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April 8-9, 2009 Cornhusker Marriott Hotel 333 South 13th Street Lincoln, Nebraska. 2009 Nebraska Public Health Conference Prevent, Promote, Protect: Working Toward a Healthier Nebraska. Repositioning MCH in America: Where We Are…Where We Need to Go. Mario Drummonds, MS, LCSW, MBA - PowerPoint PPT Presentation
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2009 Nebraska Public Health Conference 2009 Nebraska Public Health Conference Prevent, Promote, Protect: Working Toward Prevent, Promote, Protect: Working Toward
a Healthier Nebraskaa Healthier Nebraska
Repositioning MCH in America: Where We
Are…Where We Need to Go
April 8-9, 2009Cornhusker Marriott Hotel
333 South 13th StreetLincoln, Nebraska
Mario Drummonds, MS, LCSW, MBA
CEO, Northern Manhattan Perinatal Partnership, Inc.
2
AcknowledgementsAcknowledgements
Dr. Michael LuDr. Michael Lu
Dr. Neal HalfonDr. Neal Halfon
Dr. Maxine Hayes Dr. Maxine Hayes
Dr. Jimmie CollinsDr. Jimmie Collins
3
Presentation Objectives
• Define the current political & public Define the current political & public health climate that rationalizes health climate that rationalizes reinventing MCHreinventing MCH
• Discuss the new leadership mandate and Discuss the new leadership mandate and vision for a new MCH system of care vision for a new MCH system of care
• Communicate the MCH policy and Communicate the MCH policy and programmatic choices for Nebraska & programmatic choices for Nebraska & AmericaAmerica
4
Where Are Where Are We?We?
5
National MCH System Challenges
• A Recent CDC National Center for A Recent CDC National Center for
Health Statistics Report Revealed:Health Statistics Report Revealed:
• U.S. Teen Birth Rate (15-19) Increased from 41.9 U.S. Teen Birth Rate (15-19) Increased from 41.9
births per 1000 in 2006 to 42.5 in 2007 births per 1000 in 2006 to 42.5 in 2007
• Total U.S. Births rose in 2007 to over 4,317,199-Total U.S. Births rose in 2007 to over 4,317,199-
Highest Number of birth ever registered in the Highest Number of birth ever registered in the
United StatesUnited States
6
National MCH System ChallengesNational MCH System Challenges
• The Cesarean Delivery rate rose 2% in 2007, to The Cesarean Delivery rate rose 2% in 2007, to
31.8%, marking the 11th consecutive year of an 31.8%, marking the 11th consecutive year of an
increaseincrease
• Nearly 40% of Births were to Women Over 30 Nearly 40% of Births were to Women Over 30
years of Age and Unmarried years of Age and Unmarried
• Percentage of Low Birth weight Babies Declined Percentage of Low Birth weight Babies Declined
Slightly between 2006 and 2007, from 8.3% to Slightly between 2006 and 2007, from 8.3% to
8.2% -first decline8.2% -first decline
7
National MCH System Challenges
• In November 2008, the March of Dimes In November 2008, the March of Dimes
released its first annual “Premature released its first annual “Premature
Birth Report Card,” Giving the Nation Birth Report Card,” Giving the Nation
an overall “D” gradean overall “D” grade
8
Infant Mortality RatesInfant Mortality Rates
1. Singapore1. Singapore 2.7 2.7 14. Switzerland 14. Switzerland 4.94.9
2. Hong Kong2. Hong Kong 2.92.9 15. Australia 15. Australia 4.94.9
3. Japan3. Japan 3.03.0 16. Canada 16. Canada 5.35.3
4. Sweden4. Sweden 3.23.2 17. Netherlands 17. Netherlands 5.35.3
5. Norway5. Norway 3.83.8 18. Greece 18. Greece 5.45.4
6. Finland6. Finland 3.83.8 19. Belgium 19. Belgium 5.45.4
7. Czech Republic7. Czech Republic 4.14.1 20. Portugal 20. Portugal 5.65.6
8. Denmark8. Denmark 4.24.2 21. United Kingdom 21. United Kingdom 5.65.6
9. France9. France 4.44.4 22. Israel 22. Israel 5.85.8
10. Spain10. Spain 4.44.4 23. Ireland 23. Ireland 5.95.9
11. Germany11. Germany 4.44.4 24. New Zealand 24. New Zealand 6.16.1
12. Italy12. Italy 4.64.6 25. Cuba 25. Cuba 6.26.2
13. Austria13. Austria 4.8 4.8 26. United States 26. United States 6.86.8
9
Per 1,000 live Per 1,000 live birthsbirths NN
(4)(4)(8) (8)
(11)(11)(16)(16)(12)(12)
9.0 or more 9.0 or more 8.0 - 8.98.0 - 8.97.0 – 7.97.0 – 7.96.0 – 6.96.0 – 6.9Less than Less than 6.06.0
Infant Mortality RateInfant Mortality Rate
by State, 2002-2004by State, 2002-2004
D.C.
