Infant Mortality

Hello, everybody. Welcome to Health Chatter. And today's show is on infant mortality. We'll get to that in just a second with our illustrious guest. We have a great crew, as always, that makes our shows great. And they are Maddy Levine-Wolf, who's helping us today with our recording. Thank you, Maddy. Also, Maddy helps us with our background research, as does Erin Collins, Deondra Howard, and Sheridan Nygard. Sheridan also helps with our marketing. And then, of course, we have Matthew Campbell, our production person, who makes sure all these shows get out to you, the listening audience, in crisp shape. With us also is my partner in this show, Clarence Jones, he and I have been doing these for a while now. 
We like to chat, and it's been really great having you as a co-host on Health Chatter. Barry Baines is our medical advisor. He's with us today as well. He kind of puts the medical twist on all of our shows, especially those shows that have a medical twist to them. So welcome to Barry and Clarence. Our sponsor for the show is Hueman Partnership. Check them out at huemanpartnership.org, a wonderful community health organization that does really, really good creative things in the community for all different population groups. So thank you to them. Also, check us out at healthchatterpodcast.com. Leave a review if you like our shows. We love hearing from you, or if you have any questions, you can also leave those on our website, and we will get back to you as soon as we can. 
So today, infant mortality. I'm going to turn it over to my great co-host, Clarence Jones, who will be introducing our guest for the day. Hey, thanks, Dan, and welcome to all of you who are listening to our show. Michelle Chisholm, who is the state... Infant Health and Mortality Reduction Specialist at the Minnesota Department of Health is our guest today. I'm really excited about having her here because maternal child health or infant mortality was how I actually entered into this non-profit world. It was an eye-opener for me in terms of how important it was for us as a community to discuss this. It was exciting to have her to accept this invitation to come. So she provides statewide leadership around infant mortality reduction, and she manages a state infant mortality reduction initiative. 
And that particular infant mortality reduction initiative provides resources, education, information, and technical assistance to local public health agencies, tribal governments, and community-based organizations to improve birth outcomes. She currently leads a project that is funded through the CDC to reduce the incidence of Sudden Unexpected Infant Death in the Black African American Population in Minnesota. And she manages multiple grants to nonprofit organizations through the Infant Health and Mortality Prevention Grant Program. And I'm saying all these things because I think that this is an issue that we are, at least for me, I believe is very, very important for us, infant mortality in not only in the state of Minnesota, also among people of color, but also in our nation. And so... We want to just say welcome, Michelle. 
And we are going to ask a lot of questions, so have some fun. But I think it's something that we want to make sure that people are really understanding about the importance of this topic. San? Happy to be here. Good. So, Michelle, you know, it's interesting. For many, many years, I taught in the Maternal and Child Health Department at the University of Minnesota School of Public Health. And inevitably, when we were teaching students about maternal and child health, the subject of infant mortality was way up on top of the list. It really, really was. And that's many years ago already. And so what really struck me as I was reading through some of our background research here and also just being cognizant of it is this problem is still with us. 
To be honest with you, from what I can remember, it's not much better than it was all those years. What's going on? Why is it that we're seeing these rates? And why is it that it's still such a major problem? Very good question. First, thank you so much for having me here today. I'm a proud graduate of the U of M School of Public Health and CH program. So this is a topic which, of course, as you said before, it's been in the public domain and public space and public health space for a very, very long time. And what's been happening is that, well, let me backtrack. Let's define infant mortality for the public. Yeah. mortality is the death of a live born infant before the first birthday. 
