Perspective: We Can't Let Infant Mortality Disparities Continue

Shameful is the only word to describe the persistent disparities in infant mortality rates in the U.S., as outlined in a recent report by the Centers for Disease Control and Prevention (CDC). The rate at which children die in the first year of life—a basic measure of population health—has declined in the U.S. over the past decade, but remains higher than peer nations, and varies dramatically for populations across the country.

At the extremes, mortality rates for infants of black women in Wisconsin (at 14.3 deaths per 1,000 births) were more than five times higher than for infants of non-Hispanic white women in D.C. (at 2.5 deaths per 1,000 births). In fact, infant mortality for children of black women in the U.S. is persistently much higher than rates for other racial and ethnic groups, even accounting for income and education. At the state level, the CDC reports that the best rate in the nation for black infant mortality—8.3 deaths per 1,000 in Massachusetts—was still higher than the worst rates for both non-Hispanic whites (7.0 in Arkansas) and Hispanics (7.3 in Michigan). We also know that infant mortality is closely related to birth outcomes such as prematurity and low birth weight, and for those who escape the tragedy of infant death, poor birth outcomes can be associated with poorer health and educational outcomes for children later in life, especially in the absence of other interventions. In other words, there's a compounding tragedy at play.

In fact, infant mortality for children of black women in the U.S. is persistently much higher than rates for other racial and ethnic groups, even accounting for income and education.

Our work with organizations such as the W. K. Kellogg Foundation and the Episcopal Health Foundation in making the business case for racial equity has shown that, in addition to the toll of inequities on individuals and families, there are significant societal and economic consequences for states and the nation. In Texas alone, our team estimated that health disparities for populations of color come at the cost of $4.6 billion annually in excess medical care costs and lost productivity. For the nation as a whole, the combined impact of inequities in the domains of health, housing, education, employment, and incarceration correspond to trillions of dollars of lost potential earnings, tax revenues, consumer spending, and economic output. And the demographic shifts already underway will dramatically increase this impact in the decades ahead. By the middle of this century, today’s infants and children of color will be the majority of our nation’s workers, consumers, and taxpayers. We've estimated that, in Texas, by 2050, if existing health disparities remain, the economic impact to the state will rise to more than $8 billion annually.

The size and quality of our nation’s workforce, the prosperity of our consumers, the strength of our tax base, and our potential for economic growth are all at stake. No one can stand idly by.

Health has many determinants and there is no easy answer to reducing infant mortality or reducing other health disparities. Access to prenatal care matters; nonetheless, if access to care was the primary driver of infant mortality, we would expect Hispanic infant mortality rates to be closer to black rates, since both groups are more likely to be uninsured than their non-Hispanic white counterparts. Social supports and parental education during pregnancy and after birth also matter. For at-risk mothers, home visits from nurses or community health workers throughout pregnancy and early childhood have been shown to improve birth outcomes and lower infant mortality. Altarum’s work with the Henry Ford Health System demonstrates the health and economic benefits of the Women Inspired Neighborhood Network home visiting program in Detroit, a city with some of the highest infant mortality rates in the nation. Other recent research points to a need to focus particular attention on the period after birth, when the child is between one month and one year of age. A safe, secure, stable, and healthy environment in the early months and years of life affects not only physical health but mental development and capacity to learn in ways we are just beginning to understand.

The size and quality of our nation’s workforce, the prosperity of our consumers, the strength of our tax base, and our potential for economic growth are all at stake. No one can stand idly by.

In the wealthiest nation on Earth—the nation that spends more on health care than any in the world—these disparities are shameful. In fact, they're inexcusable. For states, it's not just a moral obligation to address, but also the smart fiscal decision. For employers, it's about long term growth and prosperity. For all of us, it's about basic human decency, and we're committed to uphold it.