Social Determinants of Health and Infant Mortality: Policies and Programs to Reduce Exposures of Disadvantaged People to Health Damaging Factors

October 25, 2016|2:08 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 reduce the exposure of disadvantaged people to factors that can have a lasting, damaging effect on health.


Poor housing conditions are associated with unsafe sleeping conditions, stress, and exposure to environmental hazards. For pregnant women, infants, and young children such exposures can result in life-threatening conditions. Lack of crib or bassinet, crowded living space, room temperature, and vermin infestation may all be contributing factors to sleep-related infant injury death (i.e., SIDS/SUID). A study in New York City found housing instability to be a significant predictor of low birthweight. In Boston, the Healthy Start in Housing project seeks improved birth outcomes through improved housing support. States and localities can adopt housing initiatives that focus on housing safety and stability for pregnant women, infants, and their families.

ACE, Trauma, and Resilience

Adverse Childhood Experiences (ACE) fall into two general categories: experiences of childhood abuse (e.g., physical, mental, or sexual abuse) and experiences of household dysfunction (e.g., parental substance abuse, mental illness, incarceration, violence, and separation or divorce). Decades of research show that ACE can result in disrupted health and development for children, and increased adult health problems (e.g., heart disease, depression, smoking, intimate partner violence, risky sexual behavior, and alcohol or drug abuse). For some, ACE and trauma are counterbalanced with protective factors and resilience. Programs serving families should provide “trauma-informed care,” an evidence–based approach for avoiding re-traumatization or victimization. States and communities have undertaken efforts to increase use of: 1) individual assessment with intervention; 2) data collection through surveys (e.g. BRFSS); 3) reports on ACE among children and adults; 4) intergenerational programs to foster resilience (e.g., Strengthening Families and home visiting); 5) trauma-informed systems of care.

Place-Based Initiatives

Strong and supportive communities promote health and well-being. However, many families live in communities plagued with high levels of poverty, unemployment, failing schools, and housing instability. Place-based initiatives are designed to create a community environment that promotes and protects health. The U.S. Health and Human Services Secretary’s Advisory Committee on Infant Mortality (SACIM) recommends place-based initiatives to reduce infant mortality. In addition, federally-funded Healthy Start infant mortality reduction projects are incorporating place-based approaches. Examples of place-based initiatives include: Best Babies Zones, Promise Neighborhoods (U.S. Department of Education), Choice Neighborhoods (U.S. Department of Housing and Urban Development), and Harlem Children’s Zone. States can create their own place-based initiatives, encouraging a constellation of supports in high-risk communities.

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.