Browsing by Subject "Infant mortality"

Now showing 1 - 4 of 4
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    Impact of Language Access Laws on LEP Infant Mortality Rates
    (2023-04) Griffin, Andrew
    Starting with Executive Order 13166 in 2000, the United States federal government began to address the language disparity issues in health care. Around the same time, several states have begun to pass language access (LA) legislation mandating translation and interpretation services at hospitals for limited English proficient (LEP) individuals. This study uses these multiple discontinuities to evaluate the effect of language access laws on infant mortality rates, adequacy of care, Apgar scores, and the number of prenatal visits from the years 1995 to 2004 for limited English proficient families. I find ambiguous results of language access laws positively impacting infant mortality rates or Apgar scores, but I find clear positive impacts on the adequacy of care and the number of prenatal visits. These findings suggest that language access laws have a clear effect on reducing barriers for limited English proficient mothers, and improving the care mothers receive. Furthermore, there is limited evidence that it improves infant health or outcomes, but the increase of prenatal visits and adequacy of care likely indirectly leads to improving infant mortality rates and Apgar scores. More research is needed into discovering how those mechanisms work and the costs of language services.
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    Improving Birth Outcomes in North Carolina
    (2021-04-16) Fischer, Arianna
    Birth outcomes for children are the foundational building block for life after birth. Adverse birth outcomes influence a child’s development immediately after birth, and their health outcomes throughout their lives. Health and educational outcomes are closely linked, as health problems affect a child’s ability to attend school and their ability to learn. Adverse birth outcomes are oftentimes preventable. Yet, preterm births and low birthweight are extremely common in North Carolina. These factors are two of the leading causes of infant mortality in the United States, and in North Carolina there is a large racial disparity in the rate of infant deaths between Black and White babies. This study aimed to address the racial disparity in infant mortality in North Carolina to promote a more equitable place for birth outcomes for all mothers and improve outcomes for children born into the state. The policy questions that drove this study include: What has been done among education stakeholders in North Carolina to reduce the racial disparity in infant mortality? How can education stakeholders in North Carolina work towards reducing the racial disparity in infant mortality across the state? Addressing these policy questions first involved a thorough program search and stakeholder analysis among education-oriented entities in North Carolina to understand their efforts around decreasing the gap in birth outcomes by race. A case study analysis was then conducted to learn from states that have better birth outcomes than North Carolina. California and Massachusetts were selected for the case study analysis based on preterm birth data and the preterm birth disparity ratio in each state. The final stage of the research process included a program search and stakeholder analysis among public health stakeholders in North Carolina working on this issue. The purpose of this process was to gain insight into broader work on improving birth outcomes in the state and provide education stakeholders with an overview of this work moving forward. The education stakeholders in North Carolina that are working to address racial disparities in infant mortality are focused on advancing access to prenatal care by closing the health insurance gap. While access to prenatal care is important, much more is needed to meaningfully combat this disparity. Prenatal care alone does not address the root cause of the racial disparities in birth outcomes in this country. Various studies have shown that even after accounting for external factors such as poverty status, neighborhood, and educational attainment, Black women and their babies still have worse outcomes. Without addressing the connection between racism and adverse birth outcomes, racial birth disparities will continue to exist. In California and Massachusetts, the efforts to decrease racial disparities in infant mortality revolve around tackling the root causes of racial birth disparities. Both states highlight the importance of cultural sensitivity in prenatal care, providing continuous support for mothers during the prenatal period and after giving birth, and the importance of addressing the social determinants of health to improve birth outcomes. Public health organizations and advocacy groups have primarily led this work in both states. This report includes a deep dive into two organizations in California and two organizations in Massachusetts that informed the recommendations included in this report. In order to meaningfully improve birth outcomes for children in the state, particularly for Black babies, recommendations for my client, the North Carolina Public Education Task Force (NCPETF), to take include: 1. Establishing a partnership with the North Carolina Early Childhood Action Council (NC ECAC) to discuss the insights included in this report and coordinating ongoing efforts to decrease racial birth disparities. 2. Forming a multi-sector partnership between education and public health stakeholders and advocacy groups in the state to address adverse birth outcomes. 3. Extending goals for reducing the racial disparity in birth outcomes beyond prenatal care. Recommendations that require legislative change in North Carolina to improve birth outcomes in the state include: 1. Providing doula support to Medicaid beneficiaries. 2. Addressing systemic racism in healthcare. Across all recommendations, improvements need to be targeted at the county or local level in order to address the communities with the largest racial birth disparities. In order to combat adverse birth outcomes, public health and education stakeholders invested in improving childhood outcomes need to work together.
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    Macro-Comparative Political Analysis: Do Different Healthcare Systems Result in Differential National Health Outcomes?
    (2019-03-26) Sereix, Rachel
    In this study, I will conduct a comparative analysis of how the the political-economic set-up of health care systems in affluent capitalist democracies may affect aggregate health care performance in designated OECD nations impact healthcare outcomes. The research question that will be answered is, “How does national design of health care institutions and development influence comparative quality of healthcare systems?” I will be looking closely at this macro- level relationship by identifying economic indicators and institutional rules that govern rational behaviors and that structure the interaction between individual actors, where there are principals who ultimately demand the health services and their outcomes—above all service recipients, but also their employers and the governments whose politicians try to deliver outcomes that will make voters reelect them. Agents are put in charge of the actual implementation of health services and thereby have superior knowledge of the operational steps it takes to deliver the requisite health care to restore sick patients, and principals (government and doctor) which influence patient care outcomes. A healthcare system is defined as an arrangement in which different category of actors combine in a system of institutionalized rules to deliver health services and thereby influence the physical and psychic health and satisfaction of customers with the system employing different patterns of resource expenditure (Ludwig, Van Merode, and Groot 2010). One evaluative measure of the efficacy of these components is to analyze the health service outcomes, the actual health of the citizens who are benefactors of the system. The main hypothesis explored in the thesis is that the design of health care systems, documented in institutional rules governing the interaction between the various actor groups, shapes the actual health outcomes.
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    Structural Sexism and Health in the United States
    (2018) Homan, Patricia

