Category Archives: Early childhood
Special Delivery: March of Dimes Honors Arizona State Health Director for Work on Improving Turnaround Times on Newborn Screening
An inaugural honor awarded by the March of Dimes last month—the Newborn Screening Quality Award—is the first in a series of awards to state health directors who have made changes to vastly improve newborn screening programs that help prevent death and disability for new babies.
The inaugural award was presented to Will Humble, MPH, director of the Arizona Department of Health Services. He established a policy of full transparency for the length of time it takes Arizona hospitals to send newborn blood samples to the lab for analysis, with a target of having 95 percent of samples screened within 72 hours.
“When hospitals hold onto blood samples for a few days, or a lab is closed on the weekend, this can lead to deadly delays for newborns,” said Edward McCabe, MD, the March of Dimes chief medical officer. “But under Will Humble’s leadership, Arizona has put in place a process that is a model for other states to follow.”
McCabe says the award—named for Robert Guthrie, MD, who developed the first mass screening test for babies in 1963—recognizes leadership in establishing a culture of safety as a way to avoid deadly delays in states’ newborn screening processes.
All states were put on notice about hazardous newborn screening test shipping practices by a Milwaukee Journal Sentinel investigative series, Deadly Delays, published in 2013. She series found that many hospitals delayed sending tests to labs for a variety of reasons, including staff vacations or shortages, or batched the tests in order to save money on shipping, causing diagnosis delays that resulted in babies’ deaths or disabilities.
Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.
Think you know what to expect when the camera is trained on the stars of Worldwide Wrestling Entertainment (WWE)? Think again. Three of WWE’s most popular wrestlers—Alberto Del Rio, Titus O’Neil and Roman Reigns—star in several new videos produced for Father’s Day 2014 that could make dads across the country practice their very best voices for story time, gather up the kids for a game of “go fish” and plan a tea party.
The new videos are a collaborative effort of WWE, the U.S. Department of Health and Human Services’ (HHS) Administration for Children and Families’ Office of Family Assistance, the National Responsible Fatherhood Clearinghouse and the Ad Council.
Yes, the videos are adorable, but the hope is that dads will watch and then do. That’s critical. Reams of research show that children who grow up without a father’s input can face serious and lasting social, economic and health problems, according to studies compiled by the National Fatherhood Initiative. The non-profit group’s founders include former HHS Secretary Louis Sullivan and actor James Earl Jones.
Some more facts on absent fathers:
- Children in father-absent homes are almost four times more likely to be poor. In 2011, 12 percent of children in married-couple families were living in poverty, compared to 44 percent of children in mother-only families.
- Infant mortality rates are 1.8 times higher for infants of unmarried mothers than for married mothers.
- Even after controlling for income, youths in father-absent households still had significantly higher odds of incarceration than those in mother-father families. Youths who never had a father in the household experienced the highest odds.
- Being raised by a single mother raises the risk of teen pregnancy, marrying with less than a high school degree and forming a marriage where both partners have less than a high school degree.
- A father’s involvement in schools is associated with the higher likelihood of a student getting mostly A's. This was true for fathers in biological parent families, for stepfathers and for fathers heading single-parent families.
“The importance of being a present and engaged dad lies in the long term effects and benefits that this responsibility has on the children and families we serve,” said Earl Johnson, director of the Office of Family Assistance. “Fatherhood must be respected as essential to the well being of our communities and as an investment in the creation of a caring, healthier and more productive society as a whole.”
The County Health Rankings and Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, will celebrate its fifth anniversary next month. In the last few months, NewPublicHealth has been reporting on the work of programs grantees that are making changes in their communities to help improve population health.
Utah’s Salt Lake County ranks 20th out of 27 counties in social and economic factors. Its high school graduation rate is 72 percent, below the state rate of 76 percent. Approximately 19 percent of the county’s children live in poverty, compared with 16 percent state wide.
