Your ZIP code matters more than your genetic code. Where you live predicts how long you will live. That’s what Dr. Anthony Iton, senior vice president of the California Endowment, told me. I had decided to examine Indiana’s high incidence of infant mortality, the death of a child before the age of 1, by looking at five ZIP codes with the highest rates of babies dying. The results were startling. For instance, the black infant mortality rate in East Chicago, Indiana, (27.3 deaths per 1,000 live births) is on par with such developing nations as Zimbabwe or Guatemala. The risk factors often differed by location and demographics. There were some common themes: poverty, stress, pollution. But the more urban areas had more access to health care and services, while the more rural areas had more drug use and smoking.
White mothers were more likely to smoke and use alcohol during pregnancy, while black women were less likely to breastfeed. And where the state’s solutions have focused mostly on the mothers’ behaviors – attending prenatal appointments, keeping babies in a safe sleep environment – I found that the social determinants of health play a big role in infant mortality. Medicine isn’t the problem.
As Dr. Debra Litzelman, a professor and researcher with the Indiana University School of Medicine, told me: “If you only focus on smoking, and a woman has nothing to eat, that’s not going to change her health. If you only focus on safe sleep and not domestic violence and mental health, you’re not going to make an impact.”
We also profiled several potential solutions already underway: home visitation programs, text-based pregnancy coaching, hospitals that give away “baby boxes” that act as portable cribs. I found that in the state of Indiana as a whole, which has the eighth-highest rate of infant deaths in the United States, the wellbeing of its babies is an indicator of the well-being of the entire population. The state is one of the unhealthiest in the nation, and also invests little money in public health. “This measure is the lens to the health of our state,” Dr. Jennifer Walthall, the then-deputy state health commissioner told me.