    In this dissertation, I seek to begin building a new line of health inequality research that parallels the emerging structural racism literature by developing theory and measurement for the new concept of structural sexism and examining its relationship to health. Consistent with contemporary theories of gender as a multilevel social system, I conceptualize and measure structural sexism as systematic gender inequality in power and resources at the macro-level (U.S. state), meso-level (marital dyad), and micro-level (individual). Through a series of quantitative analyses, I examine how various measures of structural sexism affect the health of men, women, and infants in the U.S.

    Chapter 2 focuses exclusively on the macro-level and drills down on a single indicator of structural sexism: political gender inequality. Using data compiled from several administrative sources across a twenty-two-year period, I find that women’s political representation in U.S. state legislatures is as strong —or stronger—a predictor of state infant mortality rates than even the state’s poverty level. This relationship holds both between states with varied levels of political gender inequality in a given year, and within the majority of states as women’s representation changes over time. To quantify the population-level costs, I estimate that women’s continued underrepresentation in legislative office was associated with nearly 3,500 excess infant deaths per year in the U.S. compared to what would be expected under conditions of gender parity.

    Chapter 3 lays out a more comprehensive, multilevel framework for structural sexism and examines how it shapes the health of women and men at midlife. I measure macro-level structural sexism at the U.S. state-level using indicators of inequality in political, economic, cultural and reproductive domains. Using restricted geo-coded data from the NLSY79, individuals are located within states to capture their exposure to structural sexism. This chapter also incorporates individual- and spousal-level data from the NLSY79 in order to measure exposure to structural sexism at the meso- and micro-levels. Results show that among women exposure to more sexism at the macro- and meso-levels is associated with more chronic conditions, worse self-rated health, and worse physical functioning. Among men, macro-level structural sexism is also associated with worse health. However, at the meso-level greater structural sexism is associated with better health among men. At the micro-level, internalized sexism is not related to health among either women or men. These results highlight the importance of a multilevel approach.

    As a whole, this work demonstrates that structural sexism takes a substantial toll on population health in the U.S. The findings also illustrate that effects of structural sexism on health depend both on an individual’s position within the gender system and the level at which sexism exposures are measured. Further research is needed to extend our understanding of how structural sexism shapes health across the life course.