Hea ealt lth h Equ quit ity an and You d Young ng Chi hild - PowerPoint PPT Presentation

Hea ealt lth h Equ quit ity an and You d Young ng Chi hild ldren en: : Overv ervie iew w of of Fed eder eral al an and St d Stat ate e Con onte texts ts BUI UILD: D: He Health Equity and Young Ch Children Co Confere rence nce May 30, 2013 David d W. Willis, s, M.D., , FA FAAP AP Dire rector ctor of th the Divisi ision on of H Home me Visiting ng and Early ly Childhood ldhood System ems s (DHVECS) ECS) Materna ernal and Child d Health th Bureau eau Heal alth th Resou ources rces and Se Servic vices s Ad Administrat nistration ion Departme partment nt of Health h and Human an Services vices 1

Ta Take ke Ho Home e Mes essages sages • Building health and health equity are key MCH strategic priorities • The emphasis on the Prenatal-to-Three period is required for building health and education readiness for the next generation of children • The ACA and the President’s Early Learning Agenda have created an unprecedented opportunity united and coordinated with unified vision 2

A A League gue Ta Table le of f Child ld We Well-Being -Being Source: UNICEF, 2013 3

Health inequalities can be seen as an outcome of… Social Inequalities 4

Wh What at cau auses ses he heal alth th ine nequities? quities? “The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. The structural roots of health inequities lie within education, taxation, labor and housing markets, urban planning, government regulation, health care systems, all of which are powerful determinants of health, and ones over which individuals have little or no direct personal control but can only be altered through social and economic policies and political processes.” WHO Commission on the Social Determinants of Health 5

“Social Determinants of Health” Social-Physi hysica cal-Eco Econom nomic-Servi Service ces s Determ rmina nant nts s • Income & income • Early child experiences inequality • Employment • Education • Housing • Race/ethnicity/gender & • Transportation related discrimination • Food Environment • Built Environment • Social standing • Stress • Social support 6

Differential Universality On average, disadvantaged children (neighborhoods) have poorer outcomes. However, most vulnerable children are in the populous middle class. Clyde Hertzman, MD Socioeconomic Socioeconomic Disadvantage Advantage 7

Ge Genetics:Orchid-Dande netics:Orchid-Dandelion lion Hyp ypothesis othesis “Biological Sensitivity to Context” W. Thomas mas Boyce ce, , M.D., 2008 • Plasticity hypothesis, sensitivity hypothesis, or differential-susceptibility hypothesis • Gene x Environment Interactions • Gene variants (orchid genes) SERT gene – depression/anxiety – 25% population • • Alleles: • S/S, S/L • L/L DRD4 gene – externalizing behaviors and antisocial risk, ADHD, risk – • 20% population “Risk becomes possibility” “Vulnerability becomes plasticity and responsiveness” 8

Hea ealt lth h an and s d soc ocia ial l pr prob oble lems ms ar are e wor orse e in mo in more e un uneq equa ual c l cou ount ntri ries es Index of: • Life expectancy • Math & Literacy Index of health and social problems • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level 9

Traditional Tr ditional Fr Framework ework Gu Guiding ding E Early ly Childhood ildhood Policy icy and Practice tice Significant Adversity Healthy Developmental Trajectory Impaired Health and Development Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments Source: Harvard 10

How Early Experience Gets Into the Body A Biodevelopmental Framework Foundations of Healthy Development and Lifelong Outcomes Sources of Early Adversity Health- Cumulative Effects Related Over Time Environment of Behaviors Relationships Educational Gene- Physiological Achievement Physical, Environment Adaptations & & Economic Chemical & Built Interaction Disruptions Productivity Environments Nutrition Physical & Mental Health Biological Embedding During Sensitive Periods 11 11

POPULATION ATTRIBUTABLE RISK A large portion of many health, safety and prosperity conditions is attributable to Adverse Childhood Experience. ACE reduction reliably predicts a decrease in all of these conditions simultaneously. 12

