Applying Racial Equity to U.S. Federal Nutrition Assistance Programs - Flipbook - Page 67
Appendix 18: Improving Birth Outcomes Among Infants in Baltimore
The Strategy to Improve Birth Outcomes in Baltimore City318 was developed by community partners to reduce the racial infant
mortality divide between African American and white residents and improve overall infant survival in Baltimore. The
strategy was to conduct a comprehensive baseline study, followed by provision of comprehensive services. Some of the
services that are offered include primary health care, obstetric care, home visits, drug and alcohol treatment, intervention
for domestic violence, mental health care, smoking cessation, family planning, nutrition support, breastfeeding promotion,
and safe sleep education.319
B’more for Healthy Babies launched in 2009. The city’s infant mortality rate has since fallen by 38 percent—from 13.5
deaths per 1,000 live births in 2009 to 8.4 in 2015. Sleep-related infant deaths (SIDS) in Baltimore have also decreased by
more than 50 percent since 2009 (from 27 deaths in 2009 to 13 deaths in 2015).320
Appendix 19: Brief History of Obesity in Indigenous Communities
High rates of obesity and overweight among Indigenous communities are due in large part to the history of forced
migration and to the many food desert areas on reservations and in urban areas where Indigenous people live. Corner
markets are often the only nearby source of groceries, and they may offer only prepared foods with low nutrient value
and high levels of salt and sugar. Many Indigenous people participate in FDIPR, a USDA food commodity program that
provides an alternative to SNAP but often offers few fresh foods and many canned and high-calorie foods. These factors
contribute to overweight and obesity.321
As a result of the forced migration of Indigenous communities in earlier generations, many were forced to live on land
that may have not been ancestral.322 This initiated a process of disengaging and disconnecting Indigenous communities
from their original homelands and original food sources—a separation that only deepened over time.323
Before forced migration, many Indigenous communities lived and worked off the land, and had adequate supplies
of food that included fish and other wildlife. In more recent years, however, pollution, habitat destruction, and other
environmental problems have put many wild food sources on or near reservations at risk of contamination.
These factors reduce the availability of healthy foods and increase the overweight and obesity epidemic in Indigenous
communities. Both overweight and obesity put people at higher risk of diabetes. While diabetes did not appear to be a
problem before colonization324—for example, many Native languages did not have a word for the disease325—poor food
quality and lack of food sovereignty have made it a significant problem today.
Appendix 20: Participation Incentive Models
Mary’s Center is a community health center based in Washington, DC, that provides health care, nutrition support,
family literacy teaching, and social services to individuals and families.326 Most clients live in low-income households, and
they are disproportionately people of color. In addition to hosting an onsite WIC agency and providing breastfeeding
support to mothers, Mary’s Center provides access to additional healthcare services regardless of patients’ ability to pay.
Mary’s Center encourages participation in its programs by offering as incentives items that people have indicated they
need. For example, women who attended breastfeeding classes were each given a box of diapers. Even more important,
however, was the center’s offering free child care so that women could attend class and focus on their babies. Lack of child
care is a barrier to participation that many women encounter.327 Another strategy—used to enable participants to eat more
fresh fruits and vegetables—was bringing the farmer’s market directly to the center, where women were already assembled.
They could then use their SNAP match dollars in a convenient way that eliminated the need to secure transportation to a
market and spend time traveling.
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