Source: NVSS, NCHS, CDC.
2010 Target = 4.52010 Target = 4.5
10
Cities With The Highest IMRCities With The Highest IMR
-- District of Columbia-- District of Columbia -- Norfolk-- Norfolk
-- Detroit-- Detroit -- Baltimore-- Baltimore
-- Atlanta-- Atlanta -- Chicago-- Chicago
-- Newark-- Newark -- Philadelphia-- Philadelphia
-- Cleveland-- Cleveland -- Milwaukee-- Milwaukee
11
Infant Mortality Rates In The U.S. Infant Mortality Rates In The U.S. (2003)(2003)
0
2
4
6
8
10
12
14
16
African-Americans
PuertoRicans
non-Latinowhites
Mexican-Americans
Asian-Americans
IMR (per 1,000 livebirths)
12
Racial & Ethnic DisparitiesInfant Mortality, 2005
13.7
5.7
0
2
4
6
8
10
12
14
African American White
Deaths Per 1,000 Live BirthsDeaths Per 1,000 Live Births
NCHS NCHS 20082008
Year 2010 GoalYear 2010 Goal
13
Racial & Ethnic DisparitiesRacial & Ethnic DisparitiesLow Birth Weight < 2500gLow Birth Weight < 2500g
20052005
14
7.3
0
2
4
6
8
10
12
14
African American White NCHS 2008
Percent of Live BirthsPercent of Live Births
Year 2010 GoalYear 2010 Goal
14
6,000 African-American infant deaths 6,000 African-American infant deaths a year could be prevented if the IMR of a year could be prevented if the IMR of African-Americans was lowered to the African-Americans was lowered to the level of whites.level of whites.
15
Healthy People 2010Healthy People 2010Infant MortalityInfant Mortality
0
2
4
6
8
10
12
14
AfricanAmericanNative
AmericanPuertoRican White
MexicanCuban
Asian/PI
Per 1,000 Live BirthsPer 1,000 Live Births
NCHS 2008NCHS 2008
Year 2010 GoalYear 2010 Goal
16
Healthy People 2010Healthy People 2010Low BirthweightLow Birthweight
0
2
4
6
8
10
12
14
16
AfricanAmericanNative
AmericanPuertoRican White
MexicanCuban
Asian/PI
Per 1,000 Live BirthsPer 1,000 Live Births
NCHS 2008NCHS 2008
Year 2010 GoalYear 2010 Goal
17
Obesity Trends Among U.S. AdultsObesity Trends Among U.S. AdultsBRFSS, 1990BRFSS, 1990
No Data <10% 10%–14%
18
Obesity Trends Among U.S. AdultsObesity Trends Among U.S. AdultsBRFSS, 1997BRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20%
19
Obesity Trends Among U.S. AdultsObesity Trends Among U.S. AdultsBRFSS, 2000BRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20%
20
Obesity Trends Among U.S. AdultsObesity Trends Among U.S. AdultsBRFSS, 2003BRFSS, 2003
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
21
1995
Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS,BRFSS, 1990, 1995, 20051990, 1995, 2005
(*BMI (*BMI 30, or about 30 lbs overweight for 5’4” person)30, or about 30 lbs overweight for 5’4” person)
2005
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
22
Maternal Obesity: 2-3xMaternal Obesity: 2-3x Risk of C-Section Risk of C-Section
Comparison Groups OR 95% CI
Overweight vs. Normal 1.46 1.34-1.60
Obese vs. Normal 2.05 1.86-2.27
Severely Obese vs. Normal 2.89 2.28-3.79
Chu et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007
• Potential mechanisms:Potential mechanisms: maternal pelvic soft tissue which narrows diameter of birth canalmaternal pelvic soft tissue which narrows diameter of birth canal
dystociadystocia macrosomic infantmacrosomic infant
• Cephalopelvic disproportionCephalopelvic disproportion Maternal obesity: Maternal obesity: intrapartum meconium staining, cord accidents intrapartum meconium staining, cord accidents Gestational diabetes (but Gestational diabetes (but C-section independent of diabetes) C-section independent of diabetes)
• Conclusion: Obesity alone is a risk factor for C-section
23
Maternal Obesity: Maternal Obesity: Congenital Congenital AnomaliesAnomalies
neural tube defects neural tube defects x1.9x1.9
anencephaly x1.5anencephaly x1.5 spina bifida x 2.2spina bifida x 2.2 cv anomaly x1.2cv anomaly x1.2 cleft palate x1.2cleft palate x1.2 anorectal atresia x1.5anorectal atresia x1.5 hydracephaly x1.7hydracephaly x1.7 limb reduction limb reduction
