African-American babies in Ohio are more than three times as likely to die before their first birthday, compared with white babies. Instead of pursuing traditional top-down attempts to change at-risk, mother behaviors, Ohio pursued a social determinates of health (SDOH) approach. It combines cross-agency data sharing and collaboration opportunities with intelligent analytics, to achieve better birth and infant mortality outcomes. Led by fast-moving cross-disciplinary teams, the approach incorporated Human-Centered Service Design techniques with appropriate ethical oversight and governance. The initiative sought to answer three questions: which mothers and infants face the greatest risk of infant death; which will benefit the most from participating in interventions; and which interventions will save the most lives? In just three months, Ohio created a first-of-its-kind, 360-degree view of the at-risk mothers, prioritized about 250,000 such cases, and prescribed targeted interventions.