Transcript PowerPoint Presentation - Slide 1

Babies Need Bathwater –
Bathwater Needs Advocates:
Policies that Promote Rights and
Routes to Well-Being
Peter A. Gorski, M.D., M.P.A.
Director of Research and Innovation
The Children’s Board of Hillsborough County
Professor of Public Health, Pediatrics and Psychiatry
University of South Florida
FAIMH Keynote Speech - May 15, 2008
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Lessons
From Research On
Infant Development
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For survival, growth and development, all infants
need:
Intimacy
Reciprocity
Trust
Security
Predictability
Efficacy
Reliability
Love  Dignity
Respect
Hope and Peace
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• Babies need the bathwater of
family care.
• Families need resources and
support from their community.
• Communities are built, grown and
sustained by citizens and the
relationships and policies they
create.
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Anyone (i.e., everyone) who has heard
anything about the brain in recent years
already knows the importance of infancy to
Lifespan Health
Behavior
Emotional Development
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Take-Home Messages
1. Infants respond to, act upon, and develop from
interaction with social, emotional and physical
environment.
2. Infant brain and CNS organizes most rapidly during
first 18-24 months, laying neural infrastructure for
subsequent patterns of social, emotional, cognitive,
communicative and motor behavior.
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Take-Home Messages (Cont)
3. Infant’s corticolimbic development also sets
course for immune system and biological stress
reactivity.
4. Development corresponds with and directed by
infant’s relationship experience and
development of bio-behavioral attunement and
attachment systems.
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Take-Home Messages (Cont)
5. Parents are primary agents/guides in these
biopsychosocial organizing processes.
6. Parents bring a set of capacities to this cause
based on their early relationship histories and
current contexts/supports.
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Take-Home Messages (Cont)
7. Primary environmental supports for parental
health, well-being, motivation, knowledge and
capital resources:
a.
b.
c.
d.
e.
f.
economic sustenance
safety and interpersonal peace – community
personal dignity – inner peace
health of natural environment
sound educational system
access to quality health care
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Take-Home Messages (Cont)
8. Two theoretical explanatory models for
reciprocity between infant mental health and
society:
a. Fetal Programming
b. Life Course Development
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Take-Home Messages (Cont)
Equity
9.
All children have the right to the conditions and
supports necessary for optimal health, growth
and development – indeed each child’s outcome
is influenced by all children’s outcomes.
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Take-Home Messages (Cont’d)
10. Policies, practices and personal behavior must
lead the way toward achieving positive
outcomes for infants, families and the prospects
for civil society and human development.
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Implications
Biological systems are most sensitive when they
are least differentiated early in life.
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Whereas:
Infancy plays such a big role in setting a course for
health and behavior through childhood and
adulthood; and
Early brain development is largely experiencedependent;
Therefore:
Disparities in population health trajectories must
somehow reflect inequalities in the social
experience of infants and young children.
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Individual Differences and
Group Differences
in the social experiences that drive
biological systems beginning very early
in life.
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Inequalities vs. Inequities
Individual differences within groups and classes
likely result from stylistic inequalities (diversity) or
variants in the expression of care among children of
one family, culture or neighborhood – e.g. different
customs, traditions, personalities.
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Inequalities vs. Inequities (Cont)
Population differences common to most members of
a group who live in close physical or cultural
proximity are more likely the result of inequities in
consistent access to health-inducing opportunities,
resources and supports.
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Why Do Some Populations Experience:
•
•
•
•
•
Higher maternal and infant mortality
Higher death rates for most diseases
Shorter life expectancies
Less health insurance
Fewer diagnostic tests/therapeutic procedures
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Beyond the background study of the bio-behavioral
interface of early brain development, focus the lens of
science on finding:
• the root sources that create unequal health outcomes
• when these root sources begin to shape lifespan health
in the life of children.
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Here the story gets challenging for us who
have worked so long and hard to provide
therapeutic and even preventive health and
mental health services to vulnerable infants
and families or to all infants and families.
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Common causal pathways to:
•
•
•
•
•
growth retardation,
susceptibility to disease and
chronic illness
premature birth and
early death
Cumulative stress and the consequent
dysregulation of the neuroendocrine system
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Stress and Infection During Pregnancy?