anomaly x1.3anomaly x1.3
Stothard et al. Maternal overweight and obesity and the risk of congenital anomalies. JAMA 2009
24
Maternal Obesity & Risk of Maternal Obesity & Risk of StillbirthStillbirth
• 2x 2x risk of stillbirth risk of stillbirth
• Possible mechanisms:Possible mechanisms: gestational DMgestational DM hypertensionhypertension
• Other factorsOther factors
Conclusion: obese women should undergo weight reduction prior to pregnancy
Comparison Group
OR 95% CI
Overweight vs. normal
1.47 1.08-1.94
Obese vs. normal 2.07 1.59-2.74
Chu et al. Maternal obesity and the risk of stillbirth: a metaanalysis. Am J Obstet Gyn 2007
25
Obesity in Pregnant WomenObesity in Pregnant Women
• Diabetes (2.6X higher)Diabetes (2.6X higher)• Maternal blindnessMaternal blindness• Maternal limb amputationMaternal limb amputation• Maternal renal failureMaternal renal failure• Increased risk of miscarriageIncreased risk of miscarriage• Increased risk of birth defectsIncreased risk of birth defects• Fetus exposed to an environment of high serum Fetus exposed to an environment of high serum
glucoseglucose
• Fetus exposed to environment of Fetus exposed to environment of nutritional deficiency (folate)nutritional deficiency (folate)
Leddy et al. Rev Obstet Gynecol. 2008Stothard et al. JAMA. 2009
Finland, 12.2
Denmark, 9.2
Portugal, 8.2
Czech Republic, 8
United Kingdom, 7.7
France, 7
New Zealand, 6.8
Canada, 5.9
Slovak Republic, 5.6
Switzerland, 5.5
Netherlands, 5.2
Germany, 5.2
Poland, 4.8
Spain, 4.6
Japan, 4.4
Hungary, 4.2
Australia, 3.9
Austria, 3.8
Greece, 2.8
Belium, 2.5
Ireland, 1.6
Sweden, 1
USA, 13.1
Norway, 0
Icleand, 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Maternal Mortality
Source: OECD Health Data 2008
27
National MCH System Strengths National MCH System Strengths & Policy Initiatives & Policy Initiatives
1.1. Children’s Health Insurance Bill Children’s Health Insurance Bill
Signed in Law by President Obama -Signed in Law by President Obama -
another 4.1 million children covered– another 4.1 million children covered–
more than 11 million children now more than 11 million children now
served in USserved in US
28
National MCH System Strengths National MCH System Strengths & Policy Initiatives& Policy Initiatives
2.2. Expansion of Preconception and Expansion of Preconception and
Interconceptional CareInterconceptional Care
3.3. Proposed Obama Administration Proposed Obama Administration
Increase in MCH Block Grant Funding Increase in MCH Block Grant Funding
29
National MCH System Strengths National MCH System Strengths & Policy Initiatives& Policy Initiatives
4.4. Proposed Increase in Early Head Start Proposed Increase in Early Head Start
& Head Start Funding over the Next & Head Start Funding over the Next
Five Years Five Years
5.5. Growth of Life Course Theory in 2003 Growth of Life Course Theory in 2003
and its Potential to Influence MCH and its Potential to Influence MCH
Practice in AmericaPractice in America
30
National MCH System Strengths & National MCH System Strengths & Policy InitiativesPolicy Initiatives
6.6. Proposed Obama Administration Proposed Obama Administration
Investments in Nurse Family Partnership & Investments in Nurse Family Partnership &
Harlem Children’s Zone Replication Harlem Children’s Zone Replication
NationallyNationally
7.7. Growing Discussion & Appreciation for the Growing Discussion & Appreciation for the
Social Determinates of Health as Explainer Social Determinates of Health as Explainer
of Racial Disparities in Health and the of Racial Disparities in Health and the
Solution to themSolution to them
31
What Is To Be What Is To Be Done?Done?
