Social Determinants of Health and Infant Mortality: Policies to Reduce Unequal Consequences in Social, Economic, and Health Terms as a Result of Illness

October 27, 2016|4:05 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 that reduce unequal consequences as a result of an illness.


Financing more than half of U.S. births, Medicaid is central to the national infant mortality reduction strategy. States have an opportunity to improve the health of men and women of childbearing age through Medicaid expansion. More than half of states expanded Medicaid to 138% of the federal poverty level as defined in the Affordable Care Act. In addition, while children’s preventive services are covered under the Medicaid Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) benefit, not all states cover adult preventive visits. States have an option to extend Medicaid coverage to the clinical preventive services benefits, including the eight women’s preventive services (e.g., well-woman visits, contraception, breastfeeding supports) and other prevention services such as immunizations now required to be covered without cost sharing for most private plans and public exchange plans.

Quality Improvement (QI) Projects Related to Unequal Treatment

The Institute of Medicine report on Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care documented significant variations in rates of medical procedures by race/ethnicity, even when insurance status, income, age, and severity of conditions were comparable. QI projects are an essential tool for promoting equitable treatment. The SDOH Learning Network suggests state-driven QI projects to reduce unequal treatment in: prenatal care, postpartum visits, well-visits for infants and women, 17P/progesterone, long-acting reversible contraceptives, and NICU care.

Implementation of National CLAS Standards

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) are designed to provide a blueprint for healthcare providers and organizations looking to implement culturally and linguistically appropriate services. State agencies have embraced the importance of cultural and linguistic competency, and a number of states have proposed or passed legislation pertaining to cultural competency training for one or more types of health professionals. Requiring use of CLAS standards is a major area of opportunity for state agencies, state and local public health departments, and/or state contracting and procurement.

Home Visiting Enhancements

Home visiting services for pregnant women and families with young children are part of a continuum of services for mothers and babies, particularly for at-risk families. All states have implemented evidence-based home visiting models through the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, and most states have additional evidence-informed programs. States can also enhance home visiting with evidence-based services designed to be delivered in the home to address particular risks and conditions common among families targeted for home visiting, (e.g., maternal depression, intimate partner violence, or early childhood mental health).

Centering Pregnancy and Parenthood and Other Group Care Strategies

Group care strategies are considered a cost-effective way to provide perinatal services, and have been shown to have positive effects on the use of prenatal care, as well as the improvement of some perinatal outcomes. In addition, group care has the potential to reduce unequal treatment and enhance support for women with less social support. Centering Pregnancy is a promising method of delivering group prenatal care with a structured approach. The U.S. HHS Centers for Medicare and Medicaid Services (CMS) Strong Start for Mothers and Newborns Initiative is studying the use of group care as a potential strategy. States have opportunities to support group care strategies, particularly in publicly funded prenatal clinics.

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.