Ohio’s infant mortality rate is among the highest in the nation; only seven states fare worse, according to the most recent data. The state’s response has targeted healthcare, but a more effective approach may lie outside doctors’ offices, according to a new report from the Health Policy Institute of Ohio.
The report, for which the Voinovich School of Leadership and Public Affairs conducted data analysis, states, “Over the past few decades, Ohio’s efforts to reduce infant mortality have focused primarily on healthcare access and quality and interventions for pregnant women.” Yet Ohio’s infant mortality rate – which was relatively stable in the past decade – has increased over the past few years, with an average of 6.8 deaths per 1,000 live births in 2014 compared with 7.4 deaths in 2016.
Titled “Social Determinants of Infant Mortality,” the report explains that Ohio’s approach has failed because research suggested that a woman’s health before pregnancy often has a greater impact than health during gestation. Moreover, evidence suggests that only 20 percent of the factors influencing health are related to clinical care and 30 percent related to personal habits. The remaining 50 percent can be broadly grouped as “social determinants,” encompassing issues such as housing, transportation, education and employment.
Social inequities are reflected in significant disparities in infant mortality rates along racial and geographical lines. In 2016, the infant mortality rate for black children was almost three times that of white children. Additionally, the state’s highest infant mortality rates occur in poorer counties such as Jefferson, Highland, Pike and Adams.
“Because infant mortality is a measure of the overall health and wellbeing of a state, Ohio’s sharp disparities in infant mortality indicate that some groups of Ohioans are being left behind,” the report states. “Infant mortality rates reveal the cumulative impact of poverty, discrimination, racism and inequities in the social, economic and physical environment.”
Ani Ruhil, a Voinovich School professor who worked on the report and analyzed the data, said the disparities demonstrated in the report were not surprising.
“The poor and minorities are more likely to be stuck in inadequate housing conditions, have less access to transportation and so on,” Ruhil said. “Having inadequate housing conditions can mean exposure to lead, mold, carbon monoxide, cockroach dust, dust mites, unreliable or inadequate heating and more – that is, living in an environment that is biologically and chemically hazardous to one’s health. A lack of reliable transportation makes it hard for people to access healthcare. We can therefore begin to see why the impact of race and poverty would be especially severe in health.”
Based on feedback from more than 100 state and local stakeholders, as well as case studies of states with impressive reductions in overall and black infant mortality rates, the report suggests a range of policy improvements. These include reversing discriminatory state policies and practices, improving housing conditions, increasing access to housing and transportation and enhancing education quality and employment opportunities.
Ruhil says he is optimistic that the state will take the report’s proposed policies seriously, because it was produced at the request of the Ohio Legislative Service Commission.
“This report was born of legislative action, which I’m sure will place a spotlight on next steps,” Ruhil said. “I expect that there will be action taken, and money committed to the cause. Not in a year, but maybe in four or five years, I’m optimistic that that we will see improved outcomes in our state, meaning improved conditions for the poor and more infants living past their first year.”
The full report, as well as a brief snapshot and an executive summary of the report’s findings, can be accessed here.