St. Louis Effort Focuses on Transportation to Reduce Black Infant Mortality

Social service agencies and health systems that survey community members are finding that transportation is a key barrier to health equity. In St. Louis, a multi-sector partnership is working to improve transportation options to address its overall goal of reducing black infant mortality.

All In, a learning network of communities testing ways to improve community health outcomes through multi-sector partnerships, led a June 5 webinar focused on transportation.

Kendra Copanas, executive director of Generate Health in St. Louis, spoke about a project called Flourish St. Louis, which is using a data-driven approach to improve maternal and infant health outcomes by targeting transportation access for pregnant women and new parents in two contiguous ZIP codes of 63106 and 63107 in the City of St. Louis. The effort was chosen to participate in the BUILD Health Challenge, a national program that puts multi-sector community partnerships at the foundation of improving health.

Generate Health’s work focuses on understanding the community’s needs, educating service providers and community leaders, advocating for positive policy change and mobilizing the region around the most pressing maternal and child issues.

Copanas began by framing the problem: Black infants in St. Louis are three times more likely than the state average to die by their first birthday and the disparities are not improving. Flourish St. Louis is a multi-sector collaboration committed to eliminating this racial disparity gap by 2033. St. Louis, she added, is “one of the most highly segregated communities in the country.” If you draw a horizontal line through a map of the region, the area north of the line is home to some of the most deeply entrenched racial disparities in the country, she added.

“We held 17 listening sessions with 350 community members,” she explained, and several priorities emerged, one of which is transportation. Poor transit options can lead to missed prenatal visits and checkups, which can lead to low-birthweight babies and other complications. She said it has been estimated that there are 4 million missed healthcare appointments each year in the United States due to transportation issues.

In these neighborhoods, residents are more than twice as likely to not own a car, and to rely upon public transit, than St. Louis residents overall. In North St. Louis, 40 percent of households have no vehicle. Public transportation is a fundamental driver of health equity in St. Louis, where nearly three out of four public transit users are black.

“Moms and families have told us that transit access to jobs, food, education and childcare located outside their community is limited,” she said. “These barriers contribute to family well-being issues and infant mortality.”

In listening sessions, Generate Health heard typical scenarios of moms who are pregnant or with a sick toddler having to take time off from part-time work to take the bus to a doctor’s appointment. The trip often includes walking many blocks to a bus, which only comes once every 40 minutes. If you miss that bus, you are likely to miss the appointment, and if you show up late, they may not be able to see you.

Generate Health is leading the Flourish St. Louis effort in partnership with the City of St. Louis Department of Health, SSM Health, St. Louis Children’s and Barnes Jewish Hospitals, Mercy Hospital St. Louis, and Project LAUNCH/Vision for Children at Risk.

Besides these groups, an action team includes a diverse array of stakeholders, such as a legal aid organization, consumers, parents and a broker for non-emergency medical transportation.

Public transportation has been the default for pregnant women, but now they can request a ride regardless of how far they live from a bus stop. The project is working to develop a rider’s “bill of rights” around the basic quality of ride with non-emergency medical transportation, said Sarah Kennedy, manager of evaluation and epidemiology. Flourish St. Louis has been working with the managed care organizations to develop community engagement strategies to increase utilization. One goal is to measure the increase in utilization of public transit and the non-emergency medical transportation system, she added.

As non-emergency medical transportation utilization increases, they expect to see more prenatal care and fewer emergency department visits. They are working with providers to gather baseline data about utilization, and have commitments from partners to produce quarterly reports to measure this process.

The project’s data also helped illuminate for the transit agency and non-emergency transportation providers where service gaps were most disproportionately impacting black families.

One challenge, Copanas said, is that citizens’ concerns about bus stop shelters, lights or sidewalks are the responsibility of the municipal government, not the public transit agency, so they have to get the city involved, too. “We had to do a lot of background research on the transportation sector to better understand their scope and focus,” she added.

Copanas concluded by stressing the importance of building relationships and aligning public health and other health partners as well as integrating community members at every step to help them advocate for more improvements. “You have to hold actors accountable for making changes,” she said. There is a real desire in the transportation sector to be responsive. It was not hard to build relationships. It is a win-win for health and transportation. It really matters to improve equity and reduces disparities.”