HJBR Jan/Feb 2023

HEALTHCARE JOURNAL OF BATON ROUGE  I  JAN / FEB 2023 53 Monique McConduit Jones, MD, MPH, FAAP Medical Director Louisiana Healthcare Connections ences that may exist because of structural racism, poverty, cultural norms, and other factors. The recommendations, updated for the first time since 2016, are designed to help pediatricians discuss sleep safety with all parents and caregivers. SIDS deaths have declined more than 60% since the academy’s Back to Sleep campaign began in 1994. But SIDS remains a leading cause of death in infants younger than 1 year old, according to the Centers for Disease Con- trol and Prevention. More than twice as many of these SIDS deaths occur among non-Hispanic Black, American Indian, andAlaska Native babies per 100,000 live births than non-Hispanic white babies. The new AAP guidelines ad- dress reasons for this disparity head on, including unsafe sleep practices such as infants sharing beds with parents and the use of soft bedding — a callout for SDOH in the new guidelines may help affect sleep safety. “This change is important to note so that health-care providers may take into account what other struggles the family may be impacted with that would poten- tially prevent them from following the new guidelines,” says Dr. Nilong Vyas, formerly a pediatrician in New Orleans. On May 16, 2022, President Biden signed H.R. 3182 — the “Safe Sleep for Babies Act” — prohibiting the manufacture and sale of inclined sleepers for infants and crib MCOs are better positioned to address the complex health needs of Medicaid bene- ficiaries through an emphasis on preven- tion, disease management, and early de- tection. In Louisiana, an average of 61,000 in- fants a year are born alive. Of these in- fants, approximately 462 die before their first birthday. From 2017-2019, 1,968 chil- dren died, representing a yearly average of 656 infant and child deaths. During this time period, Louisiana ranked in the top 10 states with the highest mortality rates for infants and children in almost all age groups. But about one-third of all infant (less than 1 year of age) deaths in Louisiana are potentially preventable, with most in- jury-related deaths occurring in the sleep environment. In support of safe sleep At the national level, safe infant sleep is being addressed through legislation and by new safe sleep recommendations. In June 2022, the AmericanAcademy of Pedi- atrics (AAP) revised its long-standing safe sleep recommendations with a specific goal: address inequities to reduce sudden unexpected infant death (SUID) and sud- den infant death syndrome (SIDS) among Black, American Indian, and Alaska Na- tive babies. Building off the academy’s call earlier in 2022 for removing race-based medicine, these revisions outline differ- PEOPLE in underserved communities — who have historically been dispropor- tionately affected by rigid policies, mini- mal support services, and limited provider hours and locations — are at greater risk of negative maternal and infant health outcomes, such as birth and postpartum complications. Those living in rural ar- eas, people of color, and individuals ex- periencing language and cultural barriers are particularly at risk, and COVID-19 has only further exacerbated these disparities. In Louisiana, where 60 out of 64 parishes are designated “Health Professional Short- ageAreas,”significant statewide disparities exist and must be eliminated. Taken as a whole, systemic inequities are daunting, and removing them requires a holistic ap- proach and collective commitment — from policymakers and legislators to communi- ty and business leaders — it takes a village. And while it cannot solve every health- care-related issue, Medicaid delivered through capitated managed care can have a meaningful impact through targeted tactics and reach. With greater innovative capacity to address health inequities and the social determinants of health (SDOH), managed care organizations (MCOs) are able to invest in research and develop- ment as well as incorporate data analytics focused on improving member engage- ment and health outcomes. Because it’s their business objective and their mission,