So we measure infant mortality. We use a rate called the infant mortality rate, which is basically the number of infant deaths per thousand live births. We need that measure so we can do comparisons across populations, across geographies, across other types of variables of interest. And that variable in and of itself, that measure is very powerful. in that it tells us a whole lot about a society and a whole lot about a community. It tells us about the quality of healthcare that's available, socioeconomic conditions. It tells us about medical care access. It tells us a whole lot. And I think too, in my opinion, that it's also a measure of our values, who we value and what we value as a society. Unfortunately, even though the rates over time have declined in the US and in Minnesota, and we have data to show that even within racial and ethnic groups, 
The gaps, the disparity gaps between, let's say, the two groups with the highest rates, African American, American Indian, then other racial groups too, those haven't shrunk. The rates are declining, but those haven't shrunk. Still today, the disparity gap is about the same as it was two decades ago. Infants born to Black and American Indian mothers in the state and also nationwide are two to sometimes even three times as likely to die before their first birthday as maybe an infant born to a white mother, and maybe compared to the state or national rates overall. So that's what we're seeing. And one of the reasons that gap is to me an opportunity gap. It's a disparity gap, but it tells us there's a lot of things that we aren't addressing. 
We've spent a number of years addressing health behaviors. No smoking, no alcohol during pregnancy, get your prenatal care. Well, a lot of women are doing those things, but what's not being addressed are the systemic and structural issues, the drivers, those forces that are really having tremendous impacts on people's lives. For example, systemic racism is still an issue today. This talk about post-racial or whatever, that doesn't exist. Racism still exists in our institutions, in our healthcare system. Let's face it, we're not all treated the same in the healthcare system. Opportunities are not made available to all of us. And so we need people to have opportunities. We need to address housing. We need to address transportation access issues. We need to address medical care issues, expand medical care, treat people better, some of us better in the health care system. 
So there are a whole lot of issues that are being addressed. And until we address those and are truly intentional and make new efforts to do that, these gaps will still persist. Michelle, sorry, Clarence. Michelle, before we go on, can you lower your camera at all? yeah a little yeah that's good. And then, um, will you just speak a little louder and also a little slower um it sounds a little bit muffled, so if you speak louder and slower, I think it'll just be a nun um just the, like, enunciation will come through a little bit more make sure your camera is a little lowered because if we, if it cuts off your face, then we have a harder time hearing you. So just louder, a little louder and a little slower would be great. 
Okay. And relax, relax. We're just having a conversation. That's the whole point here. Okay. All right. So could you lower your camera? Somehow it's just not working. There you go. Keep going. Keep a little bit more. We want to see all of you. There you go. There we go. There we go. Okay. All right. I have a question, Michelle, you know, where, where does America sit? What does the United States sit in terms of the rest of the world? around this issue of infant mortality? We usually are one of the highest ones. Is that the same here? When you compare the US's infant mortality rate to other industrialized societies, if you look at what we call OECD infant mortality rates, I can't remember what that acronym stands for, but Organization of Economic Something Development comes out of Europe. 
The US ranks dead last. Dead last? Yeah, among developed societies, yes. Wow. There's a statistic that's often been touted that even Cuba, a less developed country, has a better infant mortality rate than the U.S. So the U.S. is not doing very well. And it's because of prematurity and all that comes with those preterm births that we see a very high burden of preterm births in this country. Yeah. You mentioned a lot of different factors that... affect infant mortality. And I'm wondering, you know, according to what you think, what is one of the primary factors? Is it the fact that people don't know or they're not they're not given information to know how to have healthier babies? I don't know. I'm just I'm just I know that this is how I entered this whole public health realm. 
I came through around infant mortality. I didn't realize I didn't realize how how much it was affecting communities and things of that nature. So why do you think we haven't made any adjustments? Like I've said, the rates themselves have declined over time. It's the disparity gap. And that, to me, is also an opportunity for other interventions. And I think it's probably a combination of things. But that gap also says to me that we are addressing those structural and systemic issues that are really at the root cause of this problem, racism. Racism hasn't gone away, right? You think that you'd go to the healthcare system and be treated fairly and equally, but all people aren't treated the same in the healthcare system. There's research to back this up dating to maybe two or three or four decades ago, two decades ago. 
