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Life Course Perspective: Reducing Birth Disparities

Learn about the life course perspective and its role in reducing birth disparities and improving maternal and child health outcomes. Explore the impact of social determinants and the importance of integrated, comprehensive care throughout the lifespan.

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Life Course Perspective: Reducing Birth Disparities

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  1. Friday, June 17, 2011 Perinatal Association of Kansas ConferenceWichita, KS Janine Lewis, PhD(c), MPH Senior Associate, Practice Matters Executive Director, IL MCH Coalition Life Course Perspective

  2. Overview • Life Course Perspective • MCH Life Course Continuum • MCH Life Course Organizations • NMPP • MCH and Chronic Disease • IMCHC

  3. Socio-ecological framework

  4. Life Course Model The mission of the Life Course Initiative is to reduce disparities in birth outcomes and change the health of the next generation in by achieving health equity, optimizing reproductive potential, and shifting the paradigm of the planning, delivery, and evaluation of maternal, child, and adolescent health services. Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the black-white gap in birth outcomes: A life-course approach. Ethn Dis. 2010;20(1 Suppl 2):S62-76.

  5. Life Course Perspective • A way of looking at life not as disconnected stages, but as an integrated continuum • Suggests that a complex interplay of • biological, • behavioral, • psychological, • and social protective and risk factors contributes to health outcomes across the span of a person’s life. • The life course perspective conceptualizes birth outcomes as the end product of not only the nine months of pregnancy, but the entire life course of the mother leading up to the pregnancy.

  6. Life Course Perspective • Early programming • Experiences early in life can influence health and functions later in life • Developmental origins of health and disease • Timing (sensitive and critical period) and trajectory • Cumulative pathways • Accumulation of risks and insults can cause decline in health and functions over time • Life course chronic disease epidemiology • “weathering” (allostatic load) and pathway 6

  7. Life Course Theoretical Assumptions & Implications for MCH Practice Revised Role & Impact of Prenatal Care Maternal Health Prior to Pregnancy is Key It will Take More Than One Generation to Equalize Birth Disparities Calls for Clinical & Public Health Interventions that are more Longitudinally and Contextually Integrated Transition Must be Made from Strictly Clinical Approaches to Practice to Integrate a Social Determinants of Health Focus to Practice

  8. The Life Course Perspective Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Matern Child Health J. 2003;7:13-30. 8

  9. Life Course Perspective • Life course perspective and social determinants • Life course theory offers an explanatory model for how social determinants influence health • Life course perspective and health equity • Life course theory offers an explanatory model for how health inequities develop • Life course perspective and life course health development • LCHD is an application of the life course theory to explain how health develops and declines over the life course 9

  10. Traditional Perinatal Care Continuum Preconception Counseling Primary Care Postpartum Care Labor and Delivery PreconceptionPeriod Interconceptional period antepartum postpartum Prenatal Care Care throughout labor and delivery Well Child Care

  11. New MCH Life Course Continuum Axis 1

  12. MCH Life Course Organization A MCH Life Course Organization is an entity (local/state) that develops the capacity over time to deliver integrated, continuous and comprehensive health and social services and support to women and their family members from the womb to the tomb.

  13. MCH Life Course Organization A MCH Life Course Organization is an entity (local/state) that develops the capacity over time to deliver integrated, continuous and comprehensive health and social services and support to women and their family members from the womb to the tomb.

  14. Characteristics of a MCH Life Course Organization (LCO) Establishes an organizational structure. Builds programmatic capacity within the agency at each stage of a woman’s life course to manage her health over the life course (Axis 1). Swimsupstream from individual interventions and designs strategies and actions at the group, organizational, community and policy levels to transform social determinants to poor health (Axis 2).

  15. Characteristics of a MCH Life Course Organization If unable to build internal capacity collaborates with outside agencies and systems to create an integrated system of care to manage a woman’s health.

  16. Characteristics of a MCH Life Course Organization Unlike many maternal and child health programs that only seek to influence the health system by developing and executing a local health system action plan, a MCHLCO seeks to influence and lead their local and regional economic, political, housing, child welfare, early childhood and middle school systems of care.