32
How Do We Reposition MCH in How Do We Reposition MCH in America? America?
What Should MCH Look Like by What Should MCH Look Like by 2030?2030?
Change in Vision; Structure; Change in Vision; Structure; Financing, Policy, Program Design Financing, Policy, Program Design
Needed:Needed:
33
America’s MCH Vision America’s MCH Vision
• Recognize that Women Produce & Reproduce Recognize that Women Produce & Reproduce Life in America Life in America
• Reproduction & Nurturing of Human Capital Reproduction & Nurturing of Human Capital Key to Survival of the Nation! Key to Survival of the Nation!
• Prenatal, Preconception and Interconception Prenatal, Preconception and Interconception Care should be Linked Together as Part of a Care should be Linked Together as Part of a Comprehensive Solution to Women’s HealthComprehensive Solution to Women’s Health
34
America’s MCH VisionAmerica’s MCH Vision
• Focus on the Health of Women Beyond Focus on the Health of Women Beyond Pregnancy Pregnancy
• Women’s Health is Housing Policy, Women’s Health is Housing Policy, Economic Development Policy, Economic Development Policy, Environmental Policy, Education Policy, Environmental Policy, Education Policy, etc.etc.
35
Structure/LeadershipStructure/Leadership
• The Way MCH Services are Delivered in The Way MCH Services are Delivered in America is Currently Fragmented! America is Currently Fragmented!
• HRSA, MCHB, CDC, ACYF, NIH, etc.HRSA, MCHB, CDC, ACYF, NIH, etc.
• Immediately Create a Deputy Secretary Immediately Create a Deputy Secretary for MCH Positionfor MCH Position
36
Structure/LeadershipStructure/Leadership
• Reports Directly to DHHS Secretary Reports Directly to DHHS Secretary Nominee, Kathleen Sebelius Nominee, Kathleen Sebelius
• Charge-support systems building & Charge-support systems building & Integration at Federal, State and Local LevelsIntegration at Federal, State and Local Levels
• Incentivize MCH Innovation throughout Incentivize MCH Innovation throughout systemsystem
37
Structure/LeadershipStructure/Leadership
• Consolidating Women & Children’s Health Consolidating Women & Children’s Health Assets into One Agency can Save Money and Assets into One Agency can Save Money and Increase Operating EfficienciesIncrease Operating Efficiencies
• Utilize President Obama’s newly created Utilize President Obama’s newly created White House Council on Women and GirlsWhite House Council on Women and Girls as a as a Vehicle to Coordinate Women’s Health Policy Vehicle to Coordinate Women’s Health Policy and Financing Across Federal & State and Financing Across Federal & State Agencies Agencies
38
FinancingFinancing
• Health of Women Across the Life Course Health of Women Across the Life Course has to be a key component of any Health has to be a key component of any Health Care Reform Agenda in Washington Care Reform Agenda in Washington
39
FinancingFinancing
• If President Obama’s Health Care If President Obama’s Health Care
Reform Package stalls in Congress, these Reform Package stalls in Congress, these
are some Tactical Solutions:are some Tactical Solutions:
• Soda or Tobacco Tax to create a women’s Soda or Tobacco Tax to create a women’s
health funding stream for Interconceptional health funding stream for Interconceptional
carecare
• Medicaid Family Planning Waivers Medicaid Family Planning Waivers
40
FinancingFinancing
• Private Employer-Based PlansPrivate Employer-Based Plans
• Community Health Centers Community Health Centers
• Healthy Start Healthy Start
• Title X Family Planning Clinics Title X Family Planning Clinics
• Title V Agencies Title V Agencies
41
Policy/Program DesignPolicy/Program Design
• To achieve the vision above the MCH To achieve the vision above the MCH
system in America today must strive to system in America today must strive to
become more integrated assuring access, become more integrated assuring access,
quality and coordination of affordable quality and coordination of affordable
care across a woman’s life course!care across a woman’s life course!
