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DATE: |
September 24, 2024 |
03 |
SUBJECT
Title
AUTHORIZE ACCEPTANCE OF PERINATAL EQUITY INITIATIVE FUNDING FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH AND AUTHORIZE APPLICATIONS FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
The San Diego County Board of Supervisors (Board) has authorized the acceptance of California Department of Public Health Maternal, Child, and Adolescent Health Division Title V Maternal and Child Health (MCH) Block Grant funding since Fiscal Year 1997-98. MCH Block Grant funding addresses health disparities in African-American birth outcomes by implementing the Black Infant Health (BIH) Program in San Diego County. The 2018-19 California State Budget Act established the California Perinatal Equity Initiative (PEI) to expand the BIH Program and improve birth outcomes and reduce mortality in Black infants through evidence-based interventions. Counties that implement BIH Programs were eligible to receive PEI funding. On June 27, 2023 (3), the Board approved acceptance of the PEI allocation in the amount of $484,310 for the period of July 1, 2023, through June 30, 2024.
Today’s item requests the Board to authorize acceptance of the PEI grant allocation of $484,310 for the period of July 1, 2024, through June 30, 2025. Additionally, today’s item requests the Board authorize the Agency Director, Health and Human Services Agency, or designee, to apply for additional funds to help improve health equity for San Diego County residents.
Today’s actions support the County of San Diego vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by improving access to quality healthcare for mothers, infants, children, adolescents, and families.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grants, and Revenue Contracts-Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants.
2. Authorize the acceptance of $484,310 in grant funds from the California Department of Public Health, Maternal, Child, and Adolescent Health Division for the period of July 1, 2024 through June 30, 2025, for the Perinatal Equity Initiative grant, and authorize the Agency Director, Health and Human Services Agency, to execute all required grant documents, including any annual extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
3. Authorize the Agency Director, Health and Human Services Agency, or designee, to apply for additional funding opportunities that address improving health equity for San Diego County residents.
EQUITY IMPACT STATEMENT
Infant mortality is an important indicator of overall population health. It is a product of social well-being, disease rates, access to healthcare, economic development, and general living conditions. Prematurity and low birthweight are among the leading causes of infant death and are also associated with illness and disability in survivors. National average data from 2019 to 2021 from the Centers for Disease Control and Prevention indicates that the African-American infant mortality rates are much higher than all other race/ethnic groups. Additionally, data from the California Department of Public Health, from 2000 through 2021, suggests that the African-American infant mortality rates in San Diego County were two to five times higher than the White infant mortality rates. Many factors are responsible for this gap, including institutional racism, class oppression, and gender discrimination, which have trickled down to negatively influence social determinants of health such as job security, availability of healthy food, transportation, and quality education in this population.
The County of San Diego (County) Health and Human Services agency, Public Health Services administers the Black Infant Health (BIH) Program and the Perinatal Equity Initiative (PEI) to reduce perinatal morbidity and mortality among disadvantaged populations. These programs work to address inequities in maternal and infant health outcomes and ensure access to quality prenatal and postpartum health care and community resources through individual, family, and group-based support. Both programs also host Community Advisory Board meetings that are attended by stakeholders, health care professionals and providers, as well as community residents, with lived experience. Attendees offer guidance and insight into the needs of families served by the programs.
The BIH Program provides culturally appropriate support services and resources to African-American women and their families throughout the county to address health disparities and improve the birth outcomes noted above. The PEI, therefore, complements programs and services and supports eligible local health jurisdictions in the implementation of evidence-based interventions that reduce racial health disparities in birth outcomes among African-American women. For example, through the BIH Program, 313 African-American women were able to participate in client centered and empowering group sessions and/or received case management where they increased their knowledge on developing life skills, reducing stress, and strengthening social support.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed actions support the County of San Diego (County) Sustainability Goal #1 to engage the community; Sustainability Goal #2 to provide just and equitable access; and Sustainability Goal #4 to protect the health and well-being of everyone in the region. This will be done by ensuring vulnerable populations in all communities are given access to resources provided by the Black Infant Health (BIH) Program and the Perinatal Equity Initiative (PEI), which promote the overall health and well-being of those disproportionately impacted. The County Health and Human Services Agency, Public Health Services continues to engage with and seek community input through the BIH Advisory Board, PEI Community Advisory Board, and the Family Support Connection collaborative.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $560,282 and revenue of $484,310 in FY 2024-25. The funding source is the Perinatal Equity Initiative grant from the California Department of Public Health. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $75,972 for FY 2024-25. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the B-29 unrecoverable costs. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board recommended approval of these recommendations at its meeting on September 9, 2024.
