Health Equity and Young Children: The Imperative and Opportunity to - PowerPoint PPT Presentation

Health Equity and Young Children: The Imperative and Opportunity to Achieve the “Triple Aim”: Georgia Edition Angelica Cardenas-Chaisson, Kelly Perez, and Gerrit Westervelt BUILD Ini?a?ve and Child and Family Policy Center April 2014

THE IMPERATIVE Of all the forms of inequality, injus4ce in health care is the most shocking and inhumane. -- Mar4n Luther King We cannot allow the color of a child’s skin or zip code determine the child’s health. -- Maxine Hayes

Health’s defini.on of child health and health equity Child health is a state of physical, mental, intellectual, social and emo.onal well-being and not merely the absence of disease or infirmity . Healthy children live in families, environments, and communi7es that provide them with the opportunity to reach their fullest developmental poten7al. – World Health Organiza7on Health equity is achieving the highest level of health for all people. Health equity entails focused societal efforts to address avoidable inequali7es by equalizing the condi7ons for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injus7ces. – Healthy People 2020

Equity versus Equality – More Than “Equal Treatment”

Health’s Role in Early Childhood: The Intersec7on of Health Equity and Social Readiness

The Opportunity A mother brings her one-year-old in for a check-up and it’s clear that the mom is stressed, if not depressed, and shows little sign of responding to the child’s cues for attention. While the child isn’t “diagnosable” today, if things proceed as the primary health practitioner expects, in two years there will be significant indicators of development delay and likely social and emotional problems, including a DSM-IV diagnosis. The primary health practitioner does not want to wait two years to take action and the mom seems receptive to receiving help. At the same time, pointing out problems without offering help could be considered malpractice.

What We KNOW About Health Equity and Young Children Our youngest are our most diverse and most in 1. need The first years are the most cri5cal to lifelong 2. health (but where we invest the least) Child health is in jeopardy 3. Health dispari5es are profound and preventable 4. Affec5ng the health trajectory is essen5al to 5. future health

What We CAN DO About Health Equity and Young Children Health prac++oners have key roles to play in early 1. and effec+ve response There are exemplary programs upon which to 2. build These exemplary prac+ces can become the 3. rou+ne standard Neighborhoods ma=er too 4. Investments pay off– and must be 5. financed for the long-term

Health Equity and Young Children: The Georgia Picture What We Know About Health Equity and Young Children: Georgia Data

1a. Our Youngest Are Most Diverse Georgia Racial/Ethnic Information By Age Source: United States Census, 2010 American Community Survey

1b. Our Youngest Are Most in Need Georgia Poverty/Income Level by Age Group Source: United States Census, 2010 American Community Survey

2a. The First Years Are Most Cri2cal … • Brain development and toxic stress • Adverse Childhood Experiences/ACEs and future chronic health condi9ons The impact of social determinants • on health– social gradient, early life, stress, social exclusion and social support – all related to health equity (70% of total)

2b. … And Recognized in Both the Health and Early Childhood Worlds. • Health Terms • Early Childhood Terms – life-course model – ecological, whole child approach – pa5ent-centered care – family-centered services – an5cipatory guidance – family engagement – developmental – early iden5fica5on and response screening/surveillance – domains of school readiness – child health outcomes • Social Determinants • Protec5ve Factors – Social gradient – Concrete services in 5mes of need – Early life – Knowledge of child development – Stress – Resilience – Social exclusion – Inclusive ac5vi5es for children – Social support – Social 5es and connec5ons for parents

2c. … But Where We Invest the Least