I can think of Michelle Van Ryn's research at the U of M where she looked at this issue, the socioeconomic differentials and how people are treated in the healthcare system. So getting at those structural issues, get systemic issues, social determinants of health, inadequate housing or, you know, that's a problem. Housing is a problem, I'm sorry. We also have food insecurity. We have issues with the criminal justice system. People aren't treated fairly there. We need to expand health care. It's just a whole lot of problems, a whole lot of different issues. So I think when we think of infant mortality, we shouldn't just think about behaviors. If you think about what the determinants of health are, 40% of our health is determined by economic conditions, about 30% or so by health behavior. 
So it could be a combination of things. So when we think of infant mortality, we have to take a multifaceted approach to this complex problem. So not just tackle prenatal care, but we need to tackle all the other things that come around with it or are driving that problem. Thank you. So one of the things that we addressed in a previous show, Michelle, is the concept of access to medical care, which seems, you know, again, over the years, you know, access has been an issue, but it just seems like it's just at the forefront now. Now, can you link for us, you know, the access to medical care and infant mortality? Is that one of the major variables there? that you're seeing that affects infant mortality today? 
As I stated before, medical care is not available to everyone in this country. There are medical visits, right? So that is right. Hospitals are closing, so people may have to travel longer to get access. And even when they're in the health care system, we're all not treated very the same, right? I think about based on our race, ethnicity, maybe based on the doctors or providers perception of who we are. So even though people may have some access, health care may not be accessible in different ways. So the medical deserts issue, the closing of hospitals, and that sort of thing contributes to some of these problems that we're seeing, the differentials that we're looking at. Access to transportation, that affects infant health outcomes too. 
Like I said, this is a very complex issue. And so there's so many different inputs into the problem. And we need to tackle as many of them as possible. Yeah, go ahead, Barry. Yeah. Michelle, I just had a quick question regarding access. It comes in a lot of different flavors. It's whether you have insurance, where the doctors are. You just mentioned with a lot of hospital closings, et cetera. And I was just curious if you've noticed a disparity between rural infant mortality versus urban suburban immortality. I know what, you know, based on all the factors that you talked about, I kind of, you know, understand that. But how does it get impacted by the rural-urban divide when it comes to infant mortality? Can you speak to that and share some of your wisdom on that? 
Yeah. So in our state, The infant mortality rates vary by geography, of course, in the northwest part of the state, which I believe would include a county like Bemidji County, and they have the highest infant mortality rates, whereas the west central part of the state has the lowest infant mortality rate. When we look at, you know, greater Minnesota versus maybe the metro, what we see is that Ramsey County currently has the highest infant mortality rate. This is looking at 2018 to 2022 data. And then Hennepin County, followed by, sorry, greater Minnesota, and then Hennepin County. And the suburbs have the lowest infant mortality rates in our state. So there's geographic disparity. And if you look at it nationally, too, the southern states have the worst infant mortality rates. 
And then, you know, the northeast, even the western corridor, you know, you're looking at Washington, California, Oregon, they have, you know, more favorable rates in the northeastern part of the country, too. So... There's definitely geographic disparities. Great. Thank you. You're welcome. So tell me, it's just Clarence again. So tell me, Michelle, what are we doing to address this issue? You know, you said it. We all have said this is that this is something that's been going on for 20, this has been going on for a long time. You know, this whole issue around infant mortality. And I'm sure that there's some efforts being made, but could you share with us some of the things that the state of Minnesota is doing in order to try to address these issues? 
Yeah, that is a very good question and a timely question at that. So in addition to the infant mortality initiative, which I manage, there's a whole lot of different activities that are happening that are that benefit infant mortality. And I've been around for a long time. If you think about family home visiting, you can think about WIC, you know, eliminating health disparities initiative, which was passed through the legislature in 2001, addressing eight health areas. Infant mortality is one of them and continues to be an important area that this grant focuses on. We also have some new initiatives. We recently received a grant from the CDC and we're looking at a specific cause of infant mortality now through the sudden death in the young case registry in the Indian violence prevention area of our state. 
