Transcript Year 2010 Goal - Northern Manhattan Perinatal Partnership

2009 Nebraska Public Health Conference
Prevent, Promote, Protect: Working Toward
a Healthier Nebraska
April 8-9, 2009
Cornhusker Marriott Hotel
333 South 13th Street
Lincoln, Nebraska
Repositioning MCH in
America: Where We
Are…Where We Need to
Go
Mario Drummonds, MS, LCSW, MBA
CEO, Northern Manhattan Perinatal
Partnership, Inc.
Acknowledgements
Dr. Michael Lu
Dr. Neal Halfon
Dr. Maxine Hayes
Dr. Jimmie Collins
2
Presentation Objectives
• Define the current political & public
health climate that rationalizes
reinventing MCH
• Discuss the new leadership mandate and
vision for a new MCH system of care
• Communicate the MCH policy and
programmatic choices for Nebraska &
America
3
Where Are
We?
4
National MCH System Challenges
• A Recent CDC National Center for
Health Statistics Report Revealed:
• U.S. Teen Birth Rate (15-19) Increased from 41.9
births per 1000 in 2006 to 42.5 in 2007
• Total U.S. Births rose in 2007 to over 4,317,199Highest Number of birth ever registered in the
United States
5
National MCH System Challenges
• The Cesarean Delivery rate rose 2% in 2007, to
31.8%, marking the 11th consecutive year of an
increase
• Nearly 40% of Births were to Women Over 30
years of Age and Unmarried
• Percentage of Low Birth weight Babies Declined
Slightly between 2006 and 2007, from 8.3% to
8.2% -first decline
6
National MCH System Challenges
• In November 2008, the March of Dimes
released its first annual “Premature
Birth Report Card,” Giving the Nation
an overall “D” grade
7
Infant Mortality Rates
1. Singapore
2. Hong Kong
3. Japan
4. Sweden
5. Norway
6. Finland
7. Czech Republic
8. Denmark
9. France
10. Spain
11. Germany
12. Italy
13. Austria
2.7
2.9
3.0
3.2
3.8
3.8
4.1
4.2
4.4
4.4
4.4
4.6
4.8
14. Switzerland
15. Australia
16. Canada
17. Netherlands
18. Greece
19. Belgium
20. Portugal
21. United Kingdom
22. Israel
23. Ireland
24. New Zealand
25. Cuba
26. United States
4.9
4.9
5.3
5.3
5.4
5.4
5.6
5.6
5.8
5.9
6.1
6.2
6.8
8
Infant Mortality Rate
by State, 2002-2004
2010 Target = 4.5
D.C.
Per 1,000 live
births
N
9.0 or more
8.0 - 8.9
7.0 – 7.9
6.0 – 6.9
Less than 6.0
(4)
(8)
(11)
(16)
(12)
9
Source: NVSS, NCHS, CDC.
Cities With The Highest IMR
-- District of Columbia
-- Detroit
-- Atlanta
-- Newark
-- Cleveland
-- Norfolk
-- Baltimore
-- Chicago
-- Philadelphia
-- Milwaukee
10
Infant Mortality Rates In The U.S.
(2003)
IMR (per 1,000 livebirths)
16
14
12
10
8
6
4
2
0
AfricanAmericans
Puerto
Ricans
non-Latino
whites
MexicanAmericans
AsianAmericans
11
Racial & Ethnic Disparities
Infant Mortality, 2005
14
Deaths Per 1,000 Live Births
12
10
13.7
8
6
Year 2010 Goal
4
5.7
2
0
African American
White
NCHS
12
2008
Racial & Ethnic Disparities
Low Birth Weight < 2500g
2005
14
Percent of Live Births
12
10
14
8
6
Year 2010 Goal
7.3
4
2
0
African American
White
NCHS 2008
13
6,000 African-American infant deaths
a year could be prevented if the IMR of
African-Americans was lowered to the
level of whites.
