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Message from the Interim Health Officer for Los Angeles County
Jeffrey Gunzenhauser, MD, MPH

March 23, 2018

Infant Mortality

Infant mortality, defined as the death of a baby before her or his first birthday, is one of the most important measures of the health of a community. Improvements in the ability of all infants to survive the first year of life has been a long-standing public health goal, as the infant mortality rate is widely recognized as a fundamental measure of a country’s health and well-being. Infant mortality is typically measured as a rate and expressed as the number of infant deaths out of every 1,000 live births. In 2014, the rate in the US was 5.82 infant deaths per 1,000 live births. Although the overall national rate decreased by 15% in the decade prior to 2014, significant differences between racial/ethnic groups persist. Most notably, the infant mortality rate for African-American babies in the US is more than double that of white babies. These inequities are also evident here in Los Angeles County, where African-American infant deaths are three times higher than those among white infants. This gap is unacceptable in light of efforts by other communities that have been successful in narrowing the divide.

A multitude of factors create this health inequity, including poverty, educational attainment, racism, intimate partner violence, the environment, and access to quality health care. Although these risk factors are diverse and complex, closing the equity gap is largely attainable. As a result, the Los Angeles County Department of Public Health has identified infant mortality as a priority health equity issue and has established the goal of substantially reducing the gap between the white and African-American infant mortality rates within the next five years. Efforts have already begun to reach out to key partners to highlight the inequity, express the Department’s commitment to reducing the gap, and identify strategies that are both effective and acceptable.

Our work will need to both recognize the impact of poverty, racism and associated stress on health, and invest in a broad, collaborative effort to address the root causes of inequities in health outcomes. Building on a strong foundation of initiatives housed in clinical settings, communities, and the homes of women themselves, new efforts will be anchored in understanding the challenges facing women of color in Los Angeles County and offering a compassionate, respectful approach to women’s daily struggles to address those challenges.

Causes of Infant Mortality

In the US, the top five leading causes of infant deaths are:

  • Birth defects can cause physical and/or developmental disabilities, as well as other health problems. Defects can be present at birth or detected years later.
  • Preterm and/or low birth weight, or when a baby is born too early, and/or low birth weight, when a baby is born weighing less than 5 pounds, 8 ounces.
  • Pregnancy complications can affect the health of the mother and/or baby. Examples of complications are high blood pressure and gestational diabetes during pregnancy.
  • Sudden Infant Death Syndrome (SIDS), which is one type of Sudden Unexpected Infant Death (SUID)
  • Unintentional injuries such as falls or accidental drownings.

Ways to Reduce the Risk of Infant Mortality

The prevention of infant mortality begins before pregnancy occurs. Preconception health and regular prenatal care can help improve the likelihood that an infant will survive to enjoy her or his first birthday celebration. A few helpful tips for mothers and future mothers alike include:

  • Take good care of yourself: whenever possible, eat healthy foods, exercise regularly, and take a prenatal vitamin with 400 micrograms of folic acid daily before and during pregnancy.
  • Avoid tobacco: smoking tobacco is associated with having a poor birth outcome. African-American women who smoke have a 20-25% chance of having a preterm and/or low-birth weight baby. All persons in the family environment should also stop smoking to reduce second-hand smoke exposure.
  • Visit your doctor regularly so that you can best manage health conditions (for example, depression or high blood pressure) and prepare for a healthy pregnancy. This is especially important if you have had a previous poor birth outcome since you may want to consider medical interventions that can help you have a healthy baby.
  • Protect yourself from Sexually Transmitted Diseases (STDs) before, during and after pregnancy. Congenital syphilis has been increasing nationally as well as locally and can cause severe health effects, even death, for babies born to mothers who are infected. It is important that you and your partner be tested for STDs and take steps to reduce your risk of infection. More information on STDs during pregnancy can be found here.
  • Multi-lingual resources are available to help you. The Women’s Health Hotline 1-800-793-8090 provides information and referrals for health, health insurance, immigration, mental health, social services, family planning, pregnancy, doctor appointments, breast and cervical cancer screening, health improvement skills, dental, vision, immunizations, housing, and access to food. The Los Angeles County Domestic Violence Hotline 1-800-978-3600 can assist you and your family with intimate partner violence issues.
  • Recognize the power of woman-to-woman support and seek opportunities to join networks of neighbors, friends and family whenever possible.