We are partnering with them, the maternal and child health section. And so this grant is intended to reduce infant mortality, basically sudden unexpected infant deaths. So Those are deaths that happen suddenly and unexpectedly from causes that are not immediately understood at the time of the death. So they require a SEAL investigation, autopsy, review of the child's medical history to ascertain the cause and manner of the death. And so we have a project through the CDC where we'll be working with our communities directly to work on this issue with them. the American Indian population has the highest seaweed rate in our state, followed by the Black population. And seaweed is also the leading cause of death in the American Indian population. So what this project intends to do is to sort of bring the community together. 
And we'll have a steering committee made up of African-Americans and American Indians. They will have listening sessions to kind of uncover some of the reasons that are driving the sewage rates, develop an action plan or develop action plans. There'll be a separate what we call community action team for the American Indian population. They'll have work plan and budget separate for the African-American population. They'll have their own work plan and budget. And they have prioritized recommendations from this action plan to implement. And this is a five-year project. In addition, we have these infant mortality prevention grants, infant health and mortality prevention grants. Those are funds that came through the legislature last year through the Healthy Beginnings, Healthy Families Act. And that is intended to create opportunities across the state for addressing infant mortality in four areas. 
Prematurity, sudden unexpected deaths or sleep-related deaths, congenital malformations and the social determinants of health. And we issued 33 grants across the state. I believe it was like 55% of those grants went to the metro area and 45% went to greater Minnesota. So those grants went to tribes, non-profit agencies, and local public health agencies. In total, 33 grants went out. So we also have other products that are working to address maternal morbidity and more you can think about maternal mortality review committee, which is quite robust and doing some amazing work to try and uncover the causes of maternal mortality in Minnesota. They make recommendations. There's also another project which they call Time On For Short. It's a five year funded project, $5 million over five years. 
And that project is intended to strengthen implementation of innovative approaches data-driven kind of community-led and driven strategies to improve outcomes in the Black American, Indian, and other populations of color, refugees and immigrants as well. And this is linked very closely to the Maternal Mortality Review Committee and other work that's going on with the Minnesota Perinatal Quality Collaborative as well. And so that project they'll develop, we're working on a perinatal health plan to implement, to improve outcomes. And then there's also the Dignity in Pregnancy and Childbirth Act, which was passed by the legislature in 2021 for the student who is in maternal health care. And part of that is to develop access to a continuing education curriculum that address, that provides, it's a course that providers have to take. 
It focuses on anti-racism training and implicit bias. And I know the state worked or partnered with CARE C-A-R-H-E at the U of M to make this curriculum possible. So there's a lot of, and through this Dignity in Pregnancy and Childbirth Act too, there is resources online through a database called Help Me Connect for doulas. Anybody searching for doula, my colleague at the health department, Sarah Hill, she worked with Help Me Connect to create this fabulous area within that database so that people can search for doulas based on maybe geography or some other characteristics of interest to them. So there's also the sewage subcommittee. That's a review committee where we review certain unexpected infant deaths and then make recommendations for implementation. And so that work will also inform the project that we're doing funded through the CDC to address this issue. 
We also have grants through other agencies, some of which I mentioned that I didn't mention earlier, We work closely with the African-American Babies Coalition. We work closely with Beck, of course, and Healthy Black Pregnancies. And we just do a lot of work with our partners out in the community to address this problem. So two different ways, whether it's sharing data and bringing awareness to the problem and, yeah, so sharing resources. I know that you're doing a lot of work. I mean, so we can tell that. There's a lot of work that's going on. But one of the things I wanted to talk about was some of the ways in which some of the other ways that the state is using education to help parents to understand the importance of taking care of their children so that they don't have infant mortality. 
