Infant mortality (IM) rates in the United States remain high compared to other well-resourced countries. While the U.S. IM rate has historically trended downward, and has declined 21% since 20051, racial/ethnic disparities in IM in the United States have persisted. The highest IM rates in the country are among non-Hispanic Black, American Indian/Alaska Native (AI/AN), and Native Hawaiian/Other Pacific Islander (NHPI) infants (10.38, 7.68, 7.17 infant deaths per 1,000 live births in 2020, respectively) with rates that are 63% to 136% greater than that of non-Hispanic Whites (4.40 infant deaths per 1,000 live births in 2020)—the population with the most births and longest historical advantages.1 The stark infant mortality differences across racial and ethnic groups reflect social inequities and contribute to the high overall national IM rate. Structural inequities in access to health-promoting resources, such as education, employment, housing, and health care, contribute to racial/ethnic disparities in perinatal health. Each year, approximately 3,500 excess infant deaths occur due to higher mortality rates among non-Hispanic Black, AI/AN, and NHPI infants relative to non-Hispanic White infants.
Healthy People (HP) 2030 has established a target of 5.0 infant deaths per 1,000 live births for all race/ethnic groups–a target already exceeded at the national level for non-Hispanic White (4.40), non-Hispanic Asian (3.14), and Hispanic infants (4.69). Thus, even if non-Hispanic Black, non-Hispanic AI/AN, and non-Hispanic NHPI infants achieve the target of 5.0, these populations would still lag behind other groups. Achieving equity will require maintaining declines in the IM rate of these infants, and accelerating the rate of decline among non-Hispanic Black, Native Hawaiian/Other Pacific Islander, and non-Hispanic AI/AN infants.
To accelerate the reduction of IM disparities and excess infant deaths, the Catalyst for Infant Health Equity program launched in September 2022. The program seeks to move beyond direct services to implement targeted policy and systems changes that are focused on one or more specific SDOH domains contributing to IM disparities in a particular county/jurisdiction. The goals of the Catalyst for Infant Health Equity program are: 1) to continue reducing overall infant mortality (IM) rates in the United States, and 2) to decrease and ultimately eliminate disparities in IM across racial/ethnic groups by achieving steeper declines for groups with the highest rates.
The Catalyst for Infant Health Equity program utilizes the social ecological model as a framework for examining and addressing disparities in IM and excess infant deaths. In this model, individual outcomes and health disparities across racial groups are shaped by broader interpersonal, institutional, community and policy factors such as personally-mediated and institutional racism, providers’ cultural competence, access to quality health care, neighborhood quality, and economic and housing policy.
HRSA made nine Catalyst awards to support the implementation of existing action plans that applied data-driven policy and innovative systems strategies to reduce IM disparities and prevent excess infant deaths. Action plans had to address the social determinants of health (i.e., environmental, social, and economic conditions), and/or the structural determinants of health (e.g., institutions, systemic barriers, policies) that contribute to disparities in IM.
The first Cohort of Catalyst awardees are listed here:
|Baltimore Healthy Start, Inc.
|Broward Healthy Start Coalition, Inc.
|Florida Department of Health
|Healthy Start, Inc.
|Marillac Community Health Centers
|Newark Community Health Centers, Inc.
|Northeast Florida Healthy Start Coalition, Inc.
|Research Institute at Nationwide Children’s Hospital
|Trustees of Indiana University