Epidemiology, Fetus/Newborn Infant, Public Health Ohio's Infant Mortality Problem by Dr Lydia Furman MD, Assistant Editor, Pediatrics Ohio is a terrific place to live, but has major public health challenges. Its infant mortality rate and associated racial inequities are persistent and refractory. This week's Infant Mortality Summit in Cleveland, Ohio (https://www.odh.ohio.gov/odhprograms/cfhs/octpim/2016) sought to draw attention to the problem and focus on solutions. The Infant Mortality Rate (IMR) is the number of child deaths before one year of life per 1,000 births, and the Healthy People 2020 goal for the United States (https://www.healthypeople.gov/2020/topics- objectives/topic/maternal-infant-and-child-health/objectives, MICH-1.3) is to reduce this number to 6.0. Progress has been made nationwide to a rate of 6.08. However, Ohio's all infant IMR in 2015 was 7.2, with a rate for white infants of 5.5, for Hispanic infants of 6.0, and for Black infants of 15.1. That is not a typographic error - it's a shocking vital statistic that has defied multiple public health initiatives. Dr. Arthur James is an Ohio obstetrician who has led our efforts to reduce infant mortality statewide and close the chasm between white and black babies' chances of surviving the first year of life. Ohio's racial disparity has persisted for as long as records have been kept in our state, which is for 35 years. Dr. James points out that over the past 2 decades there has been a 51% improvement in white infant mortality, but only a 31% improvement in black infant mortality; in other words, the gap has widened, and now a black baby has a 2.75x greater chance of dying in year 1 than a white baby. More facts and figures are available from the Ohio Department of Health (ODH) (https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/cfhs/OEI/2015- Ohio-Infant-Mortality-Report-FINAL.pdf?la=en) Race is a social determinant, and I hope none of us believe there is a biological difference between white and black babies. The Ohio Commission on Minority Health White Paper (Ohio Minority Commission Infant Mortality White Paper) accompanying the conference material eloquently states, "…key to understanding this issue is to first acknowledge the complex nature of race as a social construct and adverse reactions to race, which is in fact racism…" Racism is a powerful social force that occurs at the personal, interpersonal and societal or structural levels. Race is a risk factor that can transcend income, education, marital status, and impact women's pregnancy outcomes via chronic stress generated through interpersonal racial discrimination.1 Others have similarly shown that the experiences of a lifetime of stress, not just of 9 months of pregnancy, impact each infant's chances of being born at a healthy weight, specifically that perceived racism predicted birthweight.2 It's very uncomfortable to acknowledge racism directly, and to bear witness to the role it has in weakening the fabric of our society in so many ways, its impact on inequity in infant mortality just one example. One of the most amazing small group sessions at the conference was called "Who' s Asking the Women? Using Digital Storytelling to Include African American Women at the Table in a Community Based Participatory Research Project."3 In an academic-community partnership, a group of African-American women, and a couple Copyright © 2016 American Academy of Pediatrics