For example, you know, sleeping on your back. I remember growing up, they were talking about, you know, sleeping on your back, you know, learning how to place babies in the... place babies in the crib, you know, sleep patterns. They're talking about substance abuse, those kinds of things. What other kinds of things is the state doing in order to make sure that we are reducing infant mortality? I mentioned the family visiting area. They have a huge area that focuses on families, family health and their well-being. So that would be a really important and strategic area. We have other partners in other areas like the Eliminating Health Disparities Initiative. So they're doing important work in the community to address infant mortality. We received funds from Title V that's through the federal block grants. 
And those funds go out to local public health agencies, community health boards to address infant mortality through those community health boards. That's also some of the other work that we're doing. And we also have awareness weeks and awareness months. There's just so much that touches on infant mortality. There's also work around prison, doing work in jails and prisons with mothers and their babies. That's another project that's happening. That also was funded through the Healthy Beginnings, Healthy Families Act. There's just a whole lot of different initiatives, like the ones that I just mentioned that are happening in the state. So the Title V funds come every year from the feds. They have to do a needs assessment every five years to make priorities. And they're about in the stage, I think, of starting to do the needs assessment again. 
So that's where different topics are prioritized, including infant mortality that we need to work on across the state. Last time around, last cycle infant mortality was one of the priority health topics. It makes sense. It's also a national priority, a priority that's listed in Healthy People 2020 and other federal strategic plans. Barry? Yeah. Michelle, when I was in practice, I'm a family physician by training, and I used to do OB, so I would deliver babies and do prenatal care. I remember over the arc of my practice life, and this will go back to even the time that Stan was at the School of Public Health and Maternal and Child Health. But I remember that there were two initiatives that was an area of focus. 
One of them, you know, which addressed the injuries issue was the whole car seat programs. And there was a great emphasis on that. And I know a lot of health plans started to provide uh free car seats, and they still do um because that was, you know, clearly uh one of the, you know, probably one of the top five causes of infant mortality. And then there was also a big uh push uh it kind of lumped together, but it was premature birth, you know, premature labor um and sort of linked to that was the low birth weight, because that was also a risk. if infants weren't growing. And this is sort of, it's not a 1921, 1922, or just in the past few years, it's sort of stepping back a little bit over. 
If I look over a wider time horizon, those are two initiatives that I know there's a lot of effort into that. On those two things in particular, do you have information on on what the, you know, the payback or the, you know, what was the results of some of those things? Did they make an impact on some of the, you know, it's not going to eliminate it completely, but did it have a positive impact on reducing some of the infant mortality rates over a longer period of time? That is a good question. Unfortunately, I don't have information, you know, any evaluation information about what those initiatives, how they've impacted those rates. And it's sometimes hard to isolate, you know, one single intervention or two, because there's so many different interventions that are happening that could influence those outcomes, right? 
prematurely for example, we've seen an increase in prematurity, not just nationally, but um in our state as well um and like i mentioned before, it's a major reason why we have such a poor infant mortality comparison, when we rate compared to other, industrialized societies. The March of Dimes every year comes up with a prematurely report card. I believe several years ago we had a B minus, now we're at a C plus, and the US is at a D plus. So we're not doing too great in that area. Good question though. You know, what's interesting is, you know, I was involved in getting, you know, I worked with John Schaefer in getting that whole program going for car seats in in hospitals that eventually led to child restraint seat legislation. 
And Minnesota was one of the first states in the country to get child restraint seats legislated. And so it was significant. I remember John and I saying that we didn't care what the rates were. If we saved one life, just one life by somebody, you know, by one of these kids being in a child restraint seat, then, you know, it was worthwhile. There's a couple, there's, I'm trying to focus a little bit on the prevention, intervention, and then, you know, true parenthood. Years ago, there was a program called MELD, M-E-L-D. In the state of Minnesota, it stood for Minnesota Early Learning Design. The program was really intended for couples who were considering having children or raising a family to give them guidance beforehand on what is 
truly needed and what you need to be prepared for going forward once you do have a baby. Are there still programs like that that exist so that if you're thinking of being a parent, this is a good opportunity to learn something about it? Are you aware of if any of that exists anymore? I'm not aware of any such program. I'm not aware of any program like the one you're talking about. Most of the programs that I'm aware of are for people who had babies. Yeah, yeah. So at that point, it's almost like an intervention to truly help. It would be an interesting thing to revisit again. I agree with you, Stan. I remember mail. Mail was one of those programs that came in. 
