For years, efforts to fight Ohio’s infant mortality rate have focused on health care, both for babies and expecting mothers.
A new report says addressing economic issues might be just as effective.
The 233-page report from the non-partisan Health Policy Institute of Ohio recommends "a new approach" for state lawmakers by asking them to ensure stable housing and employment, as well as increase access to transportation and affordable education.
“What constitutes anyone’s health, any definition of health, is the clinical care. But it does also include environmental conditions, financial conditions, where people live,” says Shannon Jones, a former Ohio lawmaker who now leads the child advocacy group Groundwork Ohio.
“Even folks in specific zip codes have worse health outcomes than others,” Jones says.
Recommendations in the report range from reducing “toxic workplace stress” to improving air quality by incorporating more electric vehicles into public transit fleets.
“Eighty percent of what constitutes our health really occurs outside of a doctor’s office or a provider’s office," she says. "This work is recognizing that fact and taking a deeper dive.”
Previous efforts have focused largely on educating new and expecting mothers on how to care for babies. Despite those efforts, Ohio's infant mortality rate remains stubbornly high and even increased slightly in 2016.
In 2016, the infant mortality rate for African American babies was more than twice as high as white babies.
The Health Policy Institute of Ohio report includes more than 100 recommendations to state and local lawmakers. They include changes in housing, transportation, health care, environmental, education, and workplace policies.
Housing
- State policymakers can provide funding from the General Revenue Fund for the Ohio Housing Finance Agency to establish a new state-funded rental assistance program targeted to reducing infant mortality among populations most at-risk for infant mortality.
- State policymakers can direct state agencies to increase funding from new and existing sources for rapid re-housing programs and rental assistance programs for pregnant women and families with very young children.
- State and local policymakers can increase rapid access to legal representation, landlord-tenant mediation and other supportive services, including emergency financial assistance, to prevent formal evictions experienced by low-income families.
Health Care
- Medicaid managed care plans can monitor non-emergency medical treatment (NEMT) grievances from members and promptly make changes to improve the timeliness and quality of NEMT, prioritizing infant mortality hot spot areas.
- Medicaid managed care plans can explore the use of Lyft, Uber or other ride-sharing services and innovative technologies (such as apps) for NEMT.
Transportation
- State policymakers can support bus systems by replacing lost revenue from the cut to transit authorities that resulted from the repeal of the Medicaid managed care organizations sales tax required by the federal government.
- Local transit agencies, metropolitan planning organizations and other transportation partners can actively engage groups at high risk for infant mortality—particularly African-American and low-income families with young children—in decisions about transit services and improvements to the built environment.
- Local transit agencies can improve local bus systems and prioritize the needs of pregnant women, families and people of childbearing age in transit system improvements.
Air Quality
- State policymakers can incentivize state agencies, local transit agencies, school districts and local municipalities to transition vehicle fleets to clean diesel technology.
- Local transit agencies and school districts can implement vehicle anti-idling policies (education and signage to minimize time that drivers idle engines).
- The Ohio Department of Transportation and Ohio Department of Administrative Services can allow state agencies, local governments or other entities to procure electric vehicles or compressed natural gas vehicles through state purchasing contracts.
Education And Jobs
- State policymakers can increase funding for child care subsidies so that eligibility limits can be restored to 200 percent FPL and more families can access child care. Access can also be expanded by increasing the reimbursement rate paid to child care centers to the 75th percentile, making 75 percent of the state’s child care centers affordable to voucher families.
- State policymakers can incentivize employers to provide child care subsidies to their employees in order to remove barriers to employment for parents, particularly those with part-time and/or low-wage jobs
- The Ohio Department of Job and Family Services can analyze and evaluate the effectiveness of the Comprehensive Case Management and Employment Program (CCMEP). If the evaluation is favorable, policymakers can increase funding for CCMEP to connect more youth and young adults with low incomes to skilled employment in Ohio.
- State policymakers can review eligibility levels for government programs that serve individuals with low incomes in order to remove disincentives for job attainment or wage increases (“benefit cliffs”). Eligibility levels for programs such as medical, food and child assistance should be aligned with the self-sufficiency of the program recipients.
- The Ohio Department of Job and Family Services can license day care centers that provide child care on a temporary, irregular basis to children with short-term illnesses.
Reducing Stress In The Workplace
- State policymakers can increase enforcement efforts related to discriminatory workplace practices through the Ohio Civil Rights Commission (OCRC) by increasing the staff at OCRC to implement enforcement.
- State policymakers can consider an employer’s record with the OCRC when determining tax incentives, and assess a fee on employers with regular complaints to the OCRC. Revenue gained from these fees can be dedicated to fund education programs on eliminating discrimination in the workplace.
- The State of Ohio can increase work schedule predictability for state employees, particularly those who work part-time or are on-call, by adopting a policy to provide scheduling notice at least 7 days in advance.
