When Jill Miller, President and CEO of Bethesda Inc. and the bi3 Fund, stood on the Saengar Theatre stage at the 2025 Civic Leader Summit, she shared a story that proves even the most daunting community challenges can be conquered.
- In 2011, Hamilton County, Ohio, had one of the highest infant mortality rates in the country. By 2023, it recorded the lowest rate in its history.
This dramatic transformation didn’t happen by accident—it followed what Miller calls the “IGNITE” framework for tackling wicked problems.
What Are Wicked Problems?
Miller describes wicked problems as complex, interconnected challenges with multiple factors that seem impossible to solve. Think homelessness, food deserts, or educational disparities. These problems feel paralyzing because they’re difficult to understand, much less resolve.
- But Cincinnati proved change is possible. They cut their infant mortality rate in half, from 10.8 to 5.5 per 1,000 births, and eliminated racial disparities for the first time on record.
- The result? 220 babies are alive today who might not have been otherwise.
The IGNITE Framework
Innovation: Think differently about old problems. Einstein said insanity is doing the same thing repeatedly while expecting different results. Cincinnati broke down silos between hospitals, connected OBGYNs with pediatricians, and linked healthcare systems with nonprofits.
Guide with Data: Start with numbers, but dig deeper. The data showed extreme preterm birth was the leading cause of infant death, but talking to mothers revealed the real barriers: lack of transportation, childcare, and time off work—not just appointment availability.
Narrative: Build compelling stories that move both hearts and minds. Miller emphasizes you need data for the logical brain and emotion for the heart. Share testimonials, debunk myths, and show different audiences what’s in it for them.
Influence: Identify champions who can remove barriers and break down silos. Cincinnati’s success required passionate healthcare leaders, civic officials, and community advocates working together.
Trust: You can’t just knock on doors and say “trust us, we’re here to help.” Cincinnati built trust by identifying community allies, organizing meals between doctors and mothers, and demonstrating genuine curiosity rather than judgment.
Engage: Most importantly, listen to those with lived experience. As Miller emphasizes, “Nothing for me without me.” The most effective solutions came directly from mothers who understood the real challenges and barriers they faced.
Cincinnati’s journey from crisis to success demonstrates that even the most complex community challenges can be solved when leaders embrace innovation, follow the data, build trust, and—above all—listen to those who understand the problem firsthand.
Miller is the co-author of Infant Mortality and Other Wicked Problems, which details Cincinnati’s journey to reduce infant mortality to a historic low and to demonstrate change is doable. The book is written to inspire other communities to tackle their own complex issues.
ESCAMBIA COUNTY
The most recent available data shows Escambia County, Florida’s infant mortality rate is between 7 and 8 deaths per 1,000 live births, which is higher than the state average. In 2023, Escambia County reported an infant mortality rate of approximately 8.3 deaths per 1,000 live births, according to the Florida Department of Health. The Florida statewide rate was about 6 per 1,000.
The infant mortality rate for Black babies was 11.3 per 1,000 live births, according to the Florida Department of Health.
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