I remember some people that were a part of that. And I hadn't thought about that in a long time. Me either. About taking a look at prepping people before they have children. I mean, they decided that they wanted to have a child, you know, to let them know what some of the necessities are like. What's that, folic acid and all that kind of stuff? I mean, we don't even talk about that. You know, people just have a baby. Yeah, you know, it's fun having the sexual acts, but then all of a sudden you realize, oh, my God. Yeah, there's something more to it. There's a little bit more to it. One other thing I wanted to touch base on that, and we've had, again, we've had a previous show on this, is nutrition. 
Oh, yeah. So tell me how you, in your program, you address nutrition as it relates to, in this case, infant health, maybe not infant mortality, but infant health. Yeah, so WIC, Women, Infants, and Children Nutritional Program, they're the ones who mostly handle the work is divided up at the health department. And they're the ones who mostly address breastfeeding issues, nutrition issues. in families. But through my work, I do promotion of breastfeeding because it's connected to infant mortality. And actually breastfeeding, lack of breastfeeding is actually, or breast milk is actually a risk factor in what we call sudden infant death syndrome, which is a type of sudden unexpected infant deaths. So during infant safe sleep, sorry, during infant safe sleep week, which happens every November in the States, we do a promotional post 
that targets the American Indian population that looks at basically focusing on the intersection of breastfeeding or breast milk. And it's important to reducing sewage seeds in that population. Again, that is the leading cause of death. So an unexpected infant that's in their population. So that's where my work intersects with that area. So we can partner in that way with the WIC program. They have a whole program in WIC. family home visiting, maybe a good idea to bring them on to your program to maybe flesh that out more. You know, it certainly is not unusual at the Department of Health how all these different programs kind of intertwine, and there's a need to definitely work together on these things. You know, another thing I want to bring up, and then I'll let Clarence and Barry chime in, is abuse and neglect. 
Okay, so if, you know, if God forbid, you know, a child is hurt, an infant is hurt to the point where they die, first of all, is that part of infant mortality statistics, or is that separated? And then second of all, are we seeing increases in abuse given all the different things that are going on now that lend itself towards infant mortality? That is a good question. So where my work touches on this topic is with abusive head trauma, shaken baby syndrome. Yes. So that's where I work on the prevention side. There's a law in the state or statutes and statute that hospitals must provide education to parents around this topic before they're discharged. And so the hospitals must show video to parents and educate them. 
And if they don't want to use the videos or provided by the commissioner, then they have to submit one to the commissioner, which I act in place of the commissioner, review those for certain patients. elements or we're looking for different things. So that's where my work intersects or addresses the abuse and the abuse issue is with chicken baby syndrome. And the Indian violence prevention area keeps data on this topic. I don't, I haven't seen those statistics in a while, but it's not one of the leading causes of infant mortality. It doesn't show up as a leading cause, just to let you know. For family home visiting, they focus on abuse as well, because that's how it all started through David and his work and a number of other people. 
So that area focuses on that topic too. Great, great. Yeah. You know, this is really a very important topic for a lot of people. I was looking at some of the research that one of my colleagues did, and what they said was that in 2021, only 19 states met the Healthy People's 2030 target of 5.0 infant deaths or less per 1,000 live births. So we have a lot of states that have a lot of infant deaths beyond 5,000. I know it was big, but that's a lot. Yeah, that is a lot. Yeah, if you look at a map, CDC has a map, You know, the states, you can look at their infant mortality rates. Luckily, Minnesota is below that 5.0 target. And, you know, Minnesota's infant mortality rate has consistently been lower than the nation's rate overall. 