South Salt Lake, a city in Salt Lake County, has many resources and assets that make it a great place to live. However, the city’s residents also deal with challenges similar to those faced by individuals living in the elsewhere in the country. Nearly half of South Salt Lake’s residents live in homes with annual household incomes less than $35,000. Among similar-sized communities in Utah, South Salt Lake has some of the highest rates of obesity, chronic cigarette smoking, binge drinking, mental illness and prescription drug abuse. In previous years, South Salt Lake has had the highest rate of violent crime in Utah, but over the past three years the city has noticed a 76 percent decrease in gang-related juvenile crime and a drop in overall crime of 23 percent.
In spite of these challenges, the schools, community partners and the City of South Salt Lake share a common goal to ensure all of the city’s kids are performing on grade level, graduating high school and pursuing a post-secondary opportunity. To create a foundation to allow children to achieve these goals, United Way of Salt Lake, the City of South Salt Lake and numerous other partners have created the Early Learning Network, a comprehensive, integrated early learning system for children from birth to age five. The program is critical because research shows that evidence-based investments in children from birth to age five improve school readiness; lower rates of crime, teen pregnancy, substance abuse and obesity; are essential to academic achievement; and have a direct impact on people’s health and financial well-being.
The goal of the Early Learning Network is to make sure that by the time a child enters kindergarten, he or she will be ready to learn.
The Early Learning Network is a recipient of a County Health Rankings and Roadmaps community grant. Grantees are funded to work with diverse coalitions of policy-makers, business, education, health care, public health and community organizations to improve the education system in ways that also better the health of the community. Roadmaps to Health grants support more than two dozen projects across the United States that aim to create healthier places for individuals and families to thrive. The Roadmaps to Health Community Grants project is a critical component of the County Health Rankings & Roadmaps program.
NewPublicHealth recently spoke with Elizabeth Garbe and Chris Ellis of United Way of Salt Lake.
NewPublicHealth: Tell us about the Early Learning Network.
Chris Ellis: The Early Learning Network is a coalition of early childhood providers, basic needs groups, government agencies and health organizations. The primary goals of the group are to ensure that kids are demonstrating age-appropriate development and entering kindergarten ready to learn. The Early Learning Network is focused on a specific geography, the City of South Salt Lake. It is a great example of collective impact, as non-profits, businesses and government agencies are working together to determine the most effective way to support children ages 0-5 in this community.
The Network has discussed baseline measures to better understand what services are needed to support the community. Collecting data to set a baseline is essential in order to demonstrate whether we are making any progress on our two goals.
New Report by RWJF Commission to Build a Healthier America Calls for Funding Changes to Help Improve the Health of the Nation
Recommendations released by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America yesterday call for three areas of change essential to improving the nation's health:
- Increasing access to early childhood development programs;
- Revitalizing low-income neighborhoods;
- Broadening the mission of health care providers beyond medical treatment to include the social problems their patients face that keep them from living healthy lives.
The Commission, which reconvened last June after four years, deliberated over the past several months and determined that these areas have the greatest potential for improving the health of the population, especially for low-income families.
The independent, non-partisan Commission was chaired by Alice M. Rivlin, PhD, former director of the Office of Management and Budget, and Mark McClellan, MD, PhD, the former head of the Centers for Medicare & Medicaid Services. Commission members included journalists, physicians, academics, policymakers, public health experts and people engaged in community development.
The new recommendations are part of a new report, Time to Act: Investing in the Health of Our Children and Communities.
“We cannot improve health by putting more resources into health care alone," McClellan said. "We must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities."
"To achieve a healthier America, we must change our approach to investing in health to affect the actual determinants of health, not just the consequences of ill-health," said Rivlin. "If carried out, these recommendations will build a foundation of lifelong health for generations to come."
Speaking at the release of the recommendations in Washington, D.C., yesterday RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, said, “we must join forces to foster a culture of health in which everyone—regardless of where they live, their race or ethnicity, or how poor or wealthy they may be—has the opportunity to lead a healthy life."
