A timely commentary co-authored by Dr. Woodie Kessel in the journal Pediatrics urges greater US investment in the non-healthcare related programs that play an important role in determining health outcomes, particularly related to infant mortality.
Dr. Kessel, who is a professor of the practice at the University of Maryland School of Public Health, and Dr. Michele Kiely from CUNY Graduate School of Public Health and Health Policy, wrote the commentary in response to a study on the impact of state and local government expenditures on infant mortality.
In it, Kessel and Kiely acknowledge that while infant mortality rates have decreased in the US, it remains a public health crisis, and disproportionately impacts African American babies, who are more than twice as likely to die in their first year than white babies. They also point out our shameful status in lagging behind most other industrialized nations in both infant mortality, in which we rank 22nd, and maternal mortality, in which we rank 48th, despite spending a trillion dollars annually on healthcare. They urge that more money must be targeted for prevention-related investments, including education, social services, environmental health and housing, which all impact community well-being.
“This study reinforces the importance of investing in children, like Head Start, that integrates child development with child health with family well-being, or like the WIC program improving nutrition for moms and infants. Whether it is education, social services, the environment, or family-support services, these investments in areas like these will save the lives of infants and many of our citizens," Kessel and Kiely wrote in an email.
Their commentary also points to systemic racism as a reason for the persistent difference in maternal and infant health among various racial/ethnic groups and particularly between Black and white women. This supports the findings and recommendations of Goldstein, et al which state that the increased spending in essential non–health care services won’t impact disparities unless it is directed to the communities most in need.
"If we effectively incorporated Goldstein et al.'s 'non-healthcare' approach with quality medical care into an over-arching comprehensive systems approach, we would enjoy the improvements across the population spectrum and, of course, save infant lives and improve their well-being," they said.
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