PPA Priorities

Maternal, Infant and Child Health

Infant mortality is a key indicator of health and the effectiveness of the health care system in a country. However, the infant mortality rate in the United States (US) remains consistently higher than that of other developed countries. The leading causes of infant mortality in the US – birth defects, low birthweight and preterm birth, and sudden infant death syndrome – account for nearly 45 percent of infant deaths. 


In the US, black mothers and babies are at greatest risk for poor birth outcomes. The rate of infant mortality for babies born to non-Hispanic black women (11.3 deaths per 1,000 live births) is more than two times the rate of babies born to non-Hispanic white women (4.9 deaths per 1,000 live births). Babies born to low income families or to mothers who are unmarried, obese (BMI≥30), or who smoke or consume alcohol during pregnancy are also more likely to die in infancy.  


A range of maternal health and access to care factors place mothers and babies at greater risk for infant mortality. These factors include play a role in preconception (before pregnancy),prenatal (during pregnancy), and inter-conception (between pregnancies) periods. Key maternal health risk factors associated with poor birth outcomes are hypertension and heart disease; diabetes; poor nutrition; unhealthy weight; sexually transmitted diseases (STDs); depression; tobacco, alcohol, and substance use; intimate partner violence; genetic conditions. Key access to care factors associated with poor birth outcomes include routine medical check-ups and family planning counseling for both women and men; use of ongoing care during pregnancy; access to counseling and home visits after delivery.


Social determinants of health (SDoH) are also associated with birth outcomes. These include factors such as access to health care and early intervention services, education, employment, economic opportunities, social support, and other resources that influence maternal health behaviors and health status.


NAHSE Supports Policies to Reduce the Risk of Maternal and Infant Mortality and Pregnancy-related Complications.


-Family planning counseling for women and men


-Access to health insurance coverage through Medicaid expansion, the ACA health insurance exchange, employer-based coverage, or other sources 


-Access to early intervention services for the treatment of developmental delays and disabilities and other health conditions among infants to prevent death or disability and enable children to reach their full potential


-Screening and intervention for intimate partner violence


-Screening and treatment for tobacco, alcohol and drug use


-Screening and treatment for depression or other mental health conditions


-Screening and treatment for obesity, blood pressure and diabetes


-Access to home nurse visits or other support to reduce the incidence of SIDS and accidents


References and Additional Information:

Infant Mortality: https://www.americashealthrankings.org/explore/annual/measure/IMR/state/ALL


Why Are Maternal, Infant, and Child Health Important? https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health


Determinants of Maternal, Infant, and Child Health: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health

Medicaid Expansion

Medicaid expansion is one of the three primary goals of the comprehensive health care reform legislation the Patient Protection and Affordable Care Act (known as the PPACA, ACA or “Obamacare”), signed into law in March 2010 by President Barak Obama. The ACA offered states the option to expand eligibility for Medicaid to individuals with incomes up to 138 percent of the federal poverty level (FPL), with generous federal cost-sharing commitments that provided strong economic incentives for states to expand their Medicaid programs. To date, millions of Americans have gained access to coverage under state Medicaid expansion. However, in a landmark decision in 2012, the US Supreme Court decided to limit the authority of Congress to require states to expand their Medicaid programs under the health care law (National Federation of Independent Business v. Sebelius). As a result, several states have decided not to expand Medicaid under the ACA, which thrust millions of Americans into the ACA “coverage gap,” which means they earn too much to qualify for Medicaid, but not enough to be eligible to receive premium tax credits to help them pay for ACA health insurance marketplace plans.


Despite the large coverage gains for racial and ethnic minorities under the ACA, disparities in health insurance coverage persist. Furthermore, the policies of the current, including the approval of Medicaid waivers that add eligibility restrictions, continue to threaten coverage gains, create barriers to care, and increase economic instability from medical bills and rising debt. People of color are among the groups at greatest risk for these adverse outcomes.


References and Additional Information:


Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers: https://www.kff.org/medicaid/issue-brief/section-1115-medicaid-demonstration-waivers-the-current-landscape-of-approved-and-pending-waivers/


Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State: https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/


State Waivers List: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid: https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/


The Impact of the Coverage Gap for Adults in States not Expanding Medicaid by Race and Ethnicity: https://www.kff.org/disparities-policy/issue-brief/the-impact-of-the-coverage-gap-in-states-not-expanding-medicaid-by-race-and-ethnicity/


An Overview of State Approaches to Adopting the Medicaid Expansion: https://www.kff.org/medicaid/issue-brief/an-overview-of-state-approaches-to-adopting-the-medicaid-expansion/

Social Determinants of Health

The World Health Organization (WHO) defines the social determinants of health (SDoH) as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”   The WHO further defines these forces and systems to include policies, systems, agendas, and norms – within and across public and private sectors – that influence societal well-being and quality of life. There is significant evidence that SDoH are major contributors to health inequities, or systematic differences in health processes and outcomes, that are closely linked to race, ethnicity, socioeconomic status and other social disadvantages.


