Social Determinants of Health and Infant Mortality: Policies and Programs on Social Stratification to Reduce Inequalities

October 24, 2016|1:13 p.m.| Alethia Carr and Kay Johnson

Each day this week, ASTHO’s blog 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 and programs that address social stratification and reduce inequalities.


The Earned Income Tax Credit (EITC), Child Tax Credit (CTC), and similar tax policies serve as a type of wage supplement, particularly for low-income families in their childbearing years. EITC is associated with improved maternal health and birth outcomes. Together, the EITC and CTC have a powerful anti-poverty effect, helping up to 13 million children in 2013. Tax credits reduce poverty by: 1) encouraging workforce participation; and 2) supplementing income. States can adopt their own tax policies to supplement federal law and/or assist eligible families in using available tax credits.

Family and Medical Leave

These policies allow workers to take time away from work to address a serious health condition, optimize health during pregnancy, or care for a newborn, newly-adopted child, or newly-placed foster child. The federal Family and Medical Leave Act offers unpaid leave for up to 12 weeks in a 12-month period, but only about half of workers qualify. Some states use the Temporary Assistance for Needy Families (TANF) program option to offer the equivalent of paid maternity leave. States can adopt their own family and medical leave policies, including paid leave and TANF exemptions.

Minimum Wage

The current level for the federal minimum wage ($7.25) is one-third below its value at its peak in past years and contributes to income inequality. Half of minimum wage workers are adults over age 30, just over half work full-time, and about one-quarter are parents. People of color are overrepresented among those who work at minimum wage. Increasing the minimum wage to $10 would affect about 28 million workers and lift 1-2 million people out of poverty. Many states and localities have adopted a minimum wage above the federal level.

Justice System Reform

Public discussions of criminal justice reform emphasize three primary issues: 1) too many young people end up in the criminal justice system; 2) mandatory minimum sentences for nonviolent drug crimes lead to high levels of incarceration; and 3) changes are needed to help people get back on track with work and educational attainment following incarceration. Young men of color are disproportionately affected by the justice system and related employment practices, which in turn can affect their roles as fathers. To address this, states could prohibit questions from employment applications (e.g., “ban the box”), structure criminal background checks to help ex-offenders apply for jobs, and adopt sentencing reforms.

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.