Can cities design policies to address the social determinants of health in infant mortality?

The rate of infant mortality is often used as an indicator to measure the health and well-being of a nation, because factors affecting the health of entire populations can also impact the mortality rate of infants.

Not only is the rate of infant mortality very high in the United States relative to most other developed nations, but there are stark and persistent differences in infant mortality by race, and ethnicity; for instance, the mortality rate for non-Hispanic black infants is more than twice that of non-Hispanic white infants. These disparities have persisted over time, despite large investments in neonatal intensive care unit care and improved access. 

Across disciplines there is strong concensus that health is -to a large extent- determined by factors outside healthcare, and that health outcome disparities are largely influenced by social constructs. This conceptualization is commonly referred to as 'social determinats of health'. However policies 'on the ground' to improve public health indicators (such as infant mortality) are largely the responsibility solely of departments of public health. 

In this study, funded by the Robert Wood Johnson Foundation, a team of researchers from different fields investigated what would be required in terms of technology, data collection and organizational structure for a large metropolitan area to design policies that really aimed to address in a multisectoral policies to address the disparities in infant mortality. 

We designed an analytical tool to assess the readiness of metropolitan areas to design multisectoral policies to address infant mortality and adverse child outcomes. We discuss the technological challenges (legacy systems), and incentive structures (revenue creating versus non-revenue departments and agencies) and provide a set of recommendations to address infant mortality rates using the organizational and incentive structure of the cities of Los Angeles and Philadelphia as examples.