We Can Do Better: Reinventing Maternal & Child Health in America

1. We Can Do Better:Reinventing Maternal & Child Health in America Michael C. Lu, MD, MPH Associate Professor Department of Obstetrics & Gynecology David Geffen School of Medicine at UCLA Department of Community Health Sciences UCLA School of Public Health 2008 CityMatCH Conference Albuquerque, NM September 23, 2008

2. Mario Drummond Neal Halfon Milt Kotelchuck Cheri Pies Acknowledgment

4. Why Reinvent MCH?

5. Maternal Mortality Source: OECD Health Data 2008

6. Infant Mortality Source: United Nations. Table 4. In: United Nations Demographic Yearbook, 2004. New York, NY: United Nations; 2007:73–93.

7. U.S. Rank in OECD • Maternal mortality • All races – 25th • Whites only – 19th • Infant mortality • All races – 22nd • Whites only – 22nd

8. Racial & Ethnic DisparitiesPregnancy-Related Mortality Ratio, 1991-1999 Deaths Per 1,000 Live Births Chang et al MMWR 2003

9. Racial & Ethnic DisparitiesInfant Mortality, 2005 Deaths Per 1,000 Live Births NCHS 2008

10. Healthy People 2010Infant Mortality Per 1,000 Live Births Year 2010 Goal NCHS 2008

11. Healthy People 2010Low Birthweight Per 1,000 Live Births Year 2010 Goal NCHS 2008

12. Healthy People 2010Very Low Birthweight Per 1,000 Live Births Year 2010 Goal NCHS 2008

13. Healthy People 2010Preterm Birth Per 1,000 Live Births Year 2010 Goal NCHS 2008

14. How Can This Be?

15. How Can This Be? First, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care. Schroeder SA. NEJM 2007;357:1221-8

16. How Can We Do Better? • Transform maternal and child healthcare in America • Assure the conditions in which all mothers and children can be healthy

17. 1. Transforming Maternal & Child Healthcare in America

19. Pediatric Office 2.0 Parenting Support Early Intervention Early Child Mental Health Services Home-visiting network Early HeadStart & HeadStart Child Care Resource & Referral Agency Developmental Services Lactation Support Preventive Care Acute Care Pediatric Office Developmental Services Chronic Care

20. Pediatric Office Pediatric Office 3.0 Evaluation (IDEA Sector Surveillance Community Services and Resource Sector Screening Pediatric Services Sector Assessment Peds/HPlan/PHSector IDEA Regional Center for Developmental Disabilities Mid-Level Assessment Center Preventive Care Other Specialized Services Acute Care Developmental Services Chronic Care COORDINATION CENTER Child Care/Family Resource Center Program Surveillance Program

21. Health Development • Preconception care 3.0 • Prenatal care 3.0 • Postpartum care & interconception care 3.0 • Pediatric care 3.0 • School health 3.0 • Adolescent health 3.0 • Family planning/reproductive health 3.0 • Children with special healthcare needs 3.0 • Vertical, horizontal & longitudinal integration • Universal healthcare

22. 2. Assure Conditions in Which All Mothers & Children Can Be Healthy

23. Developmental Strategies • Health development (health capital) • Educational development (human capital) • Economic development (material capital) • Family development (relational capital) • Community development (social capital) • Sustainable development (natural capital)

24. Educational Development • Preconception and prenatal care • Parenting education • Child care • Universal Preschool • Early Head Start and Head Start • K-12 – small class size, teacher quality, standards • After school and summer programs • Youth development • Health education/physical education • Comprehensive school health clinics

25. Educational Development Early Childhood programs After-school programs Summer Programs + Comprehensive school health clinics $156 billion

26. Economic Development • Raise minimum wage • Expand Earned Income Tax Credits • Strengthen collective bargaining • Providing safety net – unemployment, housing, food stamps • Providing job training and retraining • Assuring universal healthcare • Expanding access to family and medical leave, quality childcare, universal preschool • Teach financial literacy • Extend microloan programs • Macroeconomic policies

