august 31, 2011 infant mortality in the u.s.: achievements and challenges national institute for...
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August 31, 2011
Infant Mortality in the U.S.: Achievements and Challenges
National Institute for Health Care Management (NIHCM) FoundationFor
Infant Mortality in Tennessee Best Practices Forum
Kathryn Santoro, MA
About NIHCM Foundation
International, National and State trends
Federal efforts
Emerging evidence & promising practices
Things to consider
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What is NIHCM Foundation?
Nonprofit, nonpartisan organization based in Washington, DC founded in 1993
Our mission is to: Conduct nonpartisan, objective & fact-based research, analysis and educational activities that
inform the health care reform debate, provoke new thinking and ideas, and foster positive change that improves access to quality health care
Encourage dialogue and collaboration between the public and private sectors to find creative and workable solutions to health system challenges
Governed by a Board of Directors that includes CEOs of 14 BCBS health plans and an Advisory Board of health policy experts Together these health plans provide coverage to about 78 million people or over one quarter of
the U.S. population
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NIHCM Foundation’s Maternal & Child Health Track Record
14-year partnership with HRSA’s MCHB Foster public/private interchange & collaboration Educate leadership at member health plans & foundations on MCH issues Areas of focus have included:
Children’s Health Disparities Maternal Depression Children’s Mental Health Childhood Obesity Confidential Care for Adolescents Bright Futures Preventing Childhood Injuries Impact of Health Care Reform Bullying Prevention Quality of Care for Children
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About NIHCM Foundation
International, National and State trends
Federal efforts
Emerging evidence & promising practices
Things to consider
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Infant mortality rate in OECD countries per 1,000 births, 2009 or latest year
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2008 for Korea and United States, 2007 for Canada. SOURCE: OECD Health Data 2011, http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT
Infant Mortality Rate by Race, United States,1935-2007
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SOURCE: Singh GK, van Dyck PC. Infant Mortality in the United States, 1935-2007: Over Seven Decades of Progress and Disparities. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.
Leading Causes of Infant Mortality, 1935
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SOURCE: U.S. Department of Commerce and Bureau of the Census. Vital Statistics of the United States, 1937. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands , Government Printing Office, 1939.
Leading Causes of Infant Mortality, 2007
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SOURCE: Singh GK, van Dyck PC. Infant Mortality in the United States, 1935-2007: Over Seven Decades of Progress and Disparities. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.
Factors contributing to declining infant mortality rate
Improvements in environmental and living conditions Reductions in smoking during pregnancy Increased access to and use of prenatal care Advances in neonatal medicine and basic infant
health care Medicaid and other federal programs
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In 1935, Infant Care advised:
“Sunlight is necessary for the proper growth of a baby. During cool or cold weather at least one of the naps should be taken out of doors in the sun”
“He should sleep whenever possible in a room by himself”
“A sheet may be put over him and pinned so that he will not kick it off, but it should be loose enough to allow him to turn freely”
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SOURCE: Deavers, K and Kavanagh, L. Caring for Infants Then and Now: 1935 to the Present. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.
Bright Futures now recommends:
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“As much as possible, keep your baby out of the sun.”
“Do not use loose, soft bedding because they are associated with an increased risk of SIDS.”
“To reduce the risk of SIDS, it is best to always have your baby sleep on her back, not on her tummy or side.”
“It is a good idea if your baby sleeps in your room in her own crib.”
SOURCE: Deavers, K and Kavanagh, L. Caring for Infants Then and Now: 1935 to the Present. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.
Infant Mortality Rate by Race, United States,1935-2007
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SOURCE: Singh GK, van Dyck PC. Infant Mortality in the United States, 1935-2007: Over Seven Decades of Progress and Disparities. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.
Black infant mortality rate is 135% higher than white rate
NIHCM FOUNDATIONContribution of causes of death to the non-Hispanic black – non-Hispanic white infant mortality gap, 2007
SOURCE: CDC/NCHS linked birth/infant death data set, 2007
Infant, neonatal, and postneonatal mortality rates by race and Hispanic origin of mother, United States, 2007
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Infant Mortality Rates by State, 2004-06
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Leading Causes of Infant Death in TN, 2006
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SOURCE: Death Certificate Data (Tennessee Resident Data), Tennessee Department of Health
Leading Causes of Infant Death among Blacks in TN, 2006
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SOURCE: Death Certificate Data (Tennessee Resident Data), Tennessee Department of Health
Black premature babies were almost twice as likely to die in infancy as white premature babies
Challenges to Addressing Prematurity in TN
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SOURCES: March of Dimes; Vanderbilt Institute for Medicine and Public Health Women’s Health Research, 2011 Women’s Health Report Card and 2009 Women’s Health Report Card; State of Tennessee, Department of Finance and Administration, Bureau of TennCare. “2010 HEDIS/CAHPS Report: A Comparative Analysis of Audited Results from TennCare Managed Care Organizations. ”
MULTIPLE factors before, during and after pregnancy can contribute to poor birth outcomes such as premature birth and infant mortality The March of Dimes gave TN a grade of F for its premature birth rate. Factors
contributing to this: In TN, only 67% of women were enrolled in prenatal care in the first
trimester Only 53% of African American women received prenatal care in the first
trimester 18% of women smoked during pregnancy White women in TN nearly twice as likely to smoke during pregnancy as
women nationally Only 41% of adolescents receive an annual well-care visit More than 28% of African American women over 16 live below the
poverty line
About NIHCM Foundation
International, National and State trends
Federal efforts
Emerging evidence & promising practices
Things to consider
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Healthy People 2020
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Objective: Reduce the rate of all infant deaths within the first year of life Target: 6.0 infant deaths per 1,000 live births Baseline: 6.7 occurred in first year of life in 2006 How do we get there? Increase access to preconception and interconception
care Address the social & environmental determinants of
maternal and infant health Employ a life course perspective to health promotion &
disease prevention
Selected Federal Efforts
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HHS Secretary’s Advisory Committee on Infant Mortality Office of Minority Health National Infant Mortality Awareness
Month 2011 Focus: “A Healthy Baby Begins with You...and Us. Healthcare Professionals Take on Infant Mortality.”
