Download ppt - Repositioning MCH in America: Where We Are…Where We Need to Go

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.

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AcknowledgementsAcknowledgements

Dr. Michael LuDr. Michael Lu

Dr. Neal HalfonDr. Neal Halfon

Dr. Maxine Hayes Dr. Maxine Hayes

Dr. Jimmie CollinsDr. Jimmie Collins

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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

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Where Are Where Are We?We?

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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

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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

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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

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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

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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

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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

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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)

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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

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Racial & Ethnic DisparitiesRacial & Ethnic DisparitiesLow Birth Weight < 2500gLow Birth Weight < 2500g

20052005

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7.3

0

2

4

6

8

10

12

14

African American White NCHS 2008

Percent of Live BirthsPercent of Live Births


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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.

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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


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Healthy People 2010Healthy People 2010Low BirthweightLow Birthweight

0

2

4

6

8

10

12

14

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AfricanAmericanNative

AmericanPuertoRican White

MexicanCuban

Asian/PI

Per 1,000 Live BirthsPer 1,000 Live Births

NCHS 2008NCHS 2008


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Obesity Trends Among U.S. AdultsObesity Trends Among U.S. AdultsBRFSS, 1990BRFSS, 1990

No Data <10% 10%–14%

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No Data <10% 10%–14% 15%–19% ≥20%

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No Data <10% 10%–14% 15%–19% ≥20%

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No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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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%

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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

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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

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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

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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

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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

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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

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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

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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

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What Is To Be What Is To Be Done?Done?

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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:

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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

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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.

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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

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• 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

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• 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

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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

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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

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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

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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!

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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

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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


Parenting Support

Lactation Support

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Preventive Care

Acute Care

Chronic Care


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

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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

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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.

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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

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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

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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

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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

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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

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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

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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…

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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

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SummarySummary

• Leaders must be Leaders must be Decisive or or

change before others realize change before others realize

change is necessarychange is necessary

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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

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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

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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!

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Communities & Nations are Communities & Nations are

only as Strong as the Health only as Strong as the Health

of their Women!of their Women!

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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

[email protected]@msn.com