As politicians and public health advocates on Monday touted an additional $20 million in federal funds to reduce infant mortality rates in the Chicago area over the next four years, questions were raised in a new study about how well the ambitious Healthy Start program actually is working.
The report, which has not been released by the federal government but has been obtained by the Tribune, shows that the first two years of the program, which began in 1992, had not made a significant difference in Chicago and other cities.
In 1994, according to the study, 15.5 babies out of every 1,000 live births died before age 1 in six poor Chicago neighborhoods targeted by the program–roughly the same as the rate of 15.3 found in other impoverished Chicago communities that were not part of Healthy Start.
Similar results were found in eight other cities and regions–except Detroit, where the rate in targeted neighborhoods declined by 17 percent.
The significance of the findings isn’t entirely clear, especially because even the most optimistic public health workers caution that more than two years is needed before the public can expect any real advances in a stubborn problem like infant mortality.
Even though the infant mortality rate has been creeping down for years in Chicago and the nation, most of that reduction is attributed to advances in medical technology and a better understanding of treating premature babies. According to the study, the average infant mortality rate in the nine Healthy Start areas declined from 20.9 infant deaths per 1,000 live births in the late 1980s to 16.6 in 1994–showing that conditions were improving even before Healthy Start began.
But the limits of those medical advances are fast approaching, and significant improvements are likely to come only after strides in getting more women into prenatal care and encouraging behavioral changes to protect fetuses, experts say.
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“The hard work lies ahead,” said Dr. Whitney Addington, president of the Chicago Board of Health, which is not involved in the Healthy Start program. “It’s very ambitious to think that in one or two years you can bring down infant mortality rates.”
Healthy Start began as a community-based effort to improve maternal and infant health in neighborhoods struggling with issues such as teen pregnancy, low-birth-weight babies and high death rates of children under 1 year old.
Those local initiatives and networks were still being established during the years targeted in the study, said Dr. Earl Fox, acting administrator of the Health Resources and Services Administration, which is in charge of the program. That agency is part of the U.S. Department of Health and Human Services.
Yet the study’s findings should be examined closely because, with $500 million in funds during the last five years, Healthy Start is the largest federal effort aimed at reducing infant mortality rates, said one source closely familiar with the program.
“Certainly infant mortality is an entrenched problem, but this was the largest federal effort ever undertaken,” the source said. “Exploring why it hasn’t been more successful is important.”
The study by Mathematica Policy Research Inc., funded by the federal government, was scheduled to be released at the annual meeting of the American Public Health Association in Indianapolis last week. But the presentation was abruptly canceled by Fox, who said the results were too preliminary.
Illinois officials who were in charge of distributing federal funds to and overseeing the first Healthy Start programs in Chicago were surprised by the study’s findings.
Dr. Stephen Saunders, an associate director in family health at the Illinois Department of Human Services, said their own monitoring of the six Healthy Start communities on the South, West and Near North Sides showed a 27 percent decline in infant mortality rates from 1991 to 1995. In contrast, he said, the rate declined by only 14 percent in similar Chicago neighborhoods.
“Since we’ve been involved in Healthy Start, we’ve had a reduction in all three of the communities we serve,” said Rupert Evans, president of Erie Family Health Center, which serves West Town, Humboldt Park and Logan Square. In addition to Erie Family, the Chicago Urban League, Henry Booth House, YMCA of Metropolitan Chicago, Near North Services Corp. and the Cermak Women’s Prison and Cook County Jail were the first area recipients of Healthy Start funds.
Three other local health groups will now share an estimated $20 million in the next four years as part of Healthy Start’s second phase. A total of $250 million is expected to go to Healthy Start programs in more than 35 cities over the next five years.
And the flap over the Mathematica study didn’t dampen the enthusiasm at a news conference held Monday by U.S. Rep. Jesse Jackson Jr. (D-Ill.) to announce those funds would go to Aunt Martha’s Youth Service Center, Southside Health Consortium and Sinai Family Health Centers. Those groups plan to use the money to expand prenatal care and education to the south suburbs and throughout the city’s South and West Sides.