14
Healthy People 2010
Infant Mortality
14
Per 1,000 Live Births
12
10
8
6
Year 2010 Goal
4
Asian/PI
Cuban
Mexican
White
Puerto
Rican
Native
American
0
African
American
2
15
NCHS 2008
Healthy People 2010
Low Birthweight
16
Per 1,000 Live Births
14
12
10
8
6
Year 2010 Goal
4
Asian/PI
Cuban
Mexican
White
Puerto
Rican
Native
American
0
African
American
2
16
NCHS 2008
Obesity Trends Among U.S. Adults
BRFSS, 1990
No Data
<10%
10%–14%
17
Obesity Trends Among U.S. Adults
BRFSS, 1997
No Data
<10%
10%–14%
15%–19%
≥20%
18
Obesity Trends Among U.S. Adults
BRFSS, 2000
No Data
<10%
10%–14%
15%–19%
≥20%
19
Obesity Trends Among U.S. Adults
BRFSS, 2003
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
20
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1995, 2005
(*BMI 30, or about 30 lbs overweight for 5’4” person)
1995
1990
2005
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
21
Maternal Obesity: 2-3x Risk of C-Section
Comparison Groups
Overweight vs. Normal
OR
1.46
95% CI
1.34-1.60
Obese vs. Normal
Severely Obese vs. Normal
2.05
2.89
1.86-2.27
2.28-3.79
• Potential mechanisms:
  maternal pelvic soft tissue which narrows diameter of birth canal
•  dystocia
•  macrosomic infant
• Cephalopelvic disproportion
 Maternal obesity:  intrapartum meconium staining, cord accidents
 Gestational diabetes (but  C-section independent of diabetes)
• Conclusion: Obesity alone is a risk factor for C-section
Chu et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007
22
Maternal Obesity: Congenital
Anomalies
•  neural tube defects
x1.9
•  anencephaly x1.5
•  spina bifida x 2.2
•  cv anomaly x1.2
•  cleft palate x1.2
•  anorectal atresia x1.5
•  hydracephaly x1.7
•  limb reduction
anomaly x1.3
Stothard et al. Maternal overweight and obesity and the risk of congenital anomalies. JAMA 2009 23
Maternal Obesity & Risk of
Stillbirth
• 2x  risk of stillbirth
• Possible mechanisms:
•  gestational DM
•  hypertension
• Other factors
Comparison
Group
OR
95% CI
Overweight vs.
1.47 1.08-1.94
normal
Obese vs. normal 2.07 1.59-2.74
Conclusion: obese women should undergo weight reduction
prior to pregnancy
24
Chu et al. Maternal obesity and the risk of stillbirth: a metaanalysis. Am J Obstet Gyn 2007
Obesity in Pregnant Women
• Diabetes (2.6X higher)
•
•
•
•
•
•
Maternal blindness
Maternal limb amputation
Maternal renal failure
Increased risk of miscarriage
Increased risk of birth defects
Fetus exposed to an environment of high serum
glucose
• Fetus exposed to environment of
nutritional deficiency (folate)
Leddy et al. Rev Obstet Gynecol. 2008 25
Stothard et al. JAMA. 2009
Maternal Mortality
Icleand, 0
Source: OECD Health Data 2008
Norway, 0
Sweden, 1
Ireland, 1.6
Belium, 2.5
Greece, 2.8
Austria, 3.8
Australia, 3.9
Hungary, 4.2
Japan, 4.4
Spain, 4.6
Poland, 4.8
Germany, 5.2
Netherlands, 5.2
Switzerland, 5.5
Slovak Republic, 5.6
Canada, 5.9
New Zealand, 6.8
France, 7
United Kingdom, 7.7
Czech Republic, 8
Portugal, 8.2
Denmark, 9.2
Finland, 12.2
USA, 13.1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
National MCH System Strengths
& Policy Initiatives
1. Children’s Health Insurance Bill
Signed in Law by President Obama another 4.1 million children covered–
more than 11 million children now
served in US
27
National MCH System Strengths
& Policy Initiatives
2. Expansion of Preconception and
Interconceptional Care
3. Proposed Obama Administration
Increase in MCH Block Grant Funding
28
National MCH System Strengths
& Policy Initiatives
4. Proposed Increase in Early Head Start
& Head Start Funding over the Next
Five Years
5. Growth of Life Course Theory in 2003
and its Potential to Influence MCH
Practice in America
29
National MCH System Strengths &
Policy Initiatives
6. Proposed Obama Administration
Investments in Nurse Family Partnership &
Harlem Children’s Zone Replication
Nationally
7. Growing Discussion & Appreciation for the
Social Determinates of Health as Explainer
of Racial Disparities in Health and the
Solution to them
30
What Is To Be
Done?
