2021 STRATEGIC PLAN - Government Of New Jersey

III. NAVIGATING THE STRATEGIC PLAN DOCUMENTSoutcomes. The existing structures and processesare perfectly designed to get the results they arecurrently getting, and this is what the Strategic Planaims to change.A Note on LanguageThe Nurture NJ Strategic Plan uses languageconventions that are intended to be universal andinclusive. In this plan, we use the phrase “maternaland infant health” to refer to the health of pregnantindividuals, which can include cis gender females,non-binary individuals, and transgender men, and theirbiological infants. We do not assume that all individualsthat give birth to a child will care for that child, so werefer to caregivers, partners and spouses, and the planintends to address their well-being as well.MethodologyFollowing First Lady Tammy Murphy’s announcementof Nurture NJ in January of 2019, her office initiateda multi-pronged, multi-agency approach to improvematernal and infant health among New Jersey womenand infants. This multi-sector formative stage laidthe foundation for subsequent collaboration andis an important part of the methodology of theStrategic Plan’s development. High-profile events –including the annual Black Maternal and Infant HealthLeadership Summit; the First Lady’s Family Festivals;quarterly interdepartmental maternal and infanthealth meetings; and one-on-one meetings with keystakeholders and experts by the First Lady – raisedconsciousness about the challenges the State faces inmaternal and infant health disparities, and generatedcommitment and productive action on the part ofvarious stakeholders and communities.In November 2019, a team of multidisciplinary expertswas assembled to guide the development of a sciencebased, comprehensive, and actionable plan focusedon equity and improved outcomes for all women andinfants. The initial timeline was nine months fromstart to implementation of the Plan but was extendedsix months to accommodate disruptions caused bythe COVID-19 pandemic. The strategic planning teamattempted to model equity, community engagement,power-building and multisector partnershipthroughout the development process, as these areintegral components of the Plan. The equity approachis informed by critical race theory, which includesidentifying and addressing the effects of historicalracism that is currently embedded in institutions andimpacts life experiences for people of color.The Strategic Planning process entailed:1. An initial formative stage to develop interest,partnerships and common language;2. Review of the scientific evidence on state-of-the-artmethods for addressing inequities in maternal andinfant health;3. Development of an “Ecosystem Map” as a referencefor stakeholders to understand the structuralconditions necessary to achieve Nurture NJ’s goalsfor healthy communities, healthy behaviors,respectful and effective clinical practice andequitable outcomes;4. Integration of pre-existing work focused ondeveloping a clinical blueprint for improved maternalhealth using quality improvement methods;5. A statewide scan of existing state departmentsand agencies, organizations and stakeholders thatdirectly or indirectly impact maternal and infanthealth;6. Interviews with officials in eighteen statedepartments and agencies; seventy-five leadinghealth providers, advocates, academic researchers,professional organizations, specialty task forces,funders; and a range of community-based andcommunity-serving organizations;7. Four in-person dialogue groups with resident womenin South New Jersey and the coast (n 40), and fourvirtual dialogues with women in northern New Jersey(n 30);8. Development of action areas for improving maternaland infant health and eliminating disparities, alignedwith identified state needs based on interviews anddialogues;9. Wide distribution of multiple Strategic Plan draftsto stakeholders across the state, with feedbackprovided verbally and in writing.Based on the comprehensive stakeholderparticipation in the planning process, the finalStrategic Plan is considered to be a collaborativelydeveloped product.NURTURE NJ8

IV. Executive SummaryThe United States has the worst maternal mortality rateamong all comparable economically developed membercountries of the Organization for Economic Cooperationand Development (OECD). Thirty-six countries comprisethe OECD, and the US ranks the highest in maternalmortality. Within this global context, New Jersey’smaternal health outcomes and disparities are amongthe worst in the US. The state has the fourth highestmaternal mortality rate out of the fifty states; onlyIndiana, Georgia and Louisiana have higher rates. Whenlooking at the demographic breakdown of the rates inNew Jersey, Black women in New Jersey experience seventimes the rate of death from pregnancy-associatedcauses compared to their white counterparts.For infant mortality, the US again ranks poorlyinternationally—33rd out of 36 OECD countries.While New Jersey as a whole has the 5th best overallinfant mortality rate among the 50 states, its challengewith respect to infant mortality is the unacceptabledisparity: Black women in New Jersey experience a 3.5times higher rate of infant death compared to whitewomen (2017 data, courtesy of New Jersey State HealthAssessment Data (NJ SHAD)) and Hispanic women inNew Jersey experience twice the rate of infant mortalitycompared to white women (NJ SHAD 2016-2018, 3-yearrates). While nationally, Native American womenexperience high rates of infant mortality, the populationnumbers in New Jersey are too small to tabulate a rate.Over a five-year period from 2014-2018, there were 335live births to Native American women in the state andone infant death.1NURTURE NJ9