• Stressful life events or perceived stress or
anxiety
– Stress → norepinephrine and cortisol
release → placental CRH → preterm labor
– Stress alters immune function, increasing
susceptibility to intra-amniotic infection or
inflammation
– Undocumented cause of increased
susceptibility to infections during pregnancy
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Sources of Unequal Health Outcomes:
Inequitable Distribution Of Capital
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Unequal Wealth
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Post-neonatal Infant Mortality
Per 100,000 Live Births (1986)
600
500
400
300
200
100
0
I
II
III
England & Wales
IV
V
Sweden
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Unequal Education
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Illinois
School District 1 $10,000/student
School District 2 $3,000/student
School District 1 starting teachers $40,000
School District 2 starting teachers $18,000
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Unequal Environments
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Toxic Pollutants
• Environmental Racism
– waste dumps/incinerators more
common in lower SES neighborhoods
– “Cancer Belt” (Baton Rouge to New
Orleans)
– “White residential neighborhoods” - 1.7
acres parkland/1000 residents
– “African-American neighborhoods” - 0.3
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Unequal Support
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Community - Healthful Influence of
Sustaining Relationships
• Social Ties and Susceptibility to the Common Cold Cohen et al JAMA 6/25/97
• larger social network, greater host resistance
• if >5 types of social ties, 4x less susceptible than if 1-3
types of social ties
• also: smoking, poor sleep, alcohol abstinence, low
dietary Vitamin C, elevated catecholamines and being
introverted
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Community and Health
• Children Who Prosper in Unfavorable Environments:
Relationship to Social Capital - Runyan et al,
Pediatrics, 1/98
• Def: benefits that accrue from social relationships
and affiliations
• Church affiliation, mother’s perception of personal
social support, neighborhood support – 1 of these
increases the odds 29%, 2 increase them by 66%
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Community and Health (Cont)
• Collective efficacy reduces crime - Science, 8/15/97
• Not related to community wealth but to neighbors
watching out for each other.
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Challenging Paradoxes
• Low SES and race - risk for IM and LBW
• Grandmothers and LBW
• Real estate and social justice
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Where you live (and who’s your daddy)
largely determines your access to all four
of the essential capital investments in
children, all four of the major influences of
children’s outcomes.
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Infant Mental Health
(i.e. healthy primary relationships
during early childhood)
develops resilience to and helps inoculate
children from the full virulence of:
Inequity Injustice
Indignity Loneliness
(Remember the 40 developmental assets from
Peter Benson and the Search Institute!)
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At the same time, we must remember that:
• Parents’ energy for caring can be weakened,
• Their sensitivity to others’ needs can be
blunted, and
• Their biological endowment to their offspring
disordered by: poverty, hunger, ill health,
toxins, isolation, prejudice, fear and shame
Cumulative life stress gets passed on to
subsequent generations.
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Cumulative Life Events
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Therefore:
healthy, resilient, hopeful families and children are most
likely to thrive in neighborhoods that are
safe, peaceful, clean, green, connected,
socially and economically vibrant
where all children and adults have equal access to
caring relationships, nutrition, education, health care, and
human dignity.
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Questions:
1. What gives residents the will and the ability to create
and sustain communities as healthy places for young
children and families?
2. What provides resources to strengthen their resolve
and reward their efforts?
3. What can enable all people willing to work hard an
equal chance to achieve their dreams?
4. What can prevent the color of their skin, the accent of
their speech, the worship of their faith, or the location
of their neighborhood from setting a nearly irreversible
course of opportunity or despair?
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Answer:
The impact of policy on
the social determinants of health and
development.