LI LIFE FE CO COUR URSE SE Drivers ivers of of Dev evel elop opmen mental tal Traj ajec ectori tories es • Neurodevelopmental Genetic, Prenatal and Neurodevelop- • Social-economic mental Factors Social- Attachment and economic Relational environment Patterns • Relational (ACE Scores) Relational Health 13 13

Re Relat ational ional He Heal alth 14 14 14

We’re in the “building health and developmental assurance” business… Physical health Developmental health Relational health 15 15

“Innovation lies at the intersection between tween early ly ch childhood ldhood sy syst stems ems and child health” Jack Shonkoff, M.D, 2011 Harvard’s Center on the Developing Child 16 16

Bui uild ldin ing g an an En Enha hanc nced ed The heor ory of of Cha hang nge tha e that t Bal alan ances es Enr nric ichmen hment t an and P d Prot otec ection tion New Protective Interventions Significant Adversity Healthy Developmental Trajectory Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments Source: Harvard Center on Developing Child 17

An n Ear arly ly Chi hild ldho hood od Syste stem Pediatric and OB Family Practitioners Resource Child Care Centers Centers Home CHC’s Visiting Families Programs Economic Assistance (TANF, WIC, Foodstamps) Others Head CBO’s Start Early Subsidized Interv. Child Care 18

St Strategies ategies to to Im Impr prov ove e Dev evelo elopmen pmental tal Traj ajec ectories tories Developmental Progress “Healthy” Trajectory Health Services Pre-school Appropriate Discipline “At Risk” Reading to childx Trajectory High quality ECE Anticipatory Guidance “High risk” Language Stimulation Trajectory Specialized services Parent Responsiveness Home visiting What will push children in red and yellow categories towards green? Late Infancy Late Toddler Birth Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Early Infancy Late Preschool Early Toddler Early Preschool 19 19

MIE IECHV CHV Maternal Infant and Early Childhood Home Visiting • Section 2951 of the Affordable Care Act of 2010 • Amends Title V of the Social Security Act to add Section 511: Maternal, Infant, and Early Childhood Home Visiting Programs (MIECHV) • A collaboration between MCHB and ACF • $1.5 billion over 5 years • Grants to states • 3% set-aside for grants to Tribes & Tribal Organizations • 3% set-aside for research, evaluation, and TA) 20

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MIECHV IECHV Op Oppo portunities rtunities • Advance the field of maternal and early childhood heath and development • Translate science into policy • Demonstrate a data collection framework to drive Quality Improvement practices • Impetus for frontier, rural and urban infrastructure • Catalyst for collaboration and partnerships • Systems integration of HV with early intervention • Early Childhood Comprehensive Systems (ECCS) • Medical home • Early child care and education 22

MIE IECHV CHV Pri riority ority Pop opula ulations tions Families in at-risk communities • Low-income families • Pregnant women under age 21 • Families with a history of child abuse or neglect • Families with a history of substance abuse • Families that have users of tobacco in the home • Families with children with low student achievement • Families with children with developmental delays or Disabilities • Families with individuals who are serving or have served in the Armed • Forces, including those with multiple deployments continued 23 23

Ho Home me Visiting siting Pro rogram gram Go Goal als Improvements in: • Prenatal, maternal, and newborn health • Child health and development, including the prevention of child injuries and maltreatment • Parenting skills • School readiness and child academic achievement • Family economic self-sufficiency • Referrals for and provision of other community resources and supports Reductions in crime and/or domestic violence 24 24

AA AAP P Bu Buil ildi ding ng Br Brid idge ges Am Amon ong g Hea ealt lth h an and d Ear arly ly Chi hild ldho hood od Systems tems Proj ojec ect t 2 201 013 Goals • Establish collaborative leadership for EBCD message carrying • Emphasize the importance of “First 1000 Days” across all EC systems • Establish collaborations that yield linkages between expanding medical home and EC activities and programs • Focus on “crossing the data divide” and intentionally building health and developmental capacity 25