IV. Executive SummaryNJ PREGNANCy-ASSoCIATED DEATHS by RACE/ETHNICITyRATIo PER 100,000 LIVE Figure 1All WomenWhite Non-HispanicBlack Non-HispanicHispanic2017Source: NJ DOHFirst Lady of New Jersey Tammy Murphy officiallylaunched Nurture NJ in early 2019 as a statewideinitiative committed to reducing maternal and infantmortality and morbidity, as well to ensuring equity inmaternal and infant morbidity and mortality for Blackand Brown women in the state. Nurture NJ is a multipronged, multi-agency initiative that aims to makeNew Jersey the safest place in the nation to give birthand raise a baby, and to eliminate the state’s racialdisparities.In the Fall of 2019, the First Lady convened a teamof national experts to create a Strategic Plan forNurture NJ that would document the existing need,survey current efforts, and define a course forlasting, transformative change. She did so with theunderstanding that such an ambitious initiative wouldrequire significant policy changes in the social, political,and economic arenas. Improved maternal and infanthealth outcomes in the state will only be possiblewhen the racial inequities in health are eliminated.Health equity, in turn, can only occur when racial equityis achieved in all three arenas. Looming over this,however, was the knowledge that the State as a wholemust be prepared to confront its racial inequities.2018As the strategic planning unfolded, national eventsexploded, fixing the nation’s attention on racism andracial and ethnic inequities. Before the end of the firstquarter of 2020, the country was beset by a globalpandemic of COVID-19 that has killed far too manypeople in New Jersey and worldwide [over 20,000deaths in New Jersey, 400,000 US deaths, and 2 milliondeaths worldwide as of this printing]. Black populationsexperienced a disproportionate amount of illness anddeath from COVID-19. Black New Jersey residentscomprise 13 percent of the total state population butcomprise 17 percent of all COVID-19 deaths in the state.Then, in May 2020, George Floyd was murdered by apoliceman in Minnesota. The combination of these twoevents, COVID-19 and George Floyd’s murder, mark amoment in history when many Americans witnessed,and could no longer deny, the depth of structuredracial inequities in a country they assumed to be “postracial”. Those on the frontlines of racial justice priorto this moment lost patience with the slow—or nonexistent—progress in remediating racial oppression.Communities across the country and across New Jerseygathered in the streets to protest the structural racismaffecting Black people with regard to policing. The stateof maternal and infant health in New Jersey, with theNURTURE NJ10

IV. Executive Summaryextreme disparities in maternal and infant morbidityand mortality, reflects these same forces as they playout in the reproductive lives of women. This StrategicPlan offers channels through which to act.Black infant mortality rate in New Jersey was 9.4 per1000 live births, marginally surpassing the goal set in2000 (see Table 1).This is not the first attempt to address these issues.New Jersey has been setting ambitious goals fordecades. In the fall of 1996, a Blue-Ribbon Panel onBlack Infant Mortality was convened to formally studythe problem of infant mortality in New Jersey. The Paneldeveloped a series of recommendations to address thehigh rates of Black infant mortality. Meanwhile, HealthyNew Jersey 2000 set a goal to decrease Black infantmortality from the 1996 rate of 16.3 per 1000 live birthsto 11.0 deaths per 1000 live births by 2000. That targetwasn’t reached until 2011—11 years after the targetdate. By 2017, seventeen years after the expectation ofreaching a rate of 11.0 deaths per 1000 live births, theNew Jersey as a whole ranks more favorably than the USaverage on a number of social and health indices, butthe overall numbers mask the experience of Black andBrown people in the state. In a recent report, New Jerseyranks as the eighth healthiest state overall, up fromeleventh in 2018 and twenty-second in 2000, whichconsistently puts it among the states with the largestimprovements.2 However, in key indicators (see Table 2),Black and Brown New Jersey residents fare worse thanother populations in the state. There are considerabledisparities by race/ethnicity in poverty, unemploymentand per capita income.The disparities in maternal and infant outcomes are notthe result of differences in genes or behavior, but theTable 1: Infant OutcomesInfant Mortality RatePremature BirthUSNJNJ BLACKNJ WHITENJ HISPANICNJ ASIAN5.84.59.42.74.83.29.9 (CDC)9.513.58.29.88.9Sources: National Vital Statistics Reports, Vol. 68, No. 13, November 27, 2019NJ SHAD (2017)Table 2: Social Determinants of HealthUSNJNJ BLACKNJ WHITENJ HISPANICNJ ASIANPopulation Distributionby Race/Ethnicity----12.8%54.6%20.6%9.7%Percent Below 100% FPL(2018)13.19.516.15.517.17.1Unemployment Rate(2018)4.94.99.04.14.64.3Per Capita Income (2018) 33,831 42,815 29,459 52,084 24,983 50,446Food Insecurity (2017)12.5%9.6%Mercer County asproxy for Black andHispanic Pop.NANANA10.6%Source: NJ SHAD (2018)NURTURE NJ11