Healthcare providers and community organizations also play a crucial role in improving birth outcomes. Connect female clients of childbearing age with health and community resources including education, screening, health insurance, housing, and social support. Join with other providers and organizations to create solutions that promote racial equity, counter all forms of discrimination, and support access to opportunities and resources necessary for optimal health and well-being for all. In particular, it is important that African-American women and families are supported before, during, and after pregnancies. Click here to learn more about resources for public health agencies, health care providers, and communities to better understand and reduce infant deaths in the US.

Efforts to Address Racial Inequities in Birth Outcomes in Los Angeles County

The Department of Public Health is committed to protecting and improving infant health in Los Angeles County through an array of programs, initiatives, and collaborative relationships with community organizations. In June 2017, the Department of Public Health convened a meeting to address poor birth outcomes for African-American babies. Over 50 community partners and Los Angeles County Health Agency colleagues discussed the factors that influence the inequity gap and identified potential opportunities for collaboration. In October 2017, the Department of Public Health launched the Center for Health Equity in concert with the Los Angeles County Health Agency and the support of the Los Angeles County Board of Supervisors. The Center’s mission includes advancing racial, social and environmental justice in partnership with committed organizations and residents, and one of its initiatives is to close the gap between African-American and white birth outcomes. Many other activities are underway to ensure healthy babies, mothers and families in Los Angeles County. Additional information and local resources on having a healthy pregnancy and child can be found on the Los Angeles County Department of Public Health’s Maternal, Child & Adolescent Health web page.

Previous Messages

01/30/18 - Influenza, often referred to as "the flu," has increased significantly in recent weeks and is now widespread in the state of California and Los Angeles County.Text

11/21/17 - The influenza season is upon us once again. In the US, the flu season occurs during the fall and winter months with peak activity usually occurring from December through February. Text

10/03/17 - On September 19, 2017, the Los Angeles County Department of Public Health declared a local outbreak of hepatitis A occurring among persons who are homeless or actively use drugs. Text

03/24/17 - Every year, World TB Day is celebrated on March 24th to commemorate the day in 1882 that Dr. Robert Koch discovered the bacteria Mycobacterium tuberculosis and identified it as the cause of the disease tuberculosis (TB). Text

02/01/17 - We are now in the middle of the 2016-2017 flu season. A sharp increase in the number of cases has been seen throughout California, and more recently in Southern California. Even though the flu season is underway, it is still not too late to get the vaccine. Text

12/23/16 - Families often travel during the holidays to visit relatives or go on a vacation out of town. These trips are great opportunities to unplug from daily life, spend quality time together with family, and share new experiences. Text

11/09/16 - Sexually transmitted diseases (STDs) are the most commonly reported communicable diseases and rates are rising in the United States, California and Los Angeles County (LAC). In LAC, there were nearly 75,000 STD cases reported to the Department of Public Health (DPH) in 2015. Text

8/12/16 - Climate change is a source of concern for many, especially as warmer, drier weather is observed throughout the county. This affects us in many ways. While the mild El Niño season helped fill many of California’s reservoirs, water is still a major concern. We continue to experience record-breaking temperatures. In addition, in the past few weeks, a number of fires have caused many square miles of brush and property to burn. Text

7/1/16 - In the last two months, 7 cases of invasive meningococcal disease have been reported within the Los Angeles County Public Health jurisdiction. Additional cases have been reported in surrounding jurisdictions.

6/13/16 - June 27th is National HIV Testing Day. The day is a great reminder to get tested for people who don’t know their HIV status or who may have been exposed to HIV since their last test.

4/12/16 - Alcohol is a huge continuing problem that affects many lives and can tear families apart. Alcohol is also the second leading cause of premature death and disability in Los Angeles County, contributing to more than 1000 deaths every year

2/10/16 - There has been a lot of information on Zika in the news lately. Below are some ways we can address this disease to keep our friends and family safe, and to prevent Zika transmission in our County.

1/14/16 - January is Cervical Health Awareness Month. It’s a great time to learn more about cervical cancer and ways to prevent this disease from affecting family and friends.

12/08/15 - I would like to wish everyone a happy and healthy holiday season! I hope many of you are able to spend time with family and friends while enjoying and sharing your cultural traditions. To help you and your loved ones celebrate safely over the next few weeks, here are some tips and guidelines to keep in mind:

11/02/15 - November 16-22, 2015 is Get Smart Week. The goal of Get Smart Week is to raise awareness about antibiotic resistance.

