Neighborhood Privilege, Preterm Delivery, and Related Racial/Ethnic Disparities: An Intergenerational Application of the Index of Concentration at the Extremes.

We assessed whether early childhood and adulthood experiences of neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), were associated with preterm delivery and related racial/ethnic disparities using intergenerationally linked birth records of 379,794 California-born primiparous mothers (born 1982-1997) and their infants (born 1997-2011). ICE measures during early childhood and adulthood approximated racial/ethnic and economic dimensions of neighborhood privilege and disadvantage separately (ICE-income, ICE-race/ethnicity) and in combination (ICE-income + race/ethnicity). Results of our generalized estimating equation models with robust standard errors showed associations for ICE-income and ICE-income + race/ethnicity. For example, ICE-income + race/ethnicity was associated with preterm delivery in both early childhood (relative risk (RR) = 1.12, 95% confidence interval (CI): 1.08, 1.17) and adulthood (RR = 1.07, 95% CI: 1.03, 1.11). Non-Hispanic black and Hispanic women had higher risk of preterm delivery than white women (RR = 1.32, 95% CI: 1.28, 1.37; and RR = 1.11, 95% CI: 1.08, 1.14, respectively, adjusting for individual-level confounders). Adjustment for ICE-income + race/ethnicity at both time periods yielded the greatest declines in disparities (for non-Hispanic black women, RR = 1.23, 95% CI: 1.18, 1.28; for Hispanic women, RR = 1.05, 95% CI: 1.02, 1.09). Findings support independent effects of early childhood and adulthood neighborhood privilege on preterm delivery and related disparities.

Life-course neighbourhood opportunity and racial-ethnic disparities in risk of preterm birth.

BACKGROUND: Neighbourhood opportunity, measured by poverty, income and deprivation, has been associated with preterm birth, however little is known about the contribution of early-life and life-course neighbourhood opportunity to preterm birth risk and racial-ethnic disparities. We examined maternal early-life and adult neighbourhood opportunity in relation to risk of preterm birth and racial-ethnic disparities in a population-based cohort of women under age 30. METHODS: We linked census tract poverty data to 2 generations of California births from 1982-2011 for 403 315 white, black, or Latina mothers-infant pairs. We estimated the risk of preterm birth, and risk difference (RD) comparing low opportunity (≥20% poverty) in early life or adulthood to high opportunity using targeted maximum likelihood estimation. RESULTS: At each time point, low opportunity was related to increased preterm birth risk compared to higher opportunity neighbourhoods for white, black and Latina mothers (RDs 0.3-0.7%). Compared to high opportunity at both time points, risk differences were generally highest for sustained low opportunity (RD 1.5, 1.3, and 0.7% for white, black and Latina mothers, respectively); risk was elevated with downward mobility (RD 0.7, 1.3, and 0.4% for white, black and Latina mothers, respectively), and with upward mobility only among black mothers (RD 1.2%). The black-white preterm birth disparity was reduced by 22% under high life-course opportunity. CONCLUSIONS: Early-life and sustained exposure to residential poverty is related to increased PTB risk, particularly among black women, and may partially explain persistent black-white disparities.

Power, Politics, and Health: A New Public Health Practice Targeting the Root Causes of Health Equity.

Purpose Understanding the WHY, WHAT, and HOW of place-based work in maternal and child health (MCH) is critical to examining the components of the environment that shape health opportunity through the relationship between life expectancy and neighborhood residence. Description On September 18, 2014, during the CityMatCH Leadership and MCH Epidemiology Conference, Dr. Anthony Iton provided the Keynote Address focused on the root causes of health inequities. Assessment The address focused on issues of equity in California and initiatives designed to mitigate and prevent disparities, including the Bay Area Regional Health Equities Initiative framework. Dr. Iton presented information on how the framework translated into investment strategies and a policy and systems change approach to place-based work. Conclusion The field of MCH, because of its focus on supporting health during critical periods of development, is poised to play a significant role in reducing health inequities. Recognizing that human health suffers when low income communities are passive, disenfranchised and disorganized, in order to change this status quo, understanding that human capital is the greatest asset is the urgent challenge to the field of MCH.

Human-Centered Design as an Approach for Place-Based Innovation in Public Health: A Case Study from Oakland, California.

PURPOSE: This case study provides a high-level overview of the human-centered design (HCD) or "design thinking" process and its relevance to public health. DESCRIPTION: The Best Babies Zone (BBZ) initiative is a multi-year project aimed at reducing inequities in infant mortality rates. In 2012, BBZ launched pilot programs in three US cities: Cincinnati, Ohio; New Orleans, Louisiana; and Oakland, California. The Alameda County Public Health Department (ACPHD), the lead for the Oakland BBZ site, identified HCD as a promising approach for addressing the social and economic conditions that are important drivers of health inequities. HCD is a process for creating innovative products, services, and strategies that prioritizes the needs of the intended population. ACPHD partnered with the Gobee Group (a social innovation design consultancy) to develop the Design Sprint. The Design Sprint was a 12-week pilot in which 14 professionals from nine organizations used the HCD process to develop concepts for stimulating a vibrant local economy in the Oakland Best Babies Zone. ASSESSMENT: Thirty- to sixty-minute semi-structured interviews were conducted with all 14 individuals involved in the Design Sprint. With the exception of one interview, the interviews were audio-recorded, transcribed, and inductively coded to identify themes. CONCLUSION: Our experience suggests that HCD can: enhance community engagement; expedite the timeframe for challenge identification, program design, and implementation; and create innovative programs that address complex challenges.

The Building Blocks Collaborative: advancing a life course approach to health equity through multi-sector collaboration.

Too many children are born into poverty, often living in disinvested communities without adequate opportunities to be healthy and thrive. Two complementary frameworks-health equity and life course-propose new approaches to these challenges. Health equity strategies seek to improve community conditions that influence health. The life course perspective focuses on key developmental periods that can shift a person's trajectory over the life course, and highlights the importance of ensuring that children have supports in place that set them up for long-term success and health. Applying these frameworks, the Alameda County Public Health Department launched the Building Blocks Collaborative (BBC), a countywide multi-sector initiative to engage community partners in improving neighborhood conditions in low-income communities, with a focus on young children. A broad cross-section of stakeholders, called to action by the state of racial and economic inequities in children's health, came together to launch the BBC and develop a Bill of Rights that highlights the diverse factors that contribute to children's health. BBC partners then began working together to improve community conditions by learning and sharing ideas and strategies, and incubating new collaborative projects. Supportive health department leadership; dedicated staff; shared vision and ownership; a flexible partnership structure; and broad collective goals that build on partners' strengths and priorities have been critical to the growth of the BBC. Next steps include institutionalizing BBC projects into existing infrastructure, ongoing partner engagement, and continued project innovation-to achieve a common vision that all babies have the best start in life.

Agriculture Policy Is Health Policy.

The Farm Bill is meant to supplement and secure farm incomes, ensure a stable food supply, and support the American farm economy. Over time, however, it has evolved into a system that creates substantial health impacts, both directly and indirectly. By generating more profit for food producers and less for family farmers; by effectively subsidizing the production of lower-cost fats, sugars, and oils that intensify the health-destroying obesity epidemic; by amplifying environmentally destructive agricultural practices that impact air, water, and other resources, the Farm Bill influences the health of Americans more than is immediately apparent. In this article, we outline three major public health issues influenced by American farm policy. These are (1) rising obesity; (2) food safety; and (3) environmental health impacts, especially exposure to toxic substances and pesticides.