And it's always met the target. The problem, again, is those disparity gaps. That's the issue, is those disparity gaps. But you're right, there are many states, especially in the south, that's where you see states with very high rates of infant mortality, like Mississippi, Alabama, West Virginia, those states have high infant mortality rates, historically. So international, well, I guess, let me ask it this way. The United States, how do we compare with other countries? And who's the best? Who's the best? And what can we learn from them? That is a very good question. So as I mentioned earlier, Mr. Mr. Jones had asked that question. Among 30-something developed countries that I looked at the data, OECD states, the US ranks did last. Finland and those countries, the Nordic countries, sometimes Singapore, Iceland, they compete for number one. 
They go back and forth. I believe Finland, the latest data I saw, Finland had the best infant mortality rate. I believe it was like 1.7 per 1,000 life births. So that's- So what are they doing right? Oh, they have paid parental leave. We don't give extensive paid parental leave. They provide more investments in their population, right? So you get healthcare. I mean, they pay a lot of taxes, but they get their money's worth, right? So they have healthcare access, free college access. They just provide for their population, I think, a lot better than the U.S. does, including those extensive paid medical, I mean, parental leaves to both mothers and fathers, to birthing people, let's say. You know, to be honest with you, a country like Finland, it's not just infant mortality that they're good at. 
I mean, they're healthier in general. And it's just like, isn't it time that we kind of wake up a little bit to try to figure out what the heck here? Don't we want to invest in the health of our people? And if we do, then we'll be healthier overall on a lot of different things. Yeah. May I just correct one thing? Actually, I'm looking at that today. It's Japan that has the lowest in 2021, followed by Finland. Japan, Finland, Slovenia. Yeah. All right. So maybe we ought to go. Everybody should go to, we should visit Japan and Finland and say, okay, give us the clue here. Go ahead, Clarence. I'm going to say, Stan, it's too late for me. I'm not going to have any more. 
But I do want to know about community. I want to know Michelle you know what what are you doing or how is the community uh being uh included or involved in this issue uh around infant mentality what what I know that you give money out to different programs, but you know those are programs, but community engagement what's what's that about? That's a very good question um so I'll give you a really good example so um I can mention that CDC project, they have a number of different community committees like the Maternal Mortality Review Committee that involves a lot of community input to review those maternal deaths. But then on the infant side, when we write plans, at least in the past, we've always involved community input. 
So too with Title V, communities were involved with prioritizing topics. for the state or issues for the state to address. And with this new CDC grant that we have to address sudden unexpected infant deaths, it will be largely community led. In fact, like I mentioned, the steering committee, the leadership team is made up of primarily African-American and American Indians. We have people with lived experience, both lived and professional experience in this space. And so they will be steering the project. We will... hopefully will do a very good job of listening to them, taking their ideas to guide and steer the project. Additionally, we provide information to the public, right? So that's part of our job as a state agency around different infant health and mortality topics and engage them through social media and other ways. 
But having people sit on committees, being there, sharing power with them, centering and elevating their voices, That is one of the main purposes or goals of this project, too. The CDC project is to do things a little bit differently where we have communities really being at the center of steering this project to make sure that their voices are heard, but that they have an input in setting the direction of this work and making sure that it benefits the community. to the maximum. So their voices will be very important in this work. We can't do this work without communities, right? We can't sit back and make decisions and expect to see the changes that we want to see without the input or the voices of that does not make sense. 
And so if we want to see the changes that we really are desiring, then we really need to engage and involve communities in making decisions and helping to prioritize recommendations, identify what's really at the the root of the problem and making sure that they're there and being at the center of this work. That's interesting because that seems to be a trend that's happening with a lot of different organizations where they're asking for community input. And I think it's long overdue, especially when we've been talking about this issue for 20, 30, 40, 50 years. So thank you for that information. Mr. Jones, I'd like to add that We used to have a fetal and infant mortality review. That's a community-led process where cases of infant deaths are reviewed by an interdisciplinary team of community members with expertise, lived experience, however you want to say it. 
