Health Insurance Blog

What do Albania, Sri Lanka and certain Mississippi counties have in common? Infant mortality rates that hover near 20 deaths per 1,000 live births. Such statistics, on the rise in several Southern states, reflect a complex weave of individual choices and public policy. Even so, no one should miss the loud alarm sounding in the reversal of years of steady progress against infant deaths.

Countering the trend ought to be a national priority. In 2005, the most recent data from state health officials, Virginia’’s infant mortality rate was 7.34 deaths per 1,000 live births. The increase over 2003 is infinitesimal – four one hundredths of a percentage point.

Still, that puts Virginia in the same league as Mississippi, Alabama, North Carolina, Tennessee, Louisiana and South Carolina, all of which saw infant mortality rates worsen in 2004, 2005 or both. It’’s particularly unsettling that one of the wealthier states in the nation ranks 35th on a key indicator of child and maternal health, and when Hampton Roads consistently trails the state average by a percentage point or two every year. On most measures of child well-being, the Old Dominion scores in the top third of the states. On infant mortality, it plummets. “When you contrast income and infant mortality, there’’s a significant discrepancy,” said Suzanne Clark Johnson, director of the child-advocacy group Voices for Virginia’’s Children.

Commendably, both her organization and the state health department are engaged in serious, long-term efforts to find solutions. Elsewhere across the South, experts point to a mounting obesity epidemic, state and federal cutbacks in Medicaid spending and a decline in easy availability of health-care services as potential contributors. Mississippi Gov.

Haley Barbour, for instance, came to office pledging to cut Medicaid spending, and has followed through on the promise. While experts debate ways to stem infant mortality, the Virginia experience with low-income public-health care suggests a couple of directions.

First, removing barriers helps. That became clear when former Gov. Mark Warner streamlined access to FAMIS, Virginia’’s version of the federal health initiative for low-income families. Requiring formal documentation or face-to-face interviews, steps that might seem reasonable to the middle class, can scuttle efforts to get health care to poor families.

Second, the sort of in-home, culturally sensitive care provided by programs such as Healthy Families and CHIP of Virginia (Children’’s Health Involving Parents) shows demonstrated success. Such highly personalized help may be more expensive at one level, but not in the long run if the reward is higher effectiveness. Commendably, the General Assembly hasn”t ignored Virginia’’s problem. In the past session, lawmakers expanded Medicaid eligibility, making more poor women eligible for pre natal care.

Producing more healthy infants can curtail costs for FAMIS or Medicaid down the road. Solving America’’s infant mortality problem may be akin to reducing traffic fatalities, Johnson suggested.

No one thing produced recent improvements. Stricter seat-belt laws, improved air bags, tougher speeding penalties and better engineered highways all helped. Multiple steps and unrelenting scrutiny may be the keys on infant mortality. Given the long-term ramifications, back-sliding is not an option.