Effectiveness of public health spending on infant mortality in Florida, 2001–2014

Bernet, Patrick; Gümüş, Gülçin; Vishwasrao, Sharmila

doi:10.1016/j.socscimed.2018.05.044

Cited by 36 publications

(54 citation statements)

References 27 publications

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“…These results are consistent with earlier reports of a higher proportion of preventable maternal deaths among black women compared with white women . They also are consistent with the existing literature, which finds beneficial effects of public health efforts on racial disparities …”

Section: Discussionsupporting

confidence: 92%

“…If we consider a more reasonable 10% increase in targeted public health expenditures, it would lead to a 0.765 decline in the MMR, an improvement of 3.9%. Even this relatively small effect is larger than the 2.07% decrease in the infant mortality rate in response to a 10% increase in targeted spending reported by Bernet and colleagues . Although the estimate for white mothers in Model B turns negative, it still is not statistically significant.…”

Section: Resultsmentioning

confidence: 57%

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Maternal Mortality and Public Health Programs: Evidence from Florida

2020

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US maternal mortality rates (MMRs) display considerable racial disparities and exceed those of other developed countries. While worldwide MMRs have dropped sharply since the 1990s, the US MMR appears to be rising. We provide strong evidence of the effectiveness of pregnancy‐related public health spending on improvements in maternal health. Using longitudinal data from Florida counties, we found that spending on public health significantly reduced the MMR among black mothers and narrowed black‐white outcome disparities. Each 10% increase in pregnancy‐related public health expenditures was associated with a 13.5% decline in MMR among blacks and a 20.0% reduction in black‐white disparities. Context Maternal mortality rates in the United States exceed those of other developed countries. Moreover, these rates show considerable racial disparities, in which black mothers are at three to four times the risk compared with their white counterparts. With more than half of all maternal deaths deemed to be preventable, public health interventions have the potential to improve maternal health along with other pregnancy outcomes. This rigorous longitudinal study examines the impact of a package of pregnancy‐related public health programs on maternal mortality rates. Methods We analyzed administrative data on pregnancy‐related public health expenditures, maternal mortality rates, and sociodemographic factors from all 67 Florida counties between 2001 and 2014. Florida provides consistent counts of maternal deaths for the entire period of this analysis. We estimated both fixed‐effects ordinary least squares regressions (OLS) and generalized method of moments (GMM) models. GMM enabled us to identify the impact of public health expenditures on maternal mortality rates while also addressing both potential endogeneity and serial correlation problems. We also provide a series of robustness and falsification tests. Findings Overall, a 10% increase in targeted public health expenditures led to a weakly significant decline in overall maternal mortality rates of 3.9%. The estimated effect for white mothers was not statistically significant. However, we found statistically significant improvements for black mothers. Specifically, a 10% increase in pregnancy‐related public health spending led to a 13.5% decline in maternal mortality rates among black mothers and a 20.0% reduction in the black‐white maternal mortality gap. Conclusions Our analysis provides strong evidence of the effectiveness of public health programs in reducing maternal mortality rates and addressing racial disparities.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 57%

Maternal Mortality and Public Health Programs: Evidence from Florida

2020

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“…State MCH expenditures are part of the Title V MCH Block Grant with an expressed mission that includes reducing infant mortality and ensuring access to quality health services for vulnerable populations with lower incomes. Our novel finding associating higher state MCH expenditures with lower Black infant mortality is consistent with other evidence at both state and local-levels that have linked public health expenditures with infant health and birth outcomes [16,53,54,[72][73][74][75][76]. A recent Florida study that examined county-level MCH expenditures and infant mortality found that greater spending was associated with reductions in IMR, especially for the Black population, which may have a greater need and benefit from funded public health and social services [74].…”

Section: Plos Onesupporting

confidence: 89%

Regional variation in Black infant mortality: The contribution of contextual factors

et al. 2020

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Background Compared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement. Methods and findings Black infant mortality data are from the Linked Birth/Infant Death files for 2009-2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70-0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92-0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81-0.90). Modeled variables accounted for 35% of the regional variation in Black IMR. Conclusions These findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional

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“…The effort to reduce the maternal and infant mortality rates also influenced by the government's effectivity, the quality of the regulations, the laws, the accountability, and the political stability, since this effort is a part of the government's goal of sustainable development (Maria, et al, 2019). Public health programs related to maternal and infant health have an impact on the decreasing number of maternal and infant mortality rates (Bernet, Gumus, & Vishwasrao, 2018). The effort of reducing the maternal and infant mortality rates requires cooperation between the midwifes, IBI, Health Office and local power holders because it requires sustainability from the laws that include five aspects mentioned above that will further affect the established community health programs and bring out the optimal results.…”

Section: Legal Structurementioning

confidence: 99%