Healthy People 2020 utilizes a “place-based” organizing framework to reflect five key areas of SDOH:

– Economic Stability




-Social and Community Context


-Health and Health Care


-Neighborhood and Built Environment


The interrelationships among factors within these areas, and the policies that influence these areas, determine individual and population health. Therefore, SDoH reach beyond the boundaries of traditional health care and public health sectors into sectors such as education, housing, transportation, agriculture, and the built environment.  To address the SDoH, the influence health and exacerbate health inequities, a coordinated, health in all policies approach is needed.


References and Additional Information:

World Health Organization (WHO): https://www.who.int/social_determinants/en/


Health in all Policies: https://www.who.int/social_determinants/healthinallpolicies-hiap/en/


Determinants of Health: https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health


Social Determinants of Health: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health


Social Determinants of Health-FAQs: https://www.cdc.gov/socialdeterminants/faqs/index.htm#faq1


Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity: https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/


Enard KR, Laws T, Elder K. Health Services & Health Policy Research.  In MS Goodman and VS Thompson (Eds.), Public Health Research Methods for Partnerships and Practice. UK: Taylor & Francis/Routledge; 2017: 263-284.

Mental and Behavioral Health

Mental illnesses are common, treatable health conditions involving one or more changes in emotion, thinking or behavior. Mental illnesses include depression, anxiety, bipolar, eating, obsessive-compulsive, post-traumatic stress, postpartum, addiction, substance abuse and other disorders.  These conditions are associated with distress and problems functioning in social, work or family activities, as well as difficulties adapting to change and coping with adversity. Each year, approximately 18% of US adults have a diagnosable mental disorder; approximately 4% of adults have a serious mental illness. Mental and behavioral disorders are among the leading causes of disability in the US.  Although most racial or ethnic minority groups experience similar or fewer mental disorders than whites, racial and ethnic minorities often face a disproportionately high burden of disability resulting from mental disorders and are less likely to receive mental health care. Providers may underdiagnose or misdiagnose racial and ethnic minorities due to lack of cultural understanding, language differences, or greater stigma of mental illness among racial and ethnic minorities. Lack of insurance or underinsurance is also barrier to mental and behavioral health care.


Medicaid is the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use disorder services. Individuals with a behavioral health disorder also utilize significant health care services.  Furthermore, the program continues to comprise an increasing share of total spending for opioid and other addiction treatment. The Mental Health Parity and Addiction Equity Act makes it easier for Americans with mental and behavioral health disorders to obtain care by prohibiting certain discriminatory practices that limit insurance coverage for behavioral health treatment and services. Specifically, it requires coverage for mental health and substance use disorders to be no more restrictive than the coverage that generally is available for medical/surgical conditions. However, several proposed policies threaten to restrict coverage and benefits for Medicaid populations with mental and behavioral health conditions.  These policies include repealing Medicaid expansion, changing Medicaid financing into a block grant or per capita cap system, restrictive Section 1115 waivers.


References and Additional Information:

What is Mental Illness? https://www.psychiatry.org/patients-families/what-is-mental-illness


Mental Health Disparities: Diverse Populations: https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts


Medicaid Funding: https://www.thenationalcouncil.org/topics/medicaid/


Behavioral Health Services: https://www.medicaid.gov/medicaid/benefits/bhs/index.html


Parity: https://www.medicaid.gov/medicaid/benefits/bhs/parity/index.html


Medicaid’s Role in Financing Behavioral Health Services: https://www.kff.org/medicaid/issue-brief/medicaids-role-in-financing-behavioral-health-services-for-low-income-individuals/

Injury and Violence Prevention

In the first half of life, more Americans die from violence and injuries — such as motor vehicle crashes, falls, or homicides — than from any other cause.  Consequently, injuries are the leading cause of death for Americans ages 1 to 44 years, and a leading cause of disability for all ages. More than 214,000 people die from injuries each year and one in 10 people are treated in a hospital emergency department for nonfatal, serious injuries.  Those who survive nonfatal, serious injuries are faced with life-long mental, physical, and financial problems. Violence also erodes communities by reducing productivity, decreasing property values, and disrupting social services. Several modifiable factors influence the risk of unintentional injury and violence: individual behaviors; home and community physical environments; and social environments.


References and Additional Information:

Violence Prevention at CDC: https://www.cdc.gov/violenceprevention/publichealthissue/index.html


Key Injury and Violence Data: https://www.cdc.gov/injury/wisqars/overview/key_data.html


Injury and Violence Prevention: https://www.healthypeople.gov/2020/topics-objectives/topic/injury-and-violence-prevention


Why is Injury and Violence Prevention Important? https://www.healthypeople.gov/2020/topics-objectives/topic/injury-and-violence-prevention


Injury and Violence Data: https://www.cdc.gov/injury/wisqars/index.html


Ten Leading Causes of Death and Injury: https://www.cdc.gov/injury/wisqars/LeadingCauses.html