CITYMATCH CONFERENCE 2008SEPTEMBER 20-23, 2008

ALBUQUERQUE, NM

Environmental health and maternal and child

health: Healthy Start strategiesHealthy Start, Inc.

Pittsburgh/Allegheny County, PA

Cheryl Squire Flint Christine Ley

Michael CaliguiriMarlene Kolosky

Why is environmental health critical to maternal and child

health?

Sub-standard housing is associated with increased risks of infectious diseases, chronic diseases such as asthma, and more injuries and safety problems. (Krieger,Higgins,(2002)Housing and health: time again for public health action, AJPH, 758-768)

The life course perspective clearly shows that poor environmental health conditions adversely impact future health of children

Environmental health disparities persist

“The elimination of

disparities in environmental health requires attention to both environmental

hazards and social conditions.”

(U.S. Environmental Protection Agency, EPA, 2003; Institute of Medicine, 1999)

Environmental health disparities and maternal and child health

Poor neighborhoods and their residents left out of the “Greening of America”

Environmental justice is a key component of elimination of health disparities.

Community and home environment of

pregnant/parenting families

Community-based programs such as Healthy Start use a holistic approach to elimination of health disparities.

This approach involves multiple levels of intervention including partnerships with community organizations, advocacy, and case management.

Case management: home visiting and environmental

health

Healthy Start staff make home visits to participants from the period of pregnancy to the second birthday of the infant.

Assessment and developing a plan of care about issues in the home environment are ongoing.

Home environment assessment items for routine data collection

Housing and Violations eviction pending; homeless;

inadequate/no appliances; sanitation/ housekeeping; lack of safety/housing code

Lead exposure; no telephone; overcrowding; rodents/others pests

Fire hazards commonly identified

Smokers in householdElectrical

wiring/overloaded circuits

Space heaters, use of stove for heating

CandlesClutter No or non-working

smoke detectors

Air Quality hazards

Second hand smoke Danger of carbon monoxide from

unsafe furnace/appliancesAmbient fumes, chemicals Mold spores, asbestos, lead particles

Pests and other animal issues

Infestation insects/rodentsInadequate garbage disposal capacityInadequate food storageMultiple pets may lead to risk of

diseases from animal waste, bites, pet food attracts pests

Inadequate routine cleaning food preparation areas (floors, counters, dishes)

Structural/Heating and cooling

Utilities shut-off or pending notice

Non-working or poorly maintained furnace

Non-working or inadequate cooling/AC

Broken windowsBroken

floorboards

Plan of care

The Healthy Start staff sets priorities with the participant to address environmental problems

Case conferences, referrals and partnerships with community organizations are essential

Home visits for follow-up and monitoring of conditions

Co-morbidities with environmental health problems

Sub-standard conditions in the home also may be markers for other psychosocial problems Clinical depression Serious mental health

issues Domestic violence Alcohol misuse Other drug misuse

Multidisciplinary team approach

Healthy Start uses a comprehensive team with nurses, child development and social work staff

Routine screening and assessment of mental health problems

Home visits by all disciplines available to address underlying issues such as depression.

Role of community partners

Healthy Start works with many community partners to address environmental health problems affecting participants and their families.

Local and state health departments are primary resources

Community tenant organizations and neighborhood associations

Fire and police departments

Training and Prevention strategies

Community partners such as fire, police and health department environmental health provide staff training and updates to Healthy Start staff e.g. available resources such as home inspections, smoke detectors, new safety information

Healthy Start provides culturally appropriate health education

Healthy Start participates in community events and health fairs in partnership with environmental health organizations

Advocacy for environmental health

Advocacy is also important in the reduction of environmental health disparities for Healthy Start families.

Healthy Start partners with community organizations such as the health department by contributions to reports of adverse health conditions, testimony in public forums for funding for improved home-based services, and safe housing, and education/training of local MCH providers.

Case examples

Most Healthy Start families with environmental health issues have multiple problems that require long-term case management and multiple levels of interventions.

These often involve housing code violations, sanitation, and mental health or family problems may be contributing to the poor home .

Healthy Start, Inc. For more information about us,

call the Healthy Start Helplines at:(412) 247-1000

or (724) 425-1799

orvisit our website at:

www.healthystartpittsburgh.orgHealthy Start, Inc.  is supported in part by Project No. CFDA #93.926E from the Healthy Start Initiative, Division of

Perinatal Systems & Women’s Health, Maternal & Child Health Bureau, Health Resources & Services Administration, and Department of Health & Human Services.