundational in the work. The report explored how WKKF grantees are addressing, advocating for, and implementing actions to advance equity to improve maternal-child health outcomes

Health Equity; Maternal and Child Health; Racial Equity and Healing

Advancing Racial Equity in Maternal-Child Health and Addressing Disparities through a Reproductive and Birth Justice Lens - Full Report

June 24, 2022

Fom 2014 to 2015, W.K. Kellogg Foundation (WKKF) partnered with the University of New Mexico evaluation team to conduct a study to examine if and how the Foundation's investments in the strategies of folic acid initiative, home visiting, doulas, breastfeeding peer counselors and baby-friendly hospitals were improving maternal-child health in WKKF's priority places in New Mexico. One key finding in the Healthy Birth & Early Development in New Mexico evaluation report was that these strategies supported a continuum-of-care that is essential for strengthening the health and wellbeing of babies, mothers, and families from preconception through a child's third year. A continuum of care framework was developed by the evaluators to capture achievable short-term outcomes such as healthy family behaviors, policy change and systems change that over time could be linked to improvement in the long-term outcomes of full-term births, healthy birth weights, exclusive access to mother's milk, decreased adverse childhood experiences, increased social support, improved parental well-being, and healthy developmental milestones. 

Health Equity; Maternal and Child Health; Racial Equity and Healing

Urban Health Agenda

June 2, 2022

The Urban Health Agenda is a guiding framework intended to help inform the narrative and policy dialogue around the health of big cities. The Agenda rests on two key pillars: (1) Health is more than health care, and (2) The well-being of urban populations centers on a broader definition of "health." In this vision, all government agencies and relevant community-based organizations work together to promote health and safety, in part through dismantling structural inequities and systems built on generations of racism.

Health Equity

Journeying Toward Healthier Communities: Observations and Questions for Leaders and Practitioners in Community Health

January 26, 2022

In 2021, The BUILD Health Challenge® (BUILD) set out to learn about current trends and explore changes taking hold in the field of community health. This line of inquiry was planned before the COVID-19 pandemic but became increasingly relevant and necessary to inform our understanding of how the pandemic and racial justice movement were influencing community health. In collaboration with our evaluation team at Equal Measure, we conducted a literature review and posed three questions during interviews with 23 field leaders working in publichealth, health and healthcare systems, and philanthropy.

Health Equity

Community-Led Health Equity Programs Deliver Results

December 15, 2021

Public Health leaders know that location matters and has a significant impact on an individual's health—and initiatives that have the highest impact focus on localized conditions and speak directly to community needs. Nicole Alexander-Scott (director, Rhode Island Department of Health) and Katie Lamansky (health program manager, Idaho Department of Health and Welfare) discuss why place-based interventions are a key strategy for health agencies to advance health equity. We examine the Health Equity Zone model and share what states can borrow from it to reimagine how they engage with communities.

Health Equity

Listening, Learning, and Leading Together: Insights from The BUILD Health Challenge's 2021 Listening Tour

November 1, 2021

This report synthesizes learnings from listening sessions with past awardees and interviewswith external stakeholders which explored how The BUILD Health Challenge® (BUILD) canreflect a community-forward and racial equity centered program in design and practice. 

Health Equity

Nurturing a Healthy Dyad: The Importance of Maternal and Infant Mental Health

October 5, 2021

Mental health affects how individuals understand, respond and interact with the world around them and evidence suggests that addressing it is key to a healthy mother-child relationship. Maternal mental health can impact how mothers engage with their children, which has a lasting and profound influence on a child's development and overall health (1). During pregnancy, maternal stress can decrease the placenta's capacity and ability to protect the baby from elevated stress hormones (1). Exposure to these elevated stress hormones in utero has the potential to cause issues throughout the lifecourse,including difficulties in learning and developing healthy relationships (2). Parents or caregivers who experience untreated depression, anxiety, and/or significant stress may be less likely to engage with their children in positive and interactive ways which is vital in promoting healthy brain development, behavioral functioning and ensuring protective relationships. The mental health of those caring for the youngest members of a family (parents and caregivers) needs to be a priority to ensure healthy families now and across the generations. In Michigan, on average, about 40,000 mothers per year are affected by perinatal anxiety and/or depression. Effective individualized tools and interventions that can help ensure parents and infants have a healthy start exist but most women with a perinatal mood disorder go untreated (17, 16). Combining interventions like early and frequent screening, relationships with trained professionals through prevention-based activities like home visiting, or interventions such as cognitive-behavioral therapy (CBT) can provide mothers with tools to cope, and the therapy needed, to provide nurturing environments for their children. In this brief we explore measures to help address mental health for the mother or caregiver and infant dyad while highlighting some of the solutions currently in place that help mothers, infants and families start and stay on a healthy track. 

