ASTHO 2011-2012 President's Challenge: Healthy Babies

Oct 21, 2011, 8:18 PM, Posted by

For the last few years, each annual meeting of the Association of State and Territorial Health Officials has kicked off a yearlong President’s Challenge that focuses on a particular health issue impacting all states. Judith Monroe, MD, now the director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention used her Presidential Challenge in 2008 to highlight the need to “walk the talk” by promoting wellness in health department worksites.

In 2010 Paul Halverson, director of the Arkansas Department of Health, devoted his President’s Challenge to injury prevention, a topic prominent at this year’s ASTHO annual meeting as well. And last year John Auerbach, state health commissioner in Massachusetts and ASTHO’s outgoing president, made health equity his cornerstone initiative. The focus on these health issues has extended well beyond the challenge year and health officials continue to make them a priority.

For the 2011-2012 President’s Challenge, incoming president David Lakey, MD, commissioner of the Texas Department of Health, is focusing on healthy babies because too many are born too soon, often resulting in developmental and health issues that impact their entire lives.

NewPublicHealth spoke with Lakey about his President’s Challenge, why preventing preterm birth is such a critical issue and key partners across the country to help accomplish his goal to reduce prematurity in United States by 8 percent by 2014.

NPH: How did you come to focus on healthy babies for your President’s Challenge this year?

Lakey: About a year and a half ago when we were discussing the challenges that all of us were facing in the southern part of the United States, Regions 4 and 6, all of us brought up the challenge that we have with prematurity and infant mortality.

I guess the other part of my interest is my background. I’m an infectious disease physician but I did pediatric training and spent time helping to care for premature babies and the consequences that come with that, whether it was intellectual disability or problems with the lungs or other abnormalities.

So we saw this as an issue that we needed to put some focus on. It is also an area that has significant ethnic disparities. If you look at the rates in the African American community, they’re about twice as high as in other populations. And we also started to understand not only the human aspect but also the economic aspect that prematurity is a driver of our Medicaid budgets in our states. We can not only improve health outcomes and improve people’s lives but also do it in a way that saves money for the states and helps us drive our health costs in our system down.

NPH: What are some of the proven strategies for improving these health outcomes?

Lakey: We know that we can help ensure that women get the care that they need between pregnancies, so that they are healthy when they become pregnant. We know there are medical interventions that can help a woman who has had a premature baby before have a full term baby the next time she is pregnant. We know that her health, whether she smokes or is obese, can contribute to these issues.

We’re working on this project with the March of Dimes and with federal agencies. Success has already occurred in Kentucky and other states where they have come together and educated not only the moms-to-be but also the hospital systems and physicians about the importance of waiting until the baby is fully developed, waiting until after 39 weeks before delivering babies. There’s a significant difference in health outcomes if we wait and if we can keep that baby in utero as long as we can up to 40 weeks before the delivery.

NPH: What have you done so far in Texas to improve birth outcomes?

Lakey: When I received the PRAMS [Pregnancy Risk Assessment Monitoring System] report several years ago the data showed that infant mortality rates in Texas had not improved, and had even gone backwards. Part of my challenge to the state health officers is to start by looking at their state’s PRAMS report.

What we’ve done since then is to make [healthy births] a priority. We have brought together experts in the field to help us look at how we can educate the general population related to the importance of reducing inductions and C-sections before 39 weeks. We are working with the payer systems in Texas to make it a priority. One of the policies that just came into effect is that Medicaid will no longer be reimbursing providers for non-medically indicated C-sections and inductions before 39 weeks, which will be a major policy change. We also have major policy looking at the newborn ICUs to improve the quality of care provided. This is a complex issue and so we’re attacking it on many fronts.

NPH: What will the role be of the March of Dimes and other partners over the next year in helping you on the initiatives?

Lakey: They have been helpful to us as we’ve planned out our initiatives and they will help us get visibility. They have expertise in this area. [March of Dimes now has an online Prematurity Prevention Center that offers information and resources for professionals]. We’re also working with the CDC and getting advice on what are those practices and policies that have been proven to work. We’re working with HRSA. My background is in infectious disease and I’m not an expert in this area, but I’ve learned that there’s a lot of good information out there but we haven’t turned that information into consistent policy across the states. Part of the role of the partners is to guide us, help us craft the best policy, share the best policy and get visibility on this issue.

NPH: What other issues will be important this year that you will focus on as president of ASTHO?

Lakey: A key role of ASTHO is to strengthen the effectiveness of state health officers so they can lead their public health organizations. We’ve had significant turnover over the last year in state health officers and a lot of that was secondary to the changes in governors. One of my roles and the role of ASTHO is to help equip those new state health officers so they can be effective public health leaders in their state and in their agency. At the same time, we need to be a voice of state public health, especially in challenging budget times. We need to educate other individuals on the importance of public health, that this is a bipartisan endeavor and that all of us benefit as we improve the health of people.


This commentary originally appeared on the RWJF New Public Health blog.