To Build a Culture of Health, There Is No Place Like Home

Aug 11, 2014, 3:36 PM, Posted by

A mother and her son meet with a care coordinator.

A century ago, it was normal for a doctor to make a house call to tend to a patient in need. By the time I was a child growing up in New Jersey in the 1970s and 80s, the practice had become virtually obsolete.

The case for bringing health care back into the home is becoming more compelling every day. One place where we see the potential to make a big impact is with new parents and newborns.

Last month, JAMA Pediatrics published new research from on the effects of nurse-home visits on maternal and child health. The randomized, clinical trial followed a group of low-income, primarily African American mothers and children living in disadvantaged, urban neighborhoods of Memphis over a 19-year period. Specifically, they wanted to see whether home visits conducted by the Nurse-Family Partnership before and after a birth influenced whether the mothers and children died prematurely.

The research revealed that “mothers who did not receive nurse-home visits were nearly three times more likely to die from all causes of death than nurse-visited mothers.” It also found that “there were lower rates of preventable child mortality from birth until age 20.” The new findings come on top of other research showing that the same nurse-home visiting model leads to better prenatal health and behavior, reduces risks for child abuse, reduces chances that children would be hospitalized before the age of 2, and improves the mental health and behavior of children at home and in school.

As a mother of two young kids, I know that what happens at home is as important to the health of my family—if not more important—than what happens in the doctor’s office. The interactions my husband and I have with each other and with our children, how we cope with stress, whether we can meet the basic needs of our children for things like food, clothing, or a safe place to live—all of these things matter. In fact, what our children experience in the home in their first years actually affects how their bodies and brains develop. It has a lasting impact on their health over their entire lives. Recent RWJF-supported research bolsters that point of view.

As a society, we ought to be doing much more to help families with young children establish a solid foundation for health from day one. And the best way to strengthen families is to meet them where they are, and help provide them with the tools they need to make healthy choices where they live: at home.

To be clear, the best interventions are ones that empower families to make healthy choices. They don’t preach to parents or do the work for them. They give parents tools and information to help them become the parents they want to be. The nature of the relationship with parents is informal but caring because that’s what it takes to be able to hear what parents need and to offer advice in a way that is heard in return.

Home health professionals also help caregivers overcome the obstacles that make it hard for them to support their children’s well-being and development. That obstacle can be something internal, like depression, or external, like access to healthy food or a safe and stable place to live.

Not all interventions designed to help new parents at home are equal. Research suggests that trained specialists—like nurses, midwives, and mental health professionals—are much more effective at preventing or treating conditions like postpartum depression than models that depend on lay- or peer-based support. Even with the higher bar, there’s no reason why we, as a society, shouldn’t do more to make home health visits a standard practice for all new families and all new babies. It ought to be part of how we build a culture of health for families with young children.

If it sounds far-fetched, consider the fact that every family in the UK gets a visit from a nurse or midwife after the birth of a child. They start with a home visit within two weeks of the birth. After that, they maintain a relationship that combines in-home and in-clinic visits until the child is 5. They monitor and support both the physical and emotional development of children, and help to address the financial or emotional sources of stress that may affect a family’s health. They also have the ability to provide greater support to families who are especially vulnerable or face higher risks. Because home health visits are universal, they can track what is and is not effective and make improvements that can lift the health of entire populations.

For a stateside example, head down to Durham County, North Carolina. A local program, known as Durham Connects “provides in-home nurse visits free of charge to all parents of newborns in Durham County. “Nurses check the baby’s weigh and overall health. They make sure the mother is recovering well after giving birth. If necessary, they assist with breastfeeding and parenting classes. They are trained to spot and address postpartum depression. They help families find options for child care and connect them to financial resources. Research shows that families served by Durham Connects require fewer hospitalizations and emergency medical services, exhibit more positive parenting, and have a safer and healthier home environment.

Even with everything we know, there is still a lot to learn about how to get the most out of home health visits for families with newborns and, especially how to do that at a large scale. We shouldn’t be afraid to do that learning, and to learn by doing. Because home health visits have so much potential to be a home run.