42
Operationalize Life Course Theory:
• Show how health departments & MCH Show how health departments & MCH organizations change strategy, organizations change strategy, organizational structure, and integrate organizational structure, and integrate program interventions across the time-line program interventions across the time-line and swim upstream addressing social and swim upstream addressing social determinates of health, thus improving determinates of health, thus improving women’s healthwomen’s health
43
Pediatric Office 2.0Pediatric Office 2.0
Developmental Services
Home-visitingnetwork
Early Intervention
Child CareResource &ReferralAgency
Early HeadStart& HeadStart
Early ChildMental Health Services
Preventive Care
Acute Care
Chronic Care
Developmental Services
Parenting Support
Lactation Support
44
Preventive Care
Acute Care
Chronic Care
Developmental Services
Pediatric Office 3.0Pediatric Office 3.0
ScreeningPediatric Services
Sector
SurveillanceCommunity Services and Resource Sector
AssessmentPeds/HPlan/
PHSector
Evaluation (IDEA Sector
Child Care/FamilyResource Center
Mid-LevelAssessment
Center
Surveillance
Program
Program
IDEARegionalCenter for
DevelopmentalDisabilities
OtherSpecialized
Services
COORDINATIONCOORDINATIONCENTERCENTER
4545
Spectrum of Work for MCH Life Course OrganizationSpectrum of Work for MCH Life Course OrganizationBuilding Public Health Social MovementBuilding Public Health Social Movement
Economic Opportunities•Harlem Works•Financial Literacy•LPN RN Training Program•Union Employment•Micro Lending Savings•Empowerment Zone
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
Early Childhood•Early Head Start•Head Start•UPK•Choir Academy
Child Welfare•Preventive Services•Foster Care Services•Parenting Workshops•Newborn Home VisitingCOPS Waiver
Child Welfare•Preventive Services•Foster Care Services•Parenting Workshops•Newborn Home VisitingCOPS Waiver
Legislative Agenda•Reauthorize Healthy Start•SCHIP•Minimum Wage Legislation•Women’s Health Financing
Legislative Agenda•Reauthorize Healthy Start•SCHIP•Minimum Wage Legislation•Women’s Health Financing
Housing•Home Ownership•Affordable Housing•Base Building- St. Nicks
Housing•Home Ownership•Affordable Housing•Base Building- St. Nicks
Health System‾Case Management - Title V Funds‾Health Education - Regionalization‾Outreach -Harlem Hospital ‾Perinatal Mood Disorders-Birthing Center‾Interconceptional Care
Health System‾Case Management - Title V Funds‾Health Education - Regionalization‾Outreach -Harlem Hospital ‾Perinatal Mood Disorders-Birthing Center‾Interconceptional Care
Birth Young Adult
Pre-teen TeenEarly Childhood
Women over 35
46
First-time MotherhoodFirst-time MotherhoodNew Parent InitiativeNew Parent Initiative
Purpose: Develop, implement, evaluate and disseminate Purpose: Develop, implement, evaluate and disseminate novel social-marketing approaches that:novel social-marketing approaches that:
• Concurrently increase awareness of existing Concurrently increase awareness of existing preconception/interconception, prenatal care, and preconception/interconception, prenatal care, and parenting services/programs, parenting services/programs,
• Address the relationship between such services, Address the relationship between such services, health/birth outcomes, and a healthy first year of life. health/birth outcomes, and a healthy first year of life.
• Include women and men who are from populations Include women and men who are from populations disproportionately affected by adverse pregnancy outcomes disproportionately affected by adverse pregnancy outcomes in their community including racial/ethnic minorities as in their community including racial/ethnic minorities as well as their providers.well as their providers.
47
First-time MotherhoodFirst-time MotherhoodNew Parent InitiativeNew Parent Initiative
HRSA’s Maternal and Child Health Bureau was HRSA’s Maternal and Child Health Bureau was allotted approximately $4.8 million for this allotted approximately $4.8 million for this activity through the Consolidatedactivity through the Consolidated Appropriations Act 2008 (P.L. 110-161) . Appropriations Act 2008 (P.L. 110-161) .
