Putting the Cross-Sector Gears in Motion: How 3 Best Babies Zones Are Moving Towards Cross-Sector Action to Reduce Disparities in Infant Mortality

Posted May 17, 2016 by Monica Barr

Monica Barr
Monica Barr

The social determinants of health are trending. 

The root causes of poor health—like persistent poverty, unstable housing and limited educational opportunity—are getting more attention than ever. Sectors as diverse as local government, philanthropists, grassroots organizations and for-profit companies are recognizing the links between these systemic problems and health, and are calling for collaboration on solutions that support healthy people in healthy communities.

This increased attention is critical for an issue like infant mortality, where disproportionate exposure to toxic stress is suggested to be one of the reasons that babies born to African American women are twice as likely to die as babies born to White women, and where cross-sector collaboration is necessary to address the causes of this stress.

The enthusiasm for this increasingly popular approach is energizing. But, how do we make it happen? In communities with high rates of infant mortality, which social determinants should we focus on? Which sectors and which partners need to be engaged to get the work done? And what exactly should they be doing? How do we get all those gears moving at the same time, in the right direction?

The Best Babies Zone (BBZ) Initiative has been working on those questions for four years.

In 2012, BBZ was launched to address the social, economic and environmental factors that contribute to poor birth outcomes. With funding from the W.K. Kellogg Foundation, three small pilot “zones” were launched in Cincinnati, OH, New Orleans, LA, and Oakland, CA. In these cities, a lead organization connects and convenes partners from across sectors, creating possibilities for innovative projects that address the root causes of infant mortality in that community.

A new article in the Maternal and Child Health Journal and a new evaluation report on the Initiative’s fourth year highlight early successes in cross-sector collaboration to improve conditions linked to disparities in infant mortality. Though insights from the pilot zones don’t provide easy answers for making these collaborations work, they do point to ways to get the gears moving in the right direction. Here are some of the key lessons learned:

1. Listen to the community when prioritizing issues. Community members in each BBZ were already clear on the social determinants they wanted to see addressed. Projects in each BBZ that have responded to these concerns—like a monthly market that provides a platform for local entrepreneurs, or a community-led effort to advocate for neighborhood infrastructure improvements—have had the greatest participation and response. Conversely, those projects that were not driven by community voices have not performed as well. Though this may seem obvious, it has taken conscious effort and regular reflection to avoid the pull towards solutions that may not address the community’s concerns. 

2. Respond by getting the right partners to the table. Health and public health organizations might be leading the charge to improve health, but bringing in less traditional partners is key to having the expertise (and the resources) for doing things like improving housing options, changing lending practices or making public transportation more accessible. Some of these partners—like local schools, community development corporations and faith communities—may already see how their work can influence health; highlighting this shared understanding can be a starting point for a strong collaboration around a more specific issue like birth outcomes.   

3. Use tools that get you thinking outside of the box. Breaking away from the usual solutions requires creative thinking, and both the willingness and space to experiment. The quality improvement (QI) principle of rapid cycle small tests of change can support this mentality. The BBZs have also found success with design thinking, which provides a framework for brainstorming and “prototyping” possible solutions in a low-pressure, low-cost environment. Finding tools that support testing and failing in order to move towards success can help partners work together to identify the actions that they can take together to improve health.

The concept of the social determinants of health is more visible now, and more people understand how their work can improve health outcomes like infant mortality. But, as BBZ knows (and as our countless partners working to advance health equity know), it can still be challenging to get cross-sector partnership started and keep the gears turning. But, thoughtful conversation with partners and community members, coupled with practical tools for innovating, have made it possible to start moving towards solutions that improve health across the life course.

Let’s get those solutions trending too.


Monica Barr, MPH, is a program manager for Best Babies Zone.

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