27. Family Development • Human development (education, employment, legal/social services) • Life skills training • Reproductive health • Violence prevention • Marriage counseling/family therapy • Economic development • Criminal justice system reforms • Tax reform • Welfare reform • Child support reform

28. Relationality is primary, All else is derivative. -Ronald David

29. Black babies are dying because their mothers are dying in dead relationships. -Sister Byllye Avery

30. Efforts to reduce maternal and infant mortality and morbidity must focus on the repair and support of interpersonal relationships at all levels. - National Commission on Infant Mortality

31. Community Development • Economic development • Affordable decent housing • Delink schools and property tax • Community policing • Municipal services • Infrastructure development • Clean air and water • Create social capital • Create cultural capital • Residential desegregation

32. Reproductive Social Capital Features of social organization that facilitate coordination and cooperation to promote reproductive health within a community • community networks • civic engagement • local identity and a sense of solidarity and equity with other community members; • trust and reciprocal help and support.

33. Sustainable Development • Teach individual responsibility • Protect air quality • Protect water quality • Protect food safety • Provide consumer education • Mobilize consumer actions • Require higher standards and more testing of consumer products • Promote smart growth • Stop global warming • Support research on environmental influences

34. “Now that you’re here, the word of the Lorax seems perfectly clear. UNLESS someone like you Cares a whole awful lot, Nothing is going to get better. It’s not. “SO… Catch!” calls the Once-ler. He lets something fall. “It’s a Truffula Seed. It’s the last one of all! You’re in charge of the last of the Truffula Seeds. And Truffula Trees are what everyone needs. Plant a new Truffula. Treat it with care. Give it clean water. And feed it fresh air. Grow a forest. Protect it from axes that hack. Then the Lorax And all of his friends May come back.” - Dr. Seuss, the Lorax

35. Reinventing MCH

36. Reinventing MCH • Create a new roadmap for MCH • Transform maternal & child healthcare • Assure conditions for optimal MCH development • Revise MCH core functions • Retool MCH workforce • Reorganize MCH programs • Establish MCH Trust Fund • Engineer MCH innovations

37. 1. Create a New Roadmap to MCH

38. Map to Nowhere?

39. “If you don't know where you are going, any road will take you there.” Lewis Carroll, Alice in Wonderland

40. What should our national goals for MCH be for the Year 2020? 2030? 2040? What should be our Healthy People 2020 objectives for MCH?

41. 2. Transform Maternal & Child Healthcare

42. Integration

43. Not just providing stop-gap services, but building integrated systems and assuring access, quality, coordination & integration

44. Universal Coverage

45. 3. Assure Conditions for Optimal MCH Development

46. Community Development Environment MCH Healthcare Education

47. MCH Life- Course Organization

48. We must become the change we want to see. - MAHATMA GANDHI

49. 4. Redefine MCH Core Functions

50. Ten Essential Public Health Services to Promote Maternal and Child Health in America • Assess and monitor maternal and child health status to identify and address problems. • Diagnose and investigate health problems and health hazards affecting women, children, and youth. • Inform and educate the public and families about maternal and child health issues. • Mobilize community partnerships between policymakers, health care providers, families, the general public, and others to identify and solve maternal and child health problems. • Provide leadership for priority-setting, planning and policy development to support community efforts to assure the health of women, children, youth and their families. • Promote and enforce legal requirements that protect the health and safety of women, children, and youth, and ensure public accountability for their well-being. • Link women, children, and youth to health and other community and family services, and assure access to comprehensive, quality systems of care. • Assure the capacity and competency of the public health and personal health work force to effectively address maternal and child health needs. • Evaluate the effectiveness, accessibility, and quality of personal health and population-based maternal and child health needs. • Support research and demonstrations to gain new insights and innovative solutions to maternal and child health-related problems.