The Commission’s members all spoke about the findings and recommendations during panel discussions at an event at the Newseum to release the report. Suggested next steps include engaging both citizens and policymakers to advance the issues. “Often aspiring policymakers are looking for an issue and we’re trying to hand them one,” said Rivin. Anne Warhover, a member of the Commission and president and CEO of the Colorado Health Foundation, pointed out that turning the recommendations into successful actions will include helping each community determine both what it needs and what it can do, and realizing that “one size does not fit all” when it comes to these changes.
The Robert Wood Johnson Foundation, said Lavizzo-Mourey, “will make the [Commission’s report] our compass going forward to allow everyone to live a healthy life. It’s not going to stay on the shelf. We’re going to use this every day.”
- Resources created to accompany the release of the recommendations of the Commission to Build a Healthier America include video interviews with key leaders who are already helping to change the health of their communities.
Every baby should have a chance to celebrate a healthy, happy first birthday. Unfortunately, that is not always the case. And that risk disproportionately affects people with lower income and people of color. This Infant Mortality Awareness Month, we can celebrate some progress in helping more babies reach that first milestone, according to health officials who shared successes at the Association of State and Territorial Health Officials (ASTHO) Annual Meeting in Orlando, Fla., this week.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
“We are collectively moving forward in improving birth outcomes across the nation,” said David Lakey, MD, Commissioner of the Texas Department of State Health Services and former ASTHO president, who took on healthier babies as his President’s Challenge during his tenure. Lakey set out a goal of an 8 percent reduction in premature births by 2014.
“There is a high human cost of prematurity,” said Lakey, and that cost includes low birth weight, increased morbidity and mortality, and an impact on standardized test scores and other outcomes later in life for those who do survive. “Those who are born early have a much lower chance of having a healthy, happy first birthday.”
There is also an economic and societal cost of premature birth, the cost of which is largely paid for by Medicaid. Lakey said that 57 percent of all Texas births are paid for by Medicaid. Extreme preterm birth costs an average of $71,000—while a full-term birth costs an average of $420.
U.S. News & World Report has added a new set of rankings, “America's 50 Healthiest Counties for Kids” to its just released annual report on the Best Children’s Hospitals. The top counties have some important measures including fewer infant deaths, fewer low-birth-weight babies, fewer deaths from injuries, fewer teen births and fewer children in poverty than lower ranked counties. Most of the measures were taken from this year’s County Health Rankings, a collaboration of the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation.
According to U.S. News, “America’s 50 Healthiest Counties for Kids,” represents the first national, county-level assessment of how health and environmental factors affect the well-being of children younger than 18 and shows that even the highest-ranking counties grapple with challenges such as large numbers of children in poverty and high teen birth rates.
>>Read the full U.S. News & World Report article.
Healthy Babies Minnesota is an umbrella of activities aimed at using prenatal and first-year initiatives to make Minnesotans healthier throughout their lives. NewPublicHealth spoke with Edward Ehlinger, MD, the state’s commissioner of health, about the program.
Today marks the start of the regional Infant Mortality Summit, kicking off a collaborative, multi-State initiative to improve infant health outcomes. NewPublicHealth will feature some innovative programs and initiatives to support healthy babies this week.
NewPublicHealth: What are key initiatives that make up Healthy Babies Minnesota?
Dr. Ehlinger: We have a lot of activities related to pregnancy, prenatal care, preconception care and early childhood care; and so we’re collaborating on all of those. We also have a Children’s Cabinet that’s focusing on early childhood growth and development. We’re also really focusing on adverse childhood experiences. We’re collecting information across the state on what’s happening to babies in the first year of life, adverse childhood experiences, to make sure that we prevent those or can intervene quickly. And we’re also really focusing on preconception care. Trying to make sure that women who are anticipating becoming pregnant will focus on all of the important issues—make sure their weight is normal, their blood sugars are under control, if necessary, that they’re not smoking, they’re not drinking.
NPH: And what is the next set of ideas for 2012?