How well a nation cares for its youngest citizens is often considered a measure of its economic and social well-being. Yet, while the United States maintains a position as one of the richest nations in the world, evidence shows that we have not yet found an effective way to protect our children.
When it comes to health, the first 24 hours of an infant’s life are the riskiest. To assess how babies around the world are doing in those first few hours, Save the Children conducted an international survey and released the report: Surviving the First Day: State of the World’s Mothers 2013. The organization found that infants born in the United States were 50 percent more likely to die on the first day than in any other industrialized nation. This situation has only grown worse in recent years.
In the 1960s, the United States had the 12th lowest infant mortality rate in the world. According to the Department of Health and Human Services, by 2010 we had the 24th lowest. Hidden within those numbers is a drastic disparity between racial and ethnic groups. The infant mortality rate for White women is 10.5 percent for every thousand births. For African American women, it is 16.8 percent. How did we get here and how do we turn things around?
“To begin with, we have not given the needed attention to women’s health in America,” says Kay Johnson, MPH, MEd, a 1998 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research. “Prior to the Affordable Care Act, four out of 10 low-income women had no health insurance,” an obstacle to access to prenatal care. As chair of the Secretary’s Advisory Committee on Infant Mortality (SACIM), Johnson is also well along the path to helping policymakers, providers and the public understand how we—as a nation—can make things better for our children.
A New National Strategy
Johnson, who discussed SACIM’s recommendations at the 2013 American Public Health Association Annual Meeting, explains that “it will take a multifaceted approach” to enhancing the physical, mental, and economic health of women and families to really make a difference in the infant mortality crisis.
“Our plan is centered on six measures that reflect our core principles,” says Johnson, a research assistant professor of pediatrics at the Geisel School of Medicine at Dartmouth and lecturer in health policy at George Washington University. SACIM’s key areas of action are:
l. Improve women’s health before, during, and after pregnancy. Johnson explains that this life-course perspective on health involves comprehensive preventive care throughout a woman’s life, early and continuous high-quality prenatal care and postpartum visits, and care appropriate to each woman as her reproductive history develops. “This would also include support for mental health care if needed,” she adds.
2. Provide access to patient-centered, high-quality care. There is still a great deal to be done, but the goal is to “make sure all women have access to the best possible facilities for giving birth,” Johnson says. The national objective is to make sure all infants and women receive the standard of care currently recommended by the Institute of Medicine.
3. Extend evidence-based prevention efforts to a new generation of families. “We know that smoking cessation, breastfeeding, safe sleeping arrangements for babies, family planning, and immunizations reduce infant mortality. But we have to do a better job of communicating this to a new generation of mothers,” Johnson says. SACIM’s outreach would center on new forms of communication and social media to get the message out.
4. Increase health equity and reduce disparities. The authors of SACIM’s 2013 report write, “poverty and racism profoundly affect psychosocial well-being and are widely considered to be contributors to disparities in birth outcomes and infant mortality.” For these reasons, the committee intends to take a comprehensive, community-based approach to tackling disparities and reducing poverty.
“We want to create a national equivalent of the Harlem Children’s Zone [a network of supportive services] for babies as a way of shifting the curve of the social determinants of health,” says Johnson, who explains that she learned to “understand the levers that impact child health policy” while studying 20 years of child health legislation as an RWJF Investigator. “It taught me how to make policy a reality,” she adds.
5. Invest in data and monitoring, measure quality and access. The SACIM report calls for dramatic improvement in the nation’s “vital statistics system, perinatal surveys, Medicaid perinatal data collection, quality measurement systems, and other data systems.”
6. Maximize collaboration across disciplines. Johnson and the committee are clear that communities, public health agencies, and all sectors of society must “embrace infant mortality as their issue and increase their investment” to make a difference.
Like many other public health experts fighting a pitched battle against health care disparities, Johnson realizes she has to work toward incremental change. “We are hoping to bring some of the elements of the new strategy to life through the Affordable Care Act and looking at other ways to get things done. Right now the committee is revising the national guidelines for well-woman physician visits in an effort to improve pre-pregnancy care.”