Healthy Babies and Caring Communities

by Jerry King

Last week Governor Holcomb appointed Kristina Box, MD, to be Indiana’s new State Health Commissioner.  She replaces Jerome Adams, MD, MPH; who became the nation’s 20th Surgeon General earlier this month. Dr. Box is an OB-GYN practitioner from the Community Health Network.

In naming Dr. Box, the governor cited the special expertise and dedication that she brings to two of Indiana’s most pressing public health challenges with most tragic consequences – infant mortality and the opioid epidemic. In fact, she has special experience treating patients where those two dynamics intersect; that is Substance Use Disorder in pregnancy. 

Our experience with opioid addiction gets extensive coverage in the media, but I suspect that many Hoosiers are less informed about infant mortality in Indiana. Infant mortality refers to death of children under the age of one year. According to America’s Health Rankings, Indiana’s rate of 7.2 deaths per 1000 live births is one of the highest in the nation. Indeed, many readers will remember that in the early 90s, we learned that among large cities, Indianapolis had the very highest rate of infant mortality in the nation.  We continue to struggle to understand why. 

In fact, exposure to opiates in the womb, critical as that is, is only one of many factors. Children also die as a result of unsafe sleep practices, low birth weight and mothers smoking during pregnancy, pregnant moms delaying prenatal care, and multiple other contributors which can all work together to compound risk to newborns.   But we miss the point if we blame the mother. A host of well-known societal conditions: poverty, education, nutrition, race, cultural habits, and more – even air pollution help shape differences we observe in people’s health in general and infant health especially.

Among societal conditions, here’s one more layer that I believe we understand intuitively. Healthy decisions, especially among young people, are a function of what they believe about their own futures; life-expectations lay the foundation for decisions. Likewise, pregnant moms’ decisions are not separate from the future they expect for their children.  Hopefulness for our future is a matter of strong self-esteem, and self-esteem is a function of family and community relationships that support and encourage.

Not surprisingly, the Earth Charter that affirms that understanding, urging us to “Promote the active participation of women in all aspects of economic, political, civil, social, and cultural life as full and equal partners, decision makers, leaders, and beneficiaries, and to strengthen families and ensure the safety and loving nurture of all family members."