IV. EXECUTIVE SUMMARYresult of the different historic, social, economic, andhealth environments experienced by Black and Brownwomen.3 These economic and social differences matterfor health, they are determinant of health, and as longas they exist, so will the disparities in maternal andinfant health.so that the conditions and opportunities for health arealways available. Achieving these proximal objectives,and the ultimate goals of Nurture NJ, will requiresimultaneous transformation through nine domains ofaction, across three life course areas affecting maternaland infant health.The last 25 years have seen little impact on improvingmaternal health, reducing maternal morbidity andmortality, and reducing infant mortality; and noprogress toward equity in most outcomes. The USas a whole has actually gotten worse across theseindicators, and lags behind most economicallycomparable countries in maternal and infant health.New Jersey mirrors these national trends. The pathwaysleading to adverse outcomes in maternal and infanthealth include multiple dimensions of causality thataccumulate over a lifetime and across generations. Theyhave social roots with multiple intersections that formunique and complex conditions of lived experience thatthe old systems of health care and public health werenot designed to accommodate.Nurture NJ recognizes this complex reality and has beenactively building momentum toward implementingnew ways to address these challenges with the state’sstakeholders. The Nurture NJ Strategic Plan brings tobear the science to define a new structural approach,and can be an organizing force for government, privatestakeholder, and community partnership action. ThisStrategic Plan is predicated on the knowledge thatachieving the goals of Nurture NJ will require innovativeand transformative action to achieve structural change.The goal is to make New Jersey the safest place in thenation to give birth and raise a baby by improvingconditions for maternal and infant health during criticalperiods, and by achieving equity in all maternal andinfant health outcomes.The disparities inmaternal and infantoutcomes are not theresult of differencesin genes or behavior,but the result of thedifferent historic,social, economic, andhealth environmentsexperienced by Blackand Brown women.To make this massive task more digestible, the StrategicPlan identifies three proximal objectives: (1) ensureall women are healthy and have access to care beforepregnancy, (2) build a safe, high-quality, equitablesystem of care and services for all women duringprenatal, labor and delivery and postpartum care, and(3) ensure supportive community environments andcontexts during every other period of a woman’s lifeNURTURE NJ12

IV. EXECUTIVE SUMMARY9 Action Areas for the Nurture NJ Strategic Plan include:1. Build racial equity infrastructure and capacity.Racism finds its way into all systems affecting thehealth of women and children—including health,social services, criminal justice systems, housing,food systems, employment, etc. For Nurture NJ tobe successful in achieving equity in maternal andinfant outcomes and in making New Jersey thesafest place to give birth, some hard work is neededto dismantle the systems that hold racism in placeboth inside and outside government. What makesNurture NJ distinct from other strategic plans is itscommitment to eliminating the role that racismplays by systematically restructuring the systemsthat hold racism in place. Therefore, new structuresneed to be built to both provide people with thecapacity and skills to undo racism, and to ensurethat the requisite equity-promoting actions becomea part of every person’s and organization’s DNA.2. Support community infrastructures forpower-building and consistent engagement indecision-making.During the Nurture NJ strategic planning process,the voices of women in New Jersey communicatedloud and clear “not about us without us”, meaning:“listen to us; do not make decisions that profoundlyaffect our lives without us at the decision-makingtable.” The Strategic Plan outlines specific actions tostructure this engagement into practice. Communityengagement in decision-making is only the firststep. Effective collaboration between residents andagencies requires support to communities to buildtheir own knowledge base, conduct their own criticalanalyses and enhance their leadership skills. TheStrategic Plan includes recommendations to ensurea sustained, effective, and structured process ofcommunity power-building and engagement.3. Engage multiple sectors to achieve collectiveimpact on health.In order to achieve the vision of Nurture NJ,private sector participation is as critical as publicsector participation for the needed values-basedtransformation for the state. All sectors must beengaged—education, housing, health, business,government, policy, justice, service providers, andeach of these sectors needs to work with racialequity awareness, practices, and processes. TheStrategic Plan makes a series of recommendationsto ensure that all sec

Jan 20, 2021 · NTE NJ 2 2021 STRATEGIC PLAN This publication was co-funded by The Nicholson Foundation and the Community Health Acceleration Partnership (CHAP). The Nicholson Foundation is a private foundation bas