Local public health delivery of maternal child health services: are specific activities associated with reductions in Black-White mortality disparities?

Abstract

To identify which MCH services delivered by local health departments (LHD) appear associated with reducing differences in Black-White mortality. We used a time-trend design to investigate relationships between change in MCH activities provided by LHDs in 1993 and in 2005 and changes in 1993-2005 Black-White mortality disparities. Secondary data were analyzed for 558 US counties and multi-county districts. Independent variables included the six MCH services provided by LHDs and captured in the 1993 and 2005 NACCHO Profile of Local Public Health Departments surveys. MCH service variables represented change in each service from 1993 to 2005. Control variables included selected LHD characteristics and county-level socioeconomic, demographic, and health provider resource data. Absolute change in Black and White mortality rates and changes in the mortality disparity "gap" between these rates in 1993 and 2005 were examined as dependent variables. Among the MCH services examined, prenatal care had a significant beneficial relationship with Black all-age mortality change and with reducing the mortality "gap." Family planning services had a beneficial relationship with reducing the mortality "gap" for females in the jurisdictions in the study sample. WIC services indicated the most consistently beneficial relationship with both Black mortality and White mortality change, but these changes did not influence the mortality "gap" during the study period. LHD delivery of family planning and prenatal care by LHDs appears related to reductions in Black-White mortality disparities. Implications of this study suggest the importance of certain MCH services for reducing Black-White mortality disparities.

Figure 1

Percent of counties or areas in sample with changes in MCH service delivery from 1993 to 2005 (n=558). NOTE: FP = Family Planning, AP represents Antenatal (Prenatal) Care, OB represents Obstetrical Care, WIC represents Women Infants and Children Supplementary Nutrition Program, EPSDT represents Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment, IMM represents Immunizations