31
How Do We Reposition MCH in
America?
What Should MCH Look Like by
2030?
Change in Vision; Structure;
Financing, Policy, Program Design
Needed:
32
America’s MCH Vision
• Recognize that Women Produce & Reproduce
Life in America
• Reproduction & Nurturing of Human Capital
Key to Survival of the Nation!
• Prenatal, Preconception and Interconception
Care should be Linked Together as Part of a
Comprehensive Solution to Women’s Health33
America’s MCH Vision
• Focus on the Health of Women Beyond
Pregnancy
• Women’s Health is Housing Policy,
Economic Development Policy,
Environmental Policy, Education Policy,
etc.
34
Structure/Leadership
• The Way MCH Services are Delivered in
America is Currently Fragmented!
• HRSA, MCHB, CDC, ACYF, NIH, etc.
• Immediately Create a Deputy Secretary
for MCH Position
35
Structure/Leadership
• Reports Directly to DHHS Secretary
Nominee, Kathleen Sebelius
• Charge-support systems building &
Integration at Federal, State and Local Levels
• Incentivize MCH Innovation throughout
system
36
Structure/Leadership
• Consolidating Women & Children’s Health
Assets into One Agency can Save Money and
Increase Operating Efficiencies
• Utilize President Obama’s newly created White
House Council on Women and Girls as a
Vehicle to Coordinate Women’s Health Policy
and Financing Across Federal & State
Agencies
37
Financing
• Health of Women Across the Life Course
has to be a key component of any Health
Care Reform Agenda in Washington
38
Financing
• If President Obama’s Health Care
Reform Package stalls in Congress, these
are some Tactical Solutions:
• Soda or Tobacco Tax to create a women’s
health funding stream for Interconceptional
care
• Medicaid Family Planning Waivers
39
Financing
• Private Employer-Based Plans
• Community Health Centers
• Healthy Start
• Title X Family Planning Clinics
• Title V Agencies
40
Policy/Program Design
• To achieve the vision above the MCH
system in America today must strive to
become more integrated assuring access,
quality and coordination of affordable
care across a woman’s life course!
41
Operationalize Life Course Theory:
• Show how health departments & MCH
organizations change strategy,
organizational structure, and integrate
program interventions across the time-line
and swim upstream addressing social
determinates of health, thus improving
women’s health
42
Pediatric Office 2.0
Parenting Support
Early
Intervention
Early Child
Mental Health
Services
Preventive
Care
Acute
Care
Home-visiting
network
Early
HeadStart
& HeadStart
Chronic
Care
Developmental
Services
Child Care
Resource &
Referral
Agency
Developmental
Services
Lactation Support
43
Evaluation
Pediatric Office 3.0
(IDEA Sector
Surveillance
Screening
Assessment
Community Services
and Resource Sector
Pediatric Services
Sector
Peds/HPlan/
PHSector
Preventive
Care
Developmental
Services
Acute
Care
Mid-Level
Assessment
Center
IDEA
Regional
Center for
Developmental
Disabilities
Other
Specialized
Services
Chronic
Care
Child Care/Family
Resource Center
Program
COORDINATION
CENTER
Program
44
Spectrum of Work for MCH Life Course Organization
Building Public Health Social Movement
Economic Opportunities
•Harlem Works
•Financial Literacy
•LPN RN Training Program
•Union Employment
•Micro Lending Savings
•Empowerment Zone
Early Childhood
•Early Head Start
•Head Start
•UPK
•Choir Academy
Birth
Early
Childhood
Housing
•Home Ownership
•Affordable Housing
•Base Building- St. Nicks
Legislative Agenda
•Reauthorize Healthy Start
•SCHIP
•Minimum Wage Legislation
•Women’s Health Financing
Health System
‾Case Management
- Title V Funds
‾Health Education
- Regionalization
‾Outreach
-Harlem Hospital
‾Perinatal Mood Disorders-Birthing Center
‾Interconceptional Care
Child Welfare
•Preventive Services
•Foster Care Services
•Parenting Workshops
•Newborn Home
Visiting
COPS Waiver
Pre-teen
Teen
Young Adult
Women
over 35
45
First-time Motherhood
New Parent Initiative
Purpose: Develop, implement, evaluate and disseminate
novel social-marketing approaches that:
• Concurrently increase awareness of existing
preconception/interconception, prenatal care, and
parenting services/programs,
• Address the relationship between such services,
health/birth outcomes, and a healthy first year of life.
