Report calls for fresh approach to lower deaths

As state and local officials continue searching for ways to reduce Ohio’s stubbornly high infant-mortality rate, a new report released Wednesday urges them to look beyond medical care.

Improving social and economic conditions such as housing, transportation, education and employment opportunities could help Ohio make faster progress in reducing the number of babies dying before their first birthdays.

The 233-page study by the Health Policy Institute of Ohio includes 127 policy recommendations, many gleaned from experience of other states.

“We’ve always known infant mortality is very complicated. Clinical care is necessary, but we also need to look at other issues,” said Shannon Jones, executive director of Groundwork Ohio, a child-advocacy group, and a former state senator long focused on the issue.

“This report is giving us a different lens to view infant mortality and a menu of things to address the problem ... and broaden our focus.”

Jones and fellow lawmakers called for the report last year because efforts to date had not “moved the dial,” she said.

“While health-care providers play a key role in improving infant outcomes, access to quality health care is necessary, but not sufficient. Improvements to factors beyond medical care are needed to achieve infantmortality reduction goals, to overcome the inequities and community conditions driving Ohio’s worsening infantmortality rates and large disparities,” the report found.

“Addressing the social drivers of poor health, such as housing, education, employment and transportation, holds great promise for preventing infant mortality.”

Such social and economic conditions account for half of the factors that influence health, compared with 20 percent attributed to quality health care and 30 percent the result of smoking, poor nutrition or similar behaviors.

Despite the investment of millions of tax dollars to improve health outcomes for newborns, Ohio recorded a slight increase in the number of babies who died before their first birthdays in 2016.

The state averaged 7.4 infant deaths for every 1,000 births last year, up from an infantmortality rate of 7.2 in 2015, according to the Ohio Department of Health.

In raw numbers, 1,024 Ohio infants died before the age of 1 in 2016, up from 1,005 in 2015. Most troubling, the mortality rate for black babies was three times higher than white infants in 2016.

Nearly $50 million was included in the current state budget for community programs to address the problem, following about $87 million invested in the previous six years.

Still, the state’s infant-mortality rate hasn’t varied much in the past decade.

The report says those numbers underscore the need for a different approach.

“Research suggests that a woman’s health before pregnancy can have a greater impact on outcomes and disparities than do the nine months of gestation. Therefore, interventions such as prenatal care, case management and care coordination that often do not reach women until their second or third trimester are largely too little, too late,” the report said.

Yet, over the past few decades, Ohio’s efforts to reduce infant mortality have focused primarily on healthcare access, the report noted.

Instead the state should focus on improving community conditions including:

Ensuring families have decent, stable housing and income n Better connecting lowincome families to jobs, transportation, post-secondary education and social capital

Expanding early-childhood programs, decreasing education disparities, preventing violence and supporting marriage

Acknowledging and addressing the roles of racism, discrimination, violence and toxic stress

Addressing immediate needs, such as homelessness, but also pursuing fundamental changes to the housing, transportation, education and employment sectors that ensure that all Ohio families can participate in the economy, build positive social relationships and attain optimal health.