Health Equity; Maternal and Child Health

Finance and Payment Innovation: Improving Equity in Perinatal Care and Maternal and Infant Outcomes

September 1, 2021

While the U.S. spends approximately $111 billion per year on perinatal (prenatal, birth and newborn) care, maternal and infant health outcomes are among the worst of any high-income nation and racial disparities continue. Efforts to improve outcomes generally focus on coverage, health care delivery systems and payments. Many innovations and ideas have emerged in recent years. This brief will help stakeholders concerned with maternal and infant health in Michigan understand the strengths and weaknesses of payment reforms for maternity or perinatal care, costs, and outcomes, including their impact on equity. The role of Medicaid and the beneficiaries it covers are emphasized, including Michigan data and examples from other states' efforts. This work is based on information from published studies, efforts of federal and state agencies, and national expert recommendations. Maternal Child Health (MCH) leaders inside and outside of government can use this information to support the design and development of any proposed perinatal payment reforms.

Health Equity; Maternal and Child Health

Diversifying the Healthcare Workforce: Implications for Birth Outcomes

August 1, 2021

A diverse maternal and child health workplace is one that has employees of different ages, genders, racial and ethnic backgrounds, sexual orientation, socioeconomic status, and personality bringing a multitude of lived experiences to institutions and organizations. The benefits of having a diverse workforce are far-reaching and include improvements to innovation, increased productivity, increased team communication and engagement (1-3). Overall, the U.S. population continues to become more diverse, and, in some states, there is a majority-minority population. This occurs when 50% or more of the population is composed of racial and ethnic minorities (3). While the population has continued to diversify, the healthcare workforce has not kept pace. These continued changes in the racial and ethnic make-up of the general population makes it likely that health professionals will engage with patients that have different cultural backgrounds from their own. The lack of diversity in the workforce across all health professions has revealed a national public health issue that needs attention. Initiatives and sustainable strategies for all local, state and federal levels and within public and private sectors will help better ensure that the healthcare workforce meets the needs of the diverse patient population and reflects the racial and ethnic diversity across the nation and in Michigan. 

Employment Equity; Health Equity; Maternal and Child Health

Leveraging the Massachusetts perinatal quality collaborative to address the COVID-19 pandemic among diverse populations

July 5, 2021

ObjectiveWe leveraged the Massachusetts perinatal quality collaborative (PQC) to address the COVID-19 pandemic. Our goals were to: (1) implement perinatal practices thought to reduce mother-to-infant SARS-CoV-2 transmission while limiting disruption of health-promoting practices and (2) do so without inequities attributable to race/ethnicity, language status, and social vulnerability.MethodsMain outcomes were cesarean and preterm delivery, rooming-in, and breastfeeding. We examined changes over time overall and according to race/ethnicity, language status, and social vulnerability from 03/20-07/20 at 11 hospitals.ResultsOf 255 mothers with SARS-CoV-2, 67% were black or Hispanic and 47% were non-English speaking. Cesarean decreased (49% to 35%), while rooming-in (55% to 86%) and breastfeeding (53% to 72%) increased. These changes did not differ by race/ethnicity, language, or social vulnerability.ConclusionsLeveraging the Massachusetts PQC led to rapid changes in perinatal care during the COVID-19 crisis in a short time, representing a novel use of statewide PQC structures.

Health Equity; Maternal and Child Health

State Cohort Mini-grant: New York - “Connecting the Dots: Building Community Wealth to End Hunger”

June 1, 2021

"Connecting the Dots: Building Community Wealth to End Hunger", a panel discussion was scheduled forlate afternoon on the last day of New York State Association of Counties (NYSAC) Legislative Conferencein January. We wanted to keep the audience engaged so they did not leave the room early. Little did weexpect a spirited exchange, and the start of a journey down the rabbit hole to find deep leverage points.

Community Engagement; Food Systems; Health Equity

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