Infant Mortality in the U.S. Remains High; A New Drexel Study Shares How to Best Spend Money to Save Lives

Increasing state and local funding for environmental, educational and social services may lower infant mortality among those at highest risk, particularly among infants born to teenage mothers, according to findings published this week in the journal Pediatrics from researchers at Drexel University’s Dornsife School of Public Health.

After looking at a variety of education services, social services, and environmental and housing factors, the team found that increasing funding in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in infant deaths. The researchers used data on infant deaths per state from the National Center for Health Statistics, as well as state and local spending from 2000 to 2016 data from the United States Census Bureau.

Additionally, the team found that on average, state and local governments spent nine dollars per person across education, social services and environmental services. Modest increases in annual funding were associated with a small yet statistically significant improvements in infant mortality rates. A 30-cent increase in environmental spending per person was associated with a decrease of 0.03 deaths per 1,000 live births, and a 73-cent increase in social spending per-person was associated with a decrease of 0.02 deaths per 1,000 live births. Among mothers under 20 years of age, raising environmental spending by 30 cents was associated with a decrease of 0.08 deaths per 1,000 live births, and a 73-cent increase in social spending per-person was associated with a decrease of 0.06 deaths per 1,000 live births

Previous studies showed that government spending on non-healthcare services can reduce infant mortality, but this is the first study to show what types of spending has the greatest impact, particularly among race, ethnic and maternal age groups who are at highest risk.

“These findings reinforce the role social determinants of health, like accessing clean air and water, play in one’s health—even before birth,” said Neal D. Goldstein, PhD, an assistant research professor in Drexel’s Dornsife School of Public Health. “But this is more than a spending problem – we cannot simply buy our way out of this. It is addressing non-healthcare factors that occur upstream of pregnancy and may take several generations to have an impact.”

Although the U.S. infant mortality rate – death before 1 year of age – has gone from 6.75 to 5.79 infant deaths per 1,000 live births from 2007 to 2017 -- a decrease of 14 percent -- the United States reports slower progress than similar countries, and struggles with racial disparities and wide variation in mortality by geographic location, as reported by the Peterson Center on Healthcare and Kaiser Family Foundation.  

The current study is useful as it considered age, race and ethnicity to identify which populations are most likely to benefit from specific funding decisions, but the authors note that the mechanism for the associations is not clear and future studies should continue to become more nuanced to explore the many factors that may influence how spending impacts infant mortality, such as racial inequities in school funding at the community level.

“The COVID-19 pandemic is forcing states with fewer available resources to make difficult spending decisions that will impact racial justice and health equity,” said co-author Aimee Palumbo, PhD, an assistant professor at Temple University. “Our findings help lawmakers understand the impact of those decisions and hopefully align those budgets more effectively with the needs of their citizens to support communities who need it most.”

In addition to Goldstein and Palumbo, authors on this paper include Scarlett Bellamy, ScD, and Jonathan Purtle, DrPH, of the Dornsife School of Public Health, and senior author Robert Locke, DO, of Thomas Jefferson University’s Sidney Kimmel College of Medicine.

The study, "state and Local Government Expenditures and Infant Mortality in the United States," is available here.