From the New Deal to Neoliberalism: Why Sociopolitical Factors Matter for Maternal, Infant and Child Health—A Critical ReviewAuthors Stephen Nkansah-Amankra, PhD Central Michigan University, College of Health Professions Reuben Miller, PhD University of Michigan

Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

Highlights Maternal, infant, and child health (MICH) outcomes are considered a central and most important measures of population well-being. However, MICH scholars-and public health professionals in general-have been reticent to engage emerging critiques of privatization, individualism embodied in neoliberal social and economic policy. Critical analysis of MICH outcomes in the United States is associated with distinct and contrasting policy regimes: the New Deal and neoliberalism.

Purpose Demonstrate a relationship between the "New Deal" and improved health, Neoliberalism and worsening health in the United States. Demonstrate a relationship between the "New Deal" and improved health, Neoliberalism and worsening health in the United States. Analyze how emergence of neoliberalization in the U.S. is associated with poor health of mothers. Analyze how emergence of neoliberalization in the U.S. is associated with poor health of mothers. Assess the logic of individualism (associated with neoliberalism) and worsening poor child and maternal health outcomes. Assess the logic of individualism (associated with neoliberalism) and worsening poor child and maternal health outcomes.

Introduction Risk based approach and existing health disparities and inequalities across racial groups. Risk based approach and existing health disparities and inequalities across racial groups. Raises important questions on limitations of the risk based approach in health interventions. Raises important questions on limitations of the risk based approach in health interventions. Because this approach overemphasizes individual’s behavior to the exclusion of the broader contextual determinants. Because this approach overemphasizes individual’s behavior to the exclusion of the broader contextual determinants.

Issues with Neoliberalism Rising income inequality Rising income inequality Shrinking social safety net Shrinking social safety net Expanded criminal justice system differentially low income communities Expanded criminal justice system differentially low income communities These are all linked to negative public health outcomes

Need for Federal Interventions for MICH Outcomes We examine two contrasting periods:  Events Prior to the era of ‘New Deal’ - Relatively high infant and maternal mortalities - Relatively high infant and maternal mortalities -Unsafe working conditions -Unsafe working conditions - High Poverty - High Poverty These are definitely beyond the control of individual mothers The response was improvement of the social conditions of childbirth and working environment for children.

‘The New Deal Era”  These activities by social movements and federal government and social movements led to precipitous declines in infant, child and maternal deaths in the early part of the 20 th C.  The federal government vs. the Children’s Charter (1930)  Passage of Social Security Act in 1935 (Addenda to Title V)  Nonetheless, these policy choices are often to underlying social structure and racialization.

Neoliberalism Includes a set of clustered social and economic policies that privilege market deregulation and limited state intervention. Includes a set of clustered social and economic policies that privilege market deregulation and limited state intervention. It is also considered as an Americanized social and economic governance It is also considered as an Americanized social and economic governance Neoliberalization provides a unique context for American Health care system Neoliberalization provides a unique context for American Health care system

Neoliberalism Significant changes occurring in the social welfare policy are linked with the emerging market principles of individualism. Significant changes occurring in the social welfare policy are linked with the emerging market principles of individualism. Incarceration of minority populations and poor health of prisoner population due to heightened criminal justice responses. Incarceration of minority populations and poor health of prisoner population due to heightened criminal justice responses.

Consequences Rising income inequality are harmful to MICH outcomes, particularly disadvantaged populations. Higher incidence and prevalence of negative MICH outcomes including preterm births, low birth weight and high infant mortality. US as a ‘leader’ in numerous negative outcomes among industrialized countries of the world.

Consequences The collectivist approach in addressing public health policy issues is now supplanted with individualist conceptions of public health problem The collectivist approach in addressing public health policy issues is now supplanted with individualist conceptions of public health problem

Summary and Conclusion MICH indicators are sensitive to sociopolitical factors including policy decisions. Market principles have commodified MICH, resulting in concentrated disadvantages. The risk factor approach in public health minimizes mothers ability to mitigate structural constraints. Public health scholars need to subject governance strategies to critical scrutiny. Social Justice framework now replaced with market justifications of individualism.