Purpose Since 2020, Sudden Unexpected Infant Death (SUID) rates have increased to an infant mortality rate (IMR) of 1.0 per 1,000 live births in 2022. Non-Hispanic Black infants experience higher SUID IMRs (2.4) than non-Hispanic White infants (0.8) and infants born extremely prematurely (24–27 weeks’ gestation) are also at increased risk (IMR 2.7). While many SUID cases are preventable through safe sleep practices, barriers such as misinformation, lack of access to culturally tailored resources, and ineffective messaging hinder prevention efforts. Methods To address these challenges, the “Let's Talk Community Chats” program was developed to provide culturally responsive, community-based, and evidence-based education on safe sleep and infant care. Trusted community members were trained as facilitators to deliver accessible, nonjudgmental, and evidence-based guidance that reflects families' lived experiences. A 2024 pilot in Atlanta communities showed improved adherence to safe sleep practices among non-Hispanic Black families, with increased infant back to sleep placement (40% to 60%) and removal of soft items from sleep areas (40% to 70%). Building on this success, the program was expanded into the NICU of a large public safety-net hospital in Georgia, where monthly sessions were held for NICU families. Post-event surveys assessed program educational effectiveness and gathered qualitative feedback data. Results Between January and August 2025, 51 participants attended and completed post-event surveys. Most participants were Black (87%) and aged 26-35 (50%). All respondents (100%) reported feeling culturally supported by facilitators, and 82% said their specific concerns were fully addressed. Most participants learned new information, particularly about back-to-sleep (76%) and the importance of a separate sleep surface (56%). After the session, 94% reported having a safe sleep plan, and 88% of those said the event influenced that plan. All planned to use a safe sleep space (crib, bassinet, or pack-n-play), and 92% intended to place their infant on their back to sleep. 88% planned to keep the sleep space free of soft items, though 8% still intended to use bumper pads or blankets. Participants consistently described the sessions as “comprehensive, supportive, and empowering”. Conclusions The “Let's Talk” NICU program demonstrates that embedding culturally sensitive, community-led education into clinical settings can improve parental knowledge and intentions around safe sleep. Its success highlights the critical role of healthcare–community partnerships in delivering place-based, culturally informed education, especially for high-risk and historically marginalized populations. Integrating this model into existing care systems offers a scalable strategy to reduce disparities in infant mortality and improve health outcomes for vulnerable infants and families.
For the Pacific Small Island Developing States (PSIDS), climate change will greatly exacerbate their vulnerability. The PSIDS have a high ranking in the Climate Risk Index and the World Risk Index. Financial losses due to climate-induced disasters, in terms of gross domestic product (GDP), are also high in the Pacific region. While climate risk insurance solutions could play a key role in the efficient distribution of recovery resources, there are many challenges to their successful implementation. Effective climate risk insurance products for the vulnerable sections of these societies are almost non-existent in this part of the world. Among the worst climate-induced disasters to affect the PSIDS are those related to cyclones and floods. These not only adversely impact the welfare of the households affected by these disasters, but they lower the long-term development potential of the countries involved. There is also evidence to suggest that climate-induced disasters are increasing in frequency and intensity over time due to climate change. It is against this background that an inquiry into the necessity for climate risk insurance products in the context of PSIDS should take place. This paper gives a comprehensive review of the literature addressing climate risk insurance as a risk mitigation or climate adaptation tool for managing the climate-induced financial vulnerabilities in the PSIDS. The paper explores the affordability of climate risk insurance, particularly among the vulnerable sections of society, and discusses the challenges of implementing an appropriate climate risk insurance model in the region. Finally, it examines recent climate risk insurance initiatives that have been attempted by multilateral agencies, such as the United Nations Development Programme (UNDP), the United Nations' Pacific Financial Inclusion Practice (UNCDF), Pacific Insurance and Climate Adaptation Programme (PICAP), and respective local governments.
Sidney Perkowitz reviews The Janus Point: a New Theory of Time by Julian Barbour.