We no longer have that in Minnesota. The statute expired over two decades ago, and they've been trying to reinstate it, but data privacy laws get in the way. But that's a process that's used across jurisdictions, across the U.S., Um, in other states to really engage and involve communities. So hopefully we've been pushing hard to get the fetal and infant mortality reviews back in our state. And so hopefully one of these days we'll get it so we can really understand the circumstances behind these deaths, what are driving them. It involves, a an arm of it is an interview, face-to-face interview with either the surviving mother or family member. Um, and then, you know, recommendations are made and community to form community action teams within communities to really implement strategies that are prioritized by the community to address problems within communities. 
So hopefully we can get a team to really help us with understanding the circumstances and then taking action in that way. So Michelle, quick question. Is there an average age for a mother for a firstborn? That is a good question. No, I don't have any data. That would be interesting to see whether or not parents are having kids older, them as parents being older in this day and age versus before. Well, this has been very enlightening. On one hand, it's sad that we have to address this issue. On the other hand, it's positive that we are addressing that. It's kind of a balance. But I'm really, really hoping that as a country, we can make strides in this area because it really affects the future. 
It really, really does of the human race in the United States. Last comments, Barry. I came away Stan and Michelle, thank you very much as well. I also came away with feeling disheartened that this is still as prominent a problem that has been just going on for decades and it's still with us and seemingly it's like trying to move mountains and very difficult. And at the same time, the other part of this is feeling heartened by the fact of the initiatives that are being tried. Because it's multifactorial, there probably is not going to be a secret sauce that just, you know, like one thing that, you know, that does it. And also, you know, that knowing that Minnesota is... you know, really a leader in a way in being under that 5.0, at least for the healthy people, you know, 2030 kind of things. 
And so that's good to know. But again, you know, it boils down, I think, to issues of disparities and poverty. And those are societal things that, you know, Scandinavian countries, Japan, a lot of these other industrial nations really provide support for health and families, et cetera. And that's lacking in our country. And it's again, this thing, think globally about how this remains an issue, act locally. And like I say, at least Minnesota is in relatively good shape. Doesn't mean that we can't do better because clearly we can. And there's still a ways to go. And it's at least good to know that people like yourself are being a driver to come up with initiatives that may impact this in a positive way. So again, thank you. 
You're welcome. So I'm going to do my comments, Stan. OK. Michelle started off this conversation by talking about how complex it was. I'm the first person to agree to say that this is a very, very complex issue. It's one in which I know that the future of our country depends on the health of our children. I was trying to find that quote that said that, but this is one of those seemingly never-ending issues in our country. that we need to address. And I think that as a country, you know, in many cases, we're supposed to be number one in so many different things. We continuously show that we're not in some cases doing the kind of work that we need to do. And so I'm encouraged to I'm encouraged that there are people out there and organizations out there that are actually trying to address this issue. 
And I just know that having having children, I know what the impact that is. I know the I know the the emotional impact of that is on families, you know, on communities. And, you know, it's just very, very important that we as a community at least begin to look at these things. So that's, those are my thoughts. You know, I really agree with all of this. It's, you know, I have a feeling that infant mortality will be with us. I mean, you know, there are certain things that just, cause normally infant mortality. But certainly the things that we have control over or that we can prevent, I'm encouraged that at least we're aware of them and we're trying to do something about it. 
So Michelle, thank you so very, very much for your insights today on this important issue. You know, it's interesting. Our next show for our listening audience, ironically, is going to be on health care disparities, which is obviously a major variable that affects, in this case, infant mortality. And that will be with Dr. Miguel Ruiz from Health Partners. So that'll be our next show. In the meantime, everybody, thank you for listening in and keep health chatting away.