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Policies that support
Equity, Justice, Personal Dignity and
Community
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Promising Strategies
• National subsidies for healthcare – not
stigmatizing the disadvantaged
• Livable wage
• Microcredit programs to poor people
• Community Networks/Weavers
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Policy Recommendations
• Narrow gap in wealth, education and social
opportunity:
– increase minimum wage
– increase tax credits for child care
– increase quality and affordability of child care
– increase wage scale for licensed child
care/early childhood educators and teachers
– National, equitable school funding
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Child Poverty Before
and After Transfers (2003)
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Public Spending on Family Benefits in
Cash, Services and Tax Measures
Percentage of GDP (2003)
Cash
Services
Tax Breaks
Average Total (2.4%)
4.5
4.5
4.0
4.0
3.5
3.5
3.0
3.0
2.5
2.5
2.0
2.0
1.5
1.5
1.0
1.0
0.5
0.5
0.0
0.0
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Overall Child Well-Being - All Countries
25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
75
80
85
90
95
100
105
110
115
120
Swe
Net
Ice
Fin
Nor
Den
Swi
Spa
Bel
Aus
Ire
Ita
Ger
Gre
Fra
Can
Pol
Cze
Jap
Por
Aut
Hun
NZ
USA
UK
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Livable Wage
• Minimum wage adjusted for inflation (cost of
living) at lowest since 1955 (federal going up
from $5.85 to $6.55 in July, FL $6.79, MA $8.00)
• Annual minimum wage earnings are well below
the poverty level for family of three.
• Increasing numbers of wage earners, well above
minimum wage, cannot keep pace with
mortgages, rent, gas and utilities, food prices.
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Livable Wage (Continued)
Social Justice Issue
Women account for 61% of minimum wage workers
71% of minimum wage workers are age 20 and older
44% of minimum wage workers work full time
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Policies That Drain Resources
From Children And Families
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War
U.S. military spending in Iraq:
$720 million/day
Would build 84 elementary schools
and provide 34,904 students with 4 year
scholarships to college.
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Inequitable Tax Policies
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Corporate Taxation
(AKA Corporate Welfare)
Nearly 1/3 of all large corporations
(assets > $250 million or annual sales > $50 million)
pay no annual income tax.
Corporations shouldered over 30% of the nation’s
tax burden in 1950 vs. 10% today.
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Lobbying:
a Recession-Proof Industry
• Spent an average of $17 million every day Congress was
in session last year ($2.79 billion total, 8% increase over
2006).
• Health Interests #1 spender: $444.7 million
• Finance, insurance and real estate sector #2 spender $418.7 million
• Drug and Health Product makers #1 specific industry (227
million or 1.4 million/day)
• Power and utility companies, teachers’ unions,
automakers, defense contractors, communications
companies, and AARP also among top 20 spenders.
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The 2008 Florida Legislative Session
What We Advocated
Early Childhood Education And Care
Quality Child Care
Universal Pre-Kindergarten
Children’s Health
KidCare
Medicaid Reform
Child Welfare
Independent Living/Foster Care
Juvenile Justice
Healthy Start
Child Safety
Early Steps Intervention Program
Healthy Families
211 Networks
The Florida Children and
Youth Cabinet
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The 2008 Florida Legislative Session
What We Got
• Apologized for slavery
• Mixed outcome for
KidCare
• Cuts for Healthy Families
• No increase for Healthy
Start or CMS
• Compensation for
wrongfully imprisoned
inmates
• Cuts for K-12 education
funding, teacher bonuses
and School Readiness
• FCAT emphasis reduced
by 50%
• Cuts to judicial system
including DJJ
• Cuts to Community Based
Care/Child Welfare/DCF
• Cuts to County Health
Departments
• Guns at workplace
• Baggy pants
• Toxic toys
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Prevention and OOHC Cost Comparison
A Minimal Investment to Keep Families Together
Costs of Prevention Services
• 100 children at $250 per month = $300,000
• 500 children at $250 per month = 1.5 million
• 1000 children at $250 per month = 3 million
Costs of Out of Home Care
• 100 children at $2,500 per month = 3 million
• 500 children at $2,500 per month = 15 million
• 1000 children at $2,500 per month = 30 million
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“For every complex problem there is a
simple solution – and it’s wrong.”
H.L. Mencken
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A Farewell to Alms
Florida cannot afford the cost of
budget cuts.
Investing in the health and welfare of
all children and families, especially through
the early childhood years, will reduce the public
economic burden of disability and fuel human
industry, economic recovery, public safety and
national prosperity.
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A Farewell to Alms
If you’re not part of the problem,
you can’t be part of the solution.
We must erase the distance between
lawmakers and citizens and we must heed the
wisdom of those we serve, who live the
experience we know but rarely feel.
“Not everything that is faced
can be changed, but
nothing can be changed until it is faced.”
James Baldwin
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Leadership is....
Caring more than others think wise,
Dreaming more than others think practical,
Risking more than others think safe, and
Expecting more than others think possible.
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