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Creating a Paradigm Shift in Maternal and Child Health: Advancing the Life Course Perspective Cheri Pies MSW DrPH, Michael C. Lu MD MPH, Milton Kotelchuck MPH PhD MA, Padmini Parthasarathy MPH 1 Presenter Disclosures Cheri Pies The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose 2 Overview Historical Overview The Life Course Perspective A New Paradigm for MCH Life Course Work Group National MCH Life Course Meeting Next Steps 3 Historical Overview The past 40 years Large-scale national efforts Quality prenatal care to improve birth outcomes Significant and substantial disparities between racial and ethnical groups still persist 4 Spectrum of Prevention 5 The Life Course Perspective Possibly more effective approach An opportunity to transform the field Development of new paradigm in MCH Potential for expanding practice Addresses racial-ethnic disparities in birth outcomes Focus on broad environmental determinants of health 6 The Life Course Perspective A new way of looking at the health of an individual – across the life course Halfon, Lu, Wise, Guyer, Misra, and others Life Course Health Development, Health Equity, Life Course Approach, Life Span 7 The Life Course Perspective The Life Course Perspective 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. 8 Key Concepts Early (or fetal) programming Exposures during critical periods early in life, including in utero, may determine the functioning of systems in the body and resulting health and disease later in life i.e. obesity, diabetes, other chronic diseases 9 Key Concepts Cumulative pathways Wear and tear that adds up over time can influence health and disease “Allostatic load” or “weathering” = accumulation of and adaptation to chronic stress Repeated stress over life course more stress hormones in response to stressors during pregnancy increased risk of poor pregnancy outcomes 10 Life Course Work Group Formed in 2006 Michael Lu, Milton Kotelchuck, Padmini Parthasarathy, Cheri Pies Our efforts focused on: Examining the application of the Life Course approach for the field Discussing design of longitudinal data linkages, implications for policy, and the introduction of the Life Course Perspective in training and education 11 Life Course Work Group Sought to bring together MCH experts Received funding from The California Endowment Additional financial support from Contra Costa Health Services Hosted a two-day meeting in June 2008 in Oakland, CA 12 National MCH Life Course Meeting Purpose of Meeting To begin a substantive dialogue Identify critical next steps for effective dissemination and application Plan for a national conference Identify how 5 distinct areas – theory, research, practice, policy and education – would need to change 13 National MCH Life Course Meeting Objectives Engage in meaningful reflection and substantive dialogue focusing on the integration of the Life Course Perspective into five domains of MCH: Theory, Practice, Research, Policy and Education and Training 14 National MCH Life Course Meeting Objectives Discuss specific strategies necessary for implementing a paradigm shift in the philosophical foundation of MCH nationally 15 National MCH Life Course Meeting Objectives Develop a preliminary plan of action for each of the five domains, addressing new opportunities and potential barriers 16 National MCH Life Course Meeting Objectives Clarify what we can do collectively to move forward Identify several ideas for furthering one’s own work with regard to the Life Course Perspective 17 National MCH Life Course Meeting Format Richmond-Kotelchuck Framework: Knowledge Base, Social Strategies, Political Will Specific questions identified for each of the 5 domains to guide discussion Large group discussions of each domain over the course of the 2 days 18 National MCH Life Course Meeting Theory Three major disconnects in our field: longitudinal, contextual, and methodological What do we know about protective factors and critical periods of risk? Tension between optimizing everyone’s health versus improving the health of some populations Who is going to be threatened by the magnitude of change? 19 National MCH Life Course Meeting Research Creating longitudinal databases to measure trajectories over time Scalability Mapping community level indicators Linking data sources with an integration of quantitative and qualitative Social determinants of health 20 National MCH Life Course Meeting Practice Optimizing health trajectories Medical models are woefully inadequate, identify ways to create shared power Examine the commonalities between successful initiatives Develop a toolbox for practitioners and academics Challenge of working within funding silos Requires a long view for change to happen 21 National MCH Life Course Meeting Policy Institute multiple funding streams Federal grant proposals to demonstrate how they incorporate the Life Course Perspective Assign responsibility to different sectors Include living wage, family allowance, paid family leave Educate and align policy makers 22 National MCH Life Course Meeting Training and Education Development of MCH Core Curricula that includes the Life Course Perspective Revising Core Competencies for MCH professionals to include Life Course skill set Creating opportunities for learning for professionals already in the field Recognizing the ways in which we already utilize a Life Course approach 23 National MCH Life Course Meeting Highlights What should MCH look like in the next 5-10 years and how do we get there? Life Course Model shifts the focus to prevention and health promotion, primacy of prevention – moves the work upstream Reinventing MCH Master Contracting and consolidating funding streams 24 National MCH Life Course Meeting Highlights Paradigm shift must include a focus on voice: consumer voice needs to be part of this discussion This needs to become a national movement – adopting this approach must be doable at the local level Health equity as a framework for the future 25 National MCH Life Course Meeting Next Steps Policy Briefing for individuals working to improve the health of children and families Guidelines of Core Competencies for MCH professionals Life Course Perspective Toolbox for use in academic and practice settings National MCH Life Course Meeting Report National Conference 26 Thanks The California Endowment Contra Costa Health Services National MCH Life Course Meeting participants Michael Lu, Milton Kotelchuck, Padmini Parthasarathy Vast population of families and individuals with whom we work everyday 27