Social Determinants of Health and Infant Mortality: Policies to Reduce Vulnerability and Increase Resiliency of Disadvantaged People

October 26, 2016|2:12 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 policies that reduce vulnerability and increase resiliency.

Job Training, Education, and Career Paths for Economic Self-Sufficiency

Two decades after welfare reform and years into a national recession, many struggle to find jobs that lead to economic self-sufficiency. For every 100 families in poverty, 26 received cash benefits from TANF in 2013. In some states, it was 10 out of 100. Even for those who have jobs, the workplace is less “family friendly” for low-wage workers. States can help low-income women and men address work-family life barriers to employment (e.g., increased access to child care). States can also extend the time for education and training among TANF recipients. In addition, states can support education and training opportunities, especially at community colleges.

Fatherhood/Male Initiatives

In recent years, a fatherhood movement has grown across the country. A large body of research documents the role of paternal involvement in children’s health, development, and well-being across the life course. More limited studies point to the role male partners/fathers play in reducing maternal stress, encouraging prenatal care, and decreasing the use of tobacco and other substances harmful to the fetus. The federal Healthy Start program has long placed emphasis on a father’s role in reducing infant mortality. States have opportunities to develop fatherhood initiatives as part of infant mortality reduction, home visiting, and similar programs focused on birth outcomes.

Social Networking for Empowerment

Strengthening and broadening the use of social network capacity is a key strategy for empowerment. Whether through online social networking or community social support groups, the value of connecting mothers and/or parents to peer support and communication is widely acknowledged. Increasing social support during pregnancy can influence maternal and child health outcomes by influencing decisions and behaviors related to smoking, prenatal care use, breastfeeding, and parenting. Social support is also strongly related to levels of stress and depression. Support groups (i.e., “mom’s clubs” or “family support groups”) are a recognized promising practice. States have the opportunity to advance promising practices and enhance community efforts.

Medical-Legal Partnerships

Medical-legal partnerships are designed to ensure families have equal access to assistance in dealing with health-harming legal problems. These partnerships have been established in nearly 300 healthcare institutions (e.g., clinics, hospitals) in 36 states. The return on investment has been demonstrated. The five domains where complicated procedures, wrongfully denied benefits, and unenforced laws frequently affect health and require legal intervention include: health coverage, housing and utilities, employment and education, legal status, as well as personal and family stability. States have opportunities to increase support for medical-legal partnerships in publicly-funded clinics (e.g., prenatal care, WIC nutrition, FQHC) and other sites serving low-income families.

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.