Louisiana Department of Health Secretary Alan Levine today announced a statewide effort to improve Louisiana’s birth outcomes, one of the most important indicators of a healthy society. Levine has asked assistant secretary of the Office of Public Health, M. Rony Francois, M.D., Ph.D., MPH, to lead the effort full time.
Despite its high rankings for the percentage of women receiving prenatal care, Louisiana continues to rank poorly for its various birth-outcome measures. According to the 2009 America’s Health Rankings by the United Health Foundation, Louisiana ranked 49th in infant mortality at 10 deaths per 1,000 live births. And, according to the KIDS COUNT 2009 data book by the Annie E. Casey Foundation, Louisiana ranked 49th in percent of low-birth-weight babies and infant mortality rate.
These poor outcomes relative to the rest of the United States have changed little over time, despite increasing access to prenatal care for Louisiana’s mothers and a child health insurance rate among the highest in the nation.
"We cannot just scratch our heads and wonder why, despite all that has been done so well by our physicians and other providers, our outcomes continue to languish," Levine said. "What I am proposing today is a thorough inventory of all initiatives, programs and infrastructure across the state, input from the provider and social service community, and the creation and execution of a statewide action plan that all Louisianans can rally around, support and measure. Our experience shows that when we focus on a problem, we achieve results."
Levine pointed to the recent recognition Louisiana received from the U.S. Department of Health and Human Services for being the model state in administrative efficiency and maintenance of insurance for children. Louisiana also moved up drastically in child immunization rates from 44th in the nation to 2nd, according to the U.S. Centers for Disease Control and Prevention.
Francois will apply his years of domestic and international public health experience to lead the state’s new initiative. The initial focus will be to assemble department resources to support the effort, work with LDH partners (including providers, health plans and community-based organizations) to conduct a statewide inventory of services and programs along with quality and outcomes metrics, and draft and implement a multi-year statewide plan for improving our outcomes. Key to this success will be the establishment of meaningful goals and benchmarks for the state, the Legislature and providers to monitor.
"We’ve long understood that improving the health of newborns goes beyond what happens in the exam room," said Keith Perrin, M.D., president of the Louisiana Maternal and Child Health Association and a practicing pediatrician. "Prenatal nutrition, substance abuse—including smoking and alcohol, and social supports all have significant impact on short- and long-term birth outcomes. We are encouraged that the department is taking a focused and comprehensive approach."
Low birth weight is a term used to describe babies who are born weighing less than 2,500 grams (5 pounds, 8 ounces). Low weight at birth leads to increased risk for infant death and developmental disability. More than 7,000 babies were born underweight in Louisiana in 2006 according to the U.S. Centers for Disease Control and Prevention. The general causes of low birth weight include poor pre-pregnancy and pre-natal health (including poor nutrition and high rates of diabetes, hypertension, depression and sexually transmitted diseases), smoking and substance abuse, genetic predisposition, and lack of prenatal care. Lack of family and peer support, age, race, education, stable housing and other social factors are also associated with low birth weight.
Infant mortality is defined as death during the first year of life. The rate of infant mortality is commonly cited as a primary indicator of a society’s health status. The rate of infant mortality in the United States ranks 44th among U.S. states. In 2007, more than 600 infants in Louisiana died within their first year of life. The primary causes of infant mortality include congenital abnormalities, low birth weight, Sudden Infant Death Syndrome (SIDS), maternal complications and accidents.
Rates of infant mortality among African-American children are almost twice that of Caucasian children in Louisiana. There are also significant geographic disparities within Louisiana. In 2006, the infant mortality rate for Louisiana resident women was 10.0 deaths per 1,000 live births. In contrast, Louisiana resident women in the Delta parishes experienced an infant mortality rate of 11.3 deaths per 1,000 live births in 2006.
"It has long been a concern of mine and the members of the Louisiana Legislative Black Caucus that we have such unfortunate disparities in infant mortality across various races and regions in this state," said Representative Regina Barrow, Chair of the Louisiana Legislative Black Caucus. "There is no excuse that in a state where family is held to such a high value, that we are doing such a poor job of keeping our babies healthy. We know we have the capacity and capability and I look forward to supporting the Department in its efforts and seeing the state of Louisiana move forward in a positive direction as it relates to care for our babies."
The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visit http://www.dhh.louisiana.gov.