HRSA/MCHB supports the Healthy Start program, the National Fetal & Infant Mortality Review & the National Sudden and Unexpected Infant/Child Death & Pregnancy Loss Project
The Affordable Care Act
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National Prevention Strategy The federal government will increase access to comprehensive
preconception and prenatal care, especially for low-income and at-risk women, and will research and disseminate ways to effectively prevent premature birth, birth defects, and Sudden Infant Death Syndrome (SIDS).
Maternal, Infant and Early Childhood Home Visiting Program $1.5 billion over five years to develop and implement one or more
evidence-based models targeted at reducing infant and maternal mortality and its related causes.
$88 million allocated in July 2010 Women’s Preventive Services
New health plans must cover clinical preventive services with no cost-sharing, including well-baby, child and woman visits, immunizations, screenings for conditions that can harm pregnant women and their babies, and breastfeeding support, supplies and counseling, and smoking cessation counseling
Maternity services in all basic benefits packages offered through exchanges and in individual and small group markets (January 2014)
About NIHCM Foundation
International, National and State trends
Federal efforts
Emerging evidence & promising practices
Things to consider
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Emerging evidence – investing in prevention
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A recent study published in Health Affairs found that increases in local public health spending were associated with reductions in mortality For each 10% increase in spending, infant mortality rates fell by 6.9% Spending by local public health agencies included federal and state funds,
as well as private philanthropic funding Source: Mays GP and Smith SA. “Evidence Links Increases in Public Health
Spending to Declines in Preventable Deaths,” Health Affairs 30:1585-1593, August 2011
Emerging evidence – impact of racism on infant mortality
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Chronic stress of racial discrimination experienced by African American women associated with increased risk of premature & low birth weight births
12-Point plan to close the gap in birth outcomes1. Provide interconception care to women with prior adverse pregnancy outcomes
2. Increase access to preconception care for African American women
3. Improve the quality of prenatal care
4. Expand healthcare access over the life course
5. Strengthen father involvement in African American families
6. Enhance service coordination and systems integration
7. Create reproductive social capital in African American communities
8. Invest in community building and urban renewal
9. Close the education gap
10. Reduce poverty among Black families
11. Support working mothers and families
12. Undo racismSOURCE: Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the black-white gap in birth outcomes: A life-course approach. Ethnicity & Disease 2010; 20(1) Supplement 2: S2-62-76.
Promising practices – preconception health
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Why invest in preconception health? Behaviors initiated during adolescence can have a great impact on future
reproductive health outcomes The CDC strongly recommends improved preconception care as a means
to improve the outcomes of pregnancy South Carolina Adolescent Preconception Health Initiative
Partners – SC Campaign to Prevent Teen Pregnancy, SC Departments of Education and Health Environmental Control, Blue Cross Blue Shield of South Carolina Foundation
Incorporate preconception health messages into broader pregnancy prevention website Carolinateenhealth.org
“Know Your Plan” section includes specific tips on healthy eating, exercise and staying smoke free
Promising practices – home visiting
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Why invest in Nurse-Family Partnership? Positive outcomes for women living in poverty who are pregnant for the
first time and their children. Those outcomes include: improved prenatal health reduction in premature and low birthweight births among high-risk sub-groups
Economic analyses of the outcomes for participants have consistently shown significant cost-savings, estimated at up to $5.70 per $1 invested
Nurse-Family Partnership and “The Blues” Blue Cross and Blue Shield of North Carolina Foundation Blue Cross and Blue Shield of South Carolina Foundation WellPoint Foundation - $210,000 to support NFP in 8 states
Promising practices – promoting health equity
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Why invest in efforts to reduce disparities? We haven’t made great progress reducing the disparities in infant mortality rates in the U.S., even though many preterm births
should be preventable The Horizon Foundation for New Jersey
Optimal Health Program, a health literacy program for women of child-bearing age Blue Cross and Blue Shield of Minnesota Foundation
Community Dialogue Series which will address the disproportionately high level of low birth weight babies and infant mortality shared by Minnesota's African American and African immigrant as well as African-Latino and Afro-Caribbean communities
Blue & You Foundation for a Healthier Arkansas Arkansas Quality Foundation to develop a statewide infant death review process with community-based analysis and intervention
plans, to help reduce infant mortalities Blue Cross & Blue Shield of Florida Foundation
Outreach efforts to women and their OB/GYNs to encourage eligible women to access oral health care at a community health clinic
Blue Cross and Blue Shield of Georgia Local sites of Centering Pregnancy to expand access to early prenatal care in a group setting for low income rural African
American women
About NIHCM Foundation
International, National and State trends
Federal efforts
Emerging evidence & promising practices
Things to consider
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Things to consider today Continue to evaluate existing and new interventions
while investing in research to understand the causes of preterm birth and infant mortality
Encourage collaboration between the public and private sectors
Focus on health equity rather than disparities –allow all women and infants to achieve their full health potential
Align with the life course health development model – invest early for high-returns
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Thank you!
Kathryn Santoro, MA
Director of Maternal & Child Health Policy & Development
(202) 296-4196
NIHCM Foundation
http://www.nihcm.org
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