10/09/15 - The 2015-2016 influenza season has started. Make sure you and your family are protected! Get your influenza vaccine now. Influenza, or the flu, is a virus that causes mild to serious illness.

09/08/15 - Prescription drugs play a critical role in treating people when they are sick or feel pain. It is also very important to properly dispose of all unused or expired medications. Unused medication can pose a major health and safety risk if left in the home.

08/10/15 - Last Thursday the California Department of Public Health (CDPH) announced a case of human plague in California. The patient lives in LA County and was hospitalized for the illness after a family trip to Yosemite State National Park and Stanislaus National Forest. Officials are still investigating where the individual may have contracted the disease.

07/06/15 - I am happy to report that new Ebola cases in West Africa have significantly declined due to the extraordinary efforts by healthcare professionals to care for infected individuals and reduce community transmission. The number of new weekly cases in West Africa has remained below 30 for several weeks and efforts remain strong to bring the epidemic to a closure as soon as possible.

04/22/15 - Progress continues to be made as the world responds to the Ebola epidemic in West Africa. Although the situation has improved greatly and the weekly number of new cases has fallen well below 100, we must remain vigilant until the number of new cases in affected countries reaches zero. Here in Los Angeles County, we continue to closely monitor individuals who travel here from affected countries and who may be at risk of developing Ebola.

03/17/15 - The world response to the Ebola epidemic in West Africa has decreased the number of new cases occurring there and there is hope that the epidemic can be stopped sometime this year. Here in Los Angeles County, we continue to closely monitor individuals who travel here from affected countries and who may be at risk of developing Ebola. We maintain our surveillance and actively monitor a small number of travelers each day who have

11/24/14 - Earlier this week the Centers for Disease Control and Prevention (CDC) added Mali to the list of Ebola-affected countries, which continues to include Guinea, Liberia, and Sierra Leone. To date, more than 15,000 individuals have contracted Ebola during this latest epidemic and there have been 5,420 related deaths worldwide. In the United States, a second Ebola-related death occurred last Monday after Dr. Martin Salia was transferred to Nebraska Medical Center from Sierra Leone for medical care following several days of illness. His tragic passing highlights the critical importance of early intervention and care in recovery.

11/17/14 - Ebola outbreaks continue to affect Guinea, Liberia, and Sierra Leone in West Africa with some new cases reported in Mali. While the rate of new cases in Liberia and Guinea has leveled off, the rate of rise in Sierra Leone continues to accelerate. To date, approximately 14, 000 individuals have contracted Ebola during this latest epidemic and there have been 5,160 related deaths worldwide. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) will continue to monitor the situation and coordinate relief efforts to control the spread of infection. It is important to note that only two cases of Ebola have been exported from West Africa to other parts of the world, which is a testament to the effectiveness of the strategies that are in place to prevent spread. Those two cases are, of course, the case that was diagnosed in Dallas on September 30, and the more recent case in a physician in New York City who has recovered and been released.

11/10/14 - The Department of Public Health continues to coordinate efforts to ensure we have an effective strategy to respond to a potential case of Ebola in LA County. As part of these ongoing efforts, we met last week with the Hospital Association of Southern California and the California Association for Health Facilities. The meetings were held jointly with LA County Emergency Medical Services and provided hospitals and long-term health care facilities with an update on Ebola, our current activities, and response plans for LA County. Each meeting was an opportunity to strengthen partnerships and facilitate coordination with all health care providers who may play a role in identifying and treating an individual with Ebola.

11/4/14 - The State Health Officer from the California Department of Public Health recently issued a risk-based quarantine order for any individuals coming into California who had contact with a person confirmed with Ebola in Liberia, Sierra Leone, or Guinea. The Los Angeles County Department of Public Health will comply with the State’s order.
Text | Video: English | En Español

10/28/14 - Last week a doctor based in New York, who had treated patients with Ebola in Guinea, tested positive for Ebola. In Los Angeles County there are no confirmed or suspected cases of Ebola, and we remain prepared to respond should a case happen here.
Text | Video: English | En Español

10/21/14 - As the news continues to evolve around Ebola, I want to reassure all residents in Los Angeles County that, to date, there are no suspected or confirmed cases of Ebola in Los Angeles County. This past week, we have worked diligently to update and strengthen our plans to address Ebola. We are more prepared today than we were yesterday, and we will be more prepared tomorrow than we are today.
Text | Video: English | En Español

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