I attended the first meeting of the Commission on Infant Mortality last Wednesday in the Ohio Senate Finance Hearing Room. The meeting lasted for nearly 3 hours. Medicaid Director John McCarthy made the initial presentation, focusing on the new $13.4 million in the state budget for infant mortality work. He pointed out that Ohio’s high infant mortality rate has a number of causes, including premature births, smoking, and sleep practices. Medicaid is focusing on certain ZIP codes in predominantly African-American communities that are known to have extremely high infant mortality rates. Over the four months Medicaid will hold meetings in nine communities to get their feedback about approaches that are currently being used and to raise awareness of the issue. The funding in the state budget does not have a separate line item. Instead, it is rolled into the managed care plans’ capitated rate. The expectation is that they will use it for education and prevention that will benefit the entire community, not just people enrolled in their plan. An underlying issue, however, is that there are still a large number of births in fee-for-service which means that many pregnant women are not being enrolled in a managed care plan in a timely fashion, and are probably not getting care in the early stages of pregnancy.

Commission on Minority Health Director Angela Dawson gave the next presentation, which was a passionate plea for having a wider discussion of social determinants of health. Ohio still has not achieved the 1990 Healthy People goal for African-American infant mortality rates and at present rates will not achieve this goal until about 2050. Other data in her presentation related higher infant mortality rates and other negative birth outcomes to race and income variables. Dawson also stated that they can overcome the 2 year lag in official ODH statistics by using preliminary data. Apparently this is also being done in Hamilton county, according to Health Commissioner Tim Ingram who is a member of the Infant Mortality Commission.

Senator Shannon Jones, who is a chair of the commission, said that she felt that this is a moral obligation of the state and that she and Senator Charleta Tavares both have been pursuing the issue for years. The next meeting of the commission will be Sep. 17 in the afternoon, and they will meet every 2 or 3 weeks through the fall in order to have a report by January.

From my perspective, it will be fascinating to see how far this commission really digs into the social determinants of health, and whether members choose to wrestle with issues such as poverty, housing conditions, literacy, and the lack of opportunity in inner city neighborhoods. It will be hard to achieve major progress without addressing these larger issues.