Social Determinants of Health and Infant Mortality: Cross-Cutting Actions

October 28, 2016|1:25 p.m.| Alethia Carr and Kay Johnson

Each day this week, ASTHO’s blog StatePublicHealth.org will take a look at a set of strategies developed by the Social Determinants of Health Learning Network as part of the nationwide Infant Mortality Collaborative Improvement and Innovation Network (CoIIN). Today, the topic is cross-cutting policies and program as described in the WHO framework for tackling social determinants of health.

Health Equity in All Policies

Health in all Policies (HiAP) is an approach and conceptual framework designed to shift how decisions are made and implemented by government to ensure that policy decisions have neutral or positive impact on health. HiAP aims to promote health and equity, support cross-sector collaboration, benefit multiple partners, and create structural and process change. Some leaders have pushed further to pursue health equity in all policies. Many states are active in pursuit of health and health equity in all policies, including California, Colorado, Minnesota, Rhode Island, and Washington. Currently, the ASTHO President’s Challenge focuses on advancing health in all policies to achieve greater equity.

Assess Organization or Agency Capacity to Change Policy and Programs

Every state health department should assess their capacity to address SDOH and advance health equity. The Midwest states in Region V are developing a tool that can provide an assessment of capabilities to address social determinants of health and advance health equity and track progress over time. Critical categories of assessment include but are not limited to: leadership, resource utilization, policy, cross-sector engagement, partnerships, communication, system redesign, continuous quality improvement, and performance measurement. The Washington State Health Equity Review Tool is another resource available to states. Michigan has an approach to assessing and advancing Practices to Reduce Infant Mortality through Equity (PRIME).

Map Risk and Protective Factors to Help Focus Prevention and Intervention Efforts

Many state and local health departments have undertaken efforts to “map” risk and protective factors in order to better focus prevention and intervention programs. Such efforts involve several steps, including: focusing on issues of concern, identifying indicators for which data are available, preparing maps, and using the maps and data to guide policy, program, and community decisions. For example, the California Healthy Communities Data and Indicators project has a standardized set of 21 indicators and tools that a broad array of sectors can use for planning healthy communities and evaluating the impact of plans, projects, policies, and environmental changes on community health.

Monitor Unequal Treatment and Disparities in Birth Outcomes

Monitoring both unequal treatment and disparities in birth outcomes is a core, cross-cutting strategy in the SDOH Learning Network. Every state has data on birth outcomes, and health surveys offer additional data. Yet more needs to be done. Challenges include lack of data for the subpopulation of interest (e.g., African American or Native American pregnant women) or specific services (e.g., content or quality of prenatal visit). States have opportunities to: work toward implementation of uniform data collection standards, develop unique data sets, support analyses of existing administrative and survey data, and conduct special studies to provide more detail regarding subpopulations, geographic areas, or health providers/systems.

Alethia Carr, RD, MBA is co-chair of the Infant Mortality CoIIN Social Determinants of Health Learning Network. She has worked as a state maternal and child health leader for more than 30 years and retired in 2013 as the MCH Director for the state of Michigan.

Kay Johnson, president, Johnson Group Consulting, Inc. is co-chair of the Infant Mortality CoIIN Social Determinants of Health Learning Network. She has more than 30 years of experience working on maternal and child health policy.