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The death of a baby before his or her first birthday, termed infant mortality (IM), is an important indicator of population health. The U.S. infant mortality rate (IMR) is 5.8 deaths per 1,000 live births ranking 33rd out of 36 Organization for Economic Cooperative and Development (OECD) nations.1,2 Additionally, U.S. IMR shows racial disparities with Black IMR 2.5 times worse than White IMR.3 Indiana ranks (>40th) among states in the U.S. with a rate of 7.5 deaths per 1,000 live births and 14.4 deaths per 1,000 live births for Black infants. Many of Indiana's counties have higher IMRs. Marion County (Co.) had a rate of 7.5 deaths per 1,000 live births and a striking disparity between Black and White IM, with Black IMR at 11.6, and White IMR at 4.5.4,5 Risk factors known to contribute to IM include self-reported poor health, food insecurity, obesity, smoking, and lower than state average median household income.6 To address such challenges, the 2019 report from the National Academies called for research to evaluate the impact of upstream integration of social care practices on health care outcomes.7
The Indiana Perinatal Quality Improvement Collaborative (IPQIC) report5 provided a description of best-practice models for addressing IM in Indiana. Successful programs included: 1) teams with expertise in quality improvement, data collection, biostatistics, and reporting; 2) real-time data feedback loops with benchmarking against local, state, and national metrics to allow monitoring of responsiveness to change; and 3) engagement with networks of stakeholders and key partners. Behavioral change interventions for participants were also of central importance. Evidence showed that education along with coaching to address barriers and providing one-on-one advice and problem-solving resulted in measurable health behavioral change regardless of education level and socioeconomic status (SES).8
Several systematic reviews9–12 provide evidence that community health workers (CHWs) can effectively help to address health disparities and social inequities.9–12 Community health workers address disparities and improve outcomes through education, connecting individuals to healthcare services, encouraging adherence with health recommendations, including showing up for health care appointments, and providing social support and connections to financial and community resources. Evidence also supports the effectiveness in improving maternal and child health (MCH) for underserved populations by hiring,...