BACKGROUND
The health and well-being of mothers, infants, and children are important markers of the overall health of a society. Inequities and disparities are serious public health concerns with social and economic implications, such as poor health outcomes and increased healthcare costs. According to the Centers for Disease Control and Prevention, African-American infants are more than twice as likely as White infants to die before reaching their first birthday. According to the most recent data from the California Department of Public Health, in San Diego County fetal mortality rates for African Americans are more than double that of Whites and infant mortality rates for African Americans are more than five times that of Whites. Additionally, African-American infants are twice as likely to be born with a low birthweight compared to White infants.
Although disparities continue to exist, progress had been made over the years. For example, averaging three years, the African-American infant mortality rate decreased by 40%, from 14.3 in 2000-2002 to 8.6 in 2019-2021. The County of San Diego (County) Health and Human Services Agency, Public Health Services (PHS) Black Infant Health (BIH) Program and the Perinatal Equity Initiative (PEI) have played a critical role to addressing these and other inequities.
To improve the birth outcomes of African-American infants, the BIH Program provides a group-based approach with client-centered management to help develop life skills, learn strategies for reducing stress, and build social support among African-American pregnant women. The BIH Program has been implemented in San Diego County for more than 30 years. Outcomes in Fiscal Year (FY) 2023-24 include 100% of prenatally enrolled participants received education about the risks of non-medically indicated deliveries before 39 weeks gestation and 89.5% of singleton infants (non-multiple births) were of normal birthweight. Additionally, 86.4% of infants initiated breastfeeding and 63.4% of three-month-old infants sustained breastfeeding.
The 2018-19 State of California Budget Act legislation established the PEI program to address the causes of persistent inequality and identify best practices to deal with disparities in infant mortality. Establishment of PEI expanded the BIH Program by promoting the use of specific interventions designed to fill gaps in health departments to promote leadership and coordination for widespread and lasting change in public awareness, public health, and clinical practice. Counties that implement a BIH Program were eligible to receive a PEI funding allocation. PEI services include a fatherhood pilot, implicit bias trainings for healthcare providers and medical staff, and maintenance of a Community Advisory Board and Public Awareness Campaign. Although the COVID-19 pandemic significantly impacted the delivery of PEI services and participant availability, the program accomplished the following outcomes for the last grant period of FYs 2021-2024:
• Equipped 15 new and expectant fathers through an evidence-informed fatherhood pilot intervention to support African-American women during pregnancy and childbearing during August 2020 - July 2021.
• Trained 114 healthcare providers and medical staff in virtual and 144 in facilitated Implicit Bias trainings where they learned ways to reduce African-American maternal and infant health disparities by recognizing biases, understanding structural racism, and learning strategies to improve care and save lives during January 2021 - December 2022.
• Established a Community Advisory Board in March 2019, which presently consists of 50 active members and 200 community partners who are provided with birth equity information and resources to support the work activities of BIH and PEI.
• Developed the Black Legacy Now Public Awareness Campaign in September 2020 which included a website, social media posts, transit posters, and advertisements. Reached over 18 million people since the start of the Black Legacy Now campaign.
• Coordinated with the Office of Nursing Excellence to implement the Diversity Science - Implicit Bias training/exam in FY 2024-2025 to a cohort of 99 Public Health Nurses.
The San Diego County Board of Supervisors (Board) has authorized the acceptance of California Department of Public Health Maternal, Child, and Adolescent Health Division Title V Maternal and Child Health (MCH) Block Grant funding since FY 1997-98. Most recently, on June 27, 2023 (3), the Board approved acceptance of the PEI allocation in the amount of $484,310 for the period of July 1, 2023, through June 30, 2024. PEI also aligns with the Board’s action on January 12, 2021 (8), declaring racism a public health crisis by working to advance equity and raising awareness of poor birth outcomes and inequities among African Americans, and to address the role of bias and racism, particularly in health care settings, in contributing to these birth outcomes. These efforts help reduce disparities in African American maternal and infant health outcomes and would be worthy of County funding if grant funding was not available.
Today’s actions request the Board to approve and authorize acceptance of PEI funding of $484,310 in grant funds from the California Department of Public Health, Maternal, Child, and Adolescent Health Division which will be used to improve access to quality healthcare for mothers, infants, children, adolescents, and families.
A waiver of Board Policy B-29 is requested because the funding does not offset all costs. Unrecovered costs are estimated at $75,972 for FY 2024-25. The funding source for these unrecovered costs will be existing Realignment. The public benefit for providing these services far outweighs these costs by providing culturally appropriate support services and resources throughout the county to address health disparities and improve birth outcomes.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the Equity (Health) and Community (Quality of Life) Initiatives in the County of San Diego 2024-2029 Strategic Plan, as well as our commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by ensuring that San Diego County has fully optimized its health service delivery system for mothers, children, and families.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
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