Children's health gaps vary

But even the lowest infant mortality rate among children of the best-educated mothers in Massachusetts -- 3.4 deaths per 1,000 live births -- is higher than the 3.2 deaths per 1,000 live births among the best-educated mothers in New Jersey and Washington state, pointing to the potential for improvement, the report said. The overall rate in Massachusetts is 4.6 deaths per 1,000 live births.

Massachusetts fell to 16th for its gap on general health status, according to surveys of parents. Overall, 11.3 percent of children were in less than "very good" or "excellent" health, but that was true for only 5.7 percent of wealthy families. The lowest rate nationally was 3.5 percent, a level achieved in Colorado. New Hampshire has the smallest gap between its poor and wealthy families.

"This report adds to a growing body of evidence on the link between education, income, and health, particularly among children," David R. Williams of the Harvard School of Public Health said in a conference call with reporters. "We all want our children to grow up to live long and healthy lives, but not all families can provide the same opportunities and resources."

The influence of education and income on health wasn't limited to just the high and low ends, the report said.

"Poor children suffer the most, but it's not just the poorest," Susan Egerter of the University of California, San Francisco said on the call. "There's also a health shortfall among the middle class."

In Massachusetts, for example, the infant mortality rate for children whose mothers had attended some college was still 40 percent higher than the rate for mothers who had completed college.

Elmer Freeman, executive director of Center for Community Health Education, Research and Service at Northeastern University, said he found nothing surprising in the report linking social and economic factors to children's health. He was not involved in preparation of the report.

"We have a great healthcare system here in Massachusetts, but the great experiment in health reform is focused exclusively on access," he said. "I think the real focus needs to be on the social determinants of health: education, issues around affordable housing, the built environment. Food security and food access are key critical issues."