• Include women and men who are from populations
disproportionately affected by adverse pregnancy outcomes
in their community including racial/ethnic minorities as
well as their providers.
46
First-time Motherhood
New Parent Initiative
HRSA’s Maternal and Child Health Bureau was
allotted approximately $4.8 million for this
activity through the Consolidated
Appropriations Act 2008 (P.L. 110-161) .
State-based Awards
• 2009: AZ, CA, CT, FL, MA, NC, NE, NV, OR, PA, UT, WI
• 2010: AZ, CA, CT, FL, MA, ME, NC, NE, NV, OR, PA,
UT, WI
47
Integrate MCH Core Services & Chronic
Disease Management: The Ties that Bind
• Millions of women have chronic health
conditions during and prior to pregnancy
• Maternal Weight, Obesity, Mental Health
Issues Point to developing an Integrative
MCH/Chronic Disease Strategy
48
Integrate MCH Core Services & Chronic
Disease Management: The Ties that Bind
• 40,000 women in NYC have gestational
diabetes
• Focus on developing Interconceptional
Protocols to address women with previous
pregnancies that ended in adverse
outcomes
49
Integrate MCH Core Services & Chronic
Disease Management: The Ties that Bind
• Fully fund and execute CDC’s 10
Recommendations to Improve
Preconception Health & Health Care
• Develop a Work Team between MCHB &
CDC to share evidence-based practices,
develop evaluation protocols and share
funding streams to integrate care
50
This new concept
has received
much attention
in the news.
“You are what
your grandmother
ate.”
Epi Genetics
Barker Hypothesis
51
Summary
• To Pivot and Reposition MCH in
America, you, part of the leadership of
public health in America must do the
following:
• Lead by creatively destructing the past as we
plant the seeds for a new, integrated MCH
system of care tomorrow
52
Summary
• I define Leadership as…
• Leaders take the assets given to them
today…
• A leader is someone who doesn’t
do…
53
Summary
• To implement the agenda
described in my talk will take
Courage, or doing today what
others only dream of doing
tomorrow
54
Summary
• Leaders must be Decisive or
change before others realize
change is necessary
55
Summary
• MCH activists must display
Tenacity by doubling your
efforts when others are pulling
back
56
Summary
• The role of MCH leadership today is to
see around the corner strategically to
examine new trends and issues that face
the industry and then prepare our
organizations to weather the coming
storm and create the future we envision
57
Place No Limits on a
Woman’s Dreams and
Place No Obstacles to her
Achievements!
58
Communities & Nations are
only as Strong as the Health
of their Women!
59
Reinventing MCH Throughout the USA by: Building a
Social Movement, Investing in Ideas, Executing Tasks,
Returning Results!
Linking Women to Health, Power and Love Across the Life Span
60
For more information contact:
Mario Drummonds, MS, LCSW, MBA
Executive Director/CEO
Northern Manhattan Perinatal Partnership
127 W. 127th Street
New York, NY 10027
(347)489-4769
[email protected]
61