State-based Awards State-based Awards • 2009: AZ, CA, CT, FL, MA, NC, NE, NV, OR, PA, UT, WI2009: AZ, CA, CT, FL, MA, NC, NE, NV, OR, PA, UT, WI
• 2010: AZ, CA, CT, FL, MA, ME, NC, NE, NV, OR, PA, 2010: AZ, CA, CT, FL, MA, ME, NC, NE, NV, OR, PA, UT, WIUT, WI
48
Integrate MCH Core Services & Chronic Disease Management: The Ties that Bind
• Millions of women have chronic health Millions of women have chronic health conditions during and prior to pregnancy conditions during and prior to pregnancy
• Maternal Weight, Obesity, Mental Health Maternal Weight, Obesity, Mental Health
Issues Point to developing an Integrative Issues Point to developing an Integrative
MCH/Chronic Disease Strategy MCH/Chronic Disease Strategy
49
Integrate MCH Core Services & Chronic Disease Management: The Ties that Bind
• 40,000 women in NYC have gestational 40,000 women in NYC have gestational diabetes diabetes
• Focus on developing Interconceptional Focus on developing Interconceptional Protocols to address women with previous Protocols to address women with previous pregnancies that ended in adverse pregnancies that ended in adverse outcomesoutcomes
50
Integrate MCH Core Services & Chronic Integrate MCH Core Services & Chronic Disease Management: The Ties that BindDisease Management: The Ties that Bind
• Fully fund and execute CDC’s 10 Fully fund and execute CDC’s 10 Recommendations to Improve Recommendations to Improve Preconception Health & Health CarePreconception Health & Health Care
• Develop a Work Team between MCHB & Develop a Work Team between MCHB & CDC to share evidence-based practices, CDC to share evidence-based practices, develop evaluation protocols and share develop evaluation protocols and share funding streams to integrate carefunding streams to integrate care
51
This new concept This new concept has received has received much attentionmuch attentionin the news.in the news.
““You are what You are what your grandmother your grandmother ate.”ate.”
Epi GeneticsEpi Genetics
Barker HypothesisBarker Hypothesis
52
SummarySummary
• To Pivot and Reposition MCH in To Pivot and Reposition MCH in America, you, part of the leadership of America, you, part of the leadership of public health in America must do the public health in America must do the following: following: • Lead by creatively destructing the past as we Lead by creatively destructing the past as we
plant the seeds for a new, integrated MCH plant the seeds for a new, integrated MCH system of care tomorrowsystem of care tomorrow
53
SummarySummary
• I define Leadership as… I define Leadership as…
• Leaders take the assets given to them Leaders take the assets given to them today… today…
• A leader is someone who doesn’t do…A leader is someone who doesn’t do…
54
SummarySummary
• To implement the agenda To implement the agenda described in my talk will take described in my talk will take Courage, or doing today what , or doing today what others only dream of doing others only dream of doing tomorrowtomorrow
55
SummarySummary
• Leaders must be Leaders must be Decisive or or
change before others realize change before others realize
change is necessarychange is necessary
56
SummarySummary
• MCH activists must display MCH activists must display
Tenacity by doubling your by doubling your
efforts when others are pulling efforts when others are pulling
backback
57
SummarySummary
• The role of MCH leadership today is to The role of MCH leadership today is to
see around the corner strategically to see around the corner strategically to
examine new trends and issues that face examine new trends and issues that face
the industry and then prepare our the industry and then prepare our
organizations to weather the coming organizations to weather the coming
storm and create the future we envision storm and create the future we envision
58
Place No Limits on a Place No Limits on a
Woman’s Dreams and Woman’s Dreams and
Place No Obstacles to her Place No Obstacles to her
Achievements!Achievements!
59
Communities & Nations are Communities & Nations are
only as Strong as the Health only as Strong as the Health
of their Women!of their Women!
6060
Reinventing MCH Throughout the USA by: BReinventing MCH Throughout the USA by: Building a uilding a Social Movement, Investing in Ideas, Executing Tasks, Social Movement, Investing in Ideas, Executing Tasks,
Returning Results!Returning Results!
Linking Women to Health, Power and Love Across the Life Span
6161
For more information contact:For more information contact:
Mario Drummonds, MS, LCSW, MBAMario Drummonds, MS, LCSW, MBAExecutive Director/CEOExecutive Director/CEO
Northern Manhattan Perinatal PartnershipNorthern Manhattan Perinatal Partnership
127 W. 127127 W. 127thth Street Street
New York, NY 10027New York, NY 10027
(347)489-4769(347)489-4769
mdrummonds@msn.commdrummonds@msn.com
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