  17. Components of MCH LCO

  18. NMPP: Social Determinants of Health Axis

  19. Northern Manhattan Perinatal Partnership The Northern Manhattan Perinatal Partnership, Inc. (NMPP) is a not-for-profit organization comprised of a network of public and private agencies, community residents, health organizations and local businesses. NMPP provides crucial services to women and children in Central, West and East Harlem and Washington Heights

  20. Northern Manhattan Perinatal Partnership NMPP’s mission is to save babies and help women take charge of their reproductive, social and economic lives. We achieve this mission by offering a number of programs that help reduce the infant mortality rate and increase the self-sufficiency of poor and working class women throughout the above communities

  21. NMPP 1995

  22. NMPP 2009

  23. NMPP’s Individual/Clinical Life Course Interventions • Central Harlem Healthy Start Program • Nurse Family Partnership, (NYCDOH/MH) • Community Health Worker Program • Harlem Hospital Birthing Center • St. Nicholas Child Welfare Preventive Program • Mankind Fatherhood Case Management Program • Baby Steps Home Visiting Program (Healthy Families America Model) • TASA Cobra Case Management Program for Pregnant Teens

  24. NMPP’s Group/Interpersonal Interventions • Baby Mama’s Club/Circulo de Mamas Depression Groups • Centering Pregnancy • Adolescent Pregnancy Prevention Team • Harlem Weight Watchers Program • CHHS’s Consumer Involvement Organization

  25. NMPP’s Organizational Life Course Interventions • CHHS Consortium • NYC Male Involvement Consortium • Comprehensive Prenatal/Perinatal Network • Harlem Child Welfare Network • Casey Powerful Families Training Program • Harlem Health Promotion Center • Sisterlink Coalition (CDC Funded)

  26. NMPP’s Community Environmental Life Course Interventions • NMPP’s Harlem Works Job Readiness Program • NYC Breastfeeding Alliance • Harlem Strategic Action Committee • ABC Asthma Coalition • Start-Right Immunization Coalition • St. Nicholas Houses Community Organizing Project

  27. NMPP’s Public Policy Life Course Interventions • Federation of County Networks • Harlem Food & Fitness Consortium • Citywide Coalition to End Infant Mortality • Manhattan Regional Perinatal Forum • NMPP’s BBKH Diabetes Coalition

  28. Working Definition of a MCH Life Course Organization A MCH Life Course Organization is an entity (local/state) that develops the capacity over time to deliver integrated, continuous and comprehensive health and social services and support to women and their family members from the womb to the tomb.

  29. Central Harlem Infant Mortality Rate September 13, 2006 Bureau of Vital Statistics New York City Department of Health and Mental Hygiene

  30. Infant Deaths and Infant Mortality Rate by Health Center District of ResidenceNew York City, 2001-2008 January 2010- Bureau of Vital Statistics New York City Department of Health and Mental Hygiene

  31. Central Harlem MCH Life Course Organization Birth Outcome Improvements

  32. Selected Child Welfare Trends, Central Harlem2002-2005 Source: NYC Administration for Children’s Services: Office of Management Analysis • Victimization Rate is the number of children with indicated abuse/neglect per thousand youth 17 and under in the population. is the number of children placed into foster care per 100o youth 17 and under in the population.

  33. Other Best Practices: Municipal and State Health Departments • Alameda County Public Health Department • Life Course Initiative: Life Course “Bill of Rights” • “Life Span” Health Services: Indiana and Nebraska DOH • Integration of early childhood, perinatal and interconceptional care programs managed across the life course in 1 Division • Family Wellness: Department of Human Services, Illinois

  34. IL Maternal & Child Health Coalition • Healthy Mothers, Healthy Babies Illinois Affiliate: created in 1988 (incorporated in 1989) • Promote community empowerment through advocacy, policy development, consumer and professional education • IMCHC’s main objectives are directed to overcome critical barriers, such as poverty and racism, that prevent achievement of maternal & child wellness. • Statewide, membership-based coalition: Approximately 160 members Illinois Maternal & Child Health Coalition

  35. Illinois Maternal and Child Health Coalition Resources www.ilmaternal.org Become a fan on Facebook! Follow us on Twitter at ILMaternal! Our Projects: • Campaign to Save Our Babies • Chicago Area Immunization Campaign • Illinois Coalition for School Health Centers • Illinois Premature Infant Health Network

  36. Campaign to Save Our Mothers and Babies Illinois Maternal & Child Health Coalition • Awareness • Mass media campaign – Closing the Gap • Text4Baby • Education • Importance of prenatal care/medical home • Primary/secondary prevention – educational classes with teen females at Robeson High School/Teamwork Englewood • Partnerships with CDPH, Healthy Start, block clubs, faith-based organizations, FQHCs • Advocacy • Budget issues - federal and state • Health care reform • Comprehensive sexual health education

  37. IMCHC: Social Determinants of Health Axis 37

  38. 38 Linking Women to Health, Power and Love Across the Life Span

  39. "The journey of a thousand miles starts with a single step." Lao Tzu

  40. Acknowledgements Mario Drummonds, MS, LCSW, MBA Executive Director/CEO Northern Manhattan Perinatal Partnership, Inc. Tamara Wrenn, MA, CCE, CIMT, CWC Senior Consultant, Practice Matters Brenda Jones, DHSc, MSN, WHNP-C Consultant, Practice Matters

  41. For more information: Janine Lewis, MPH, PhD(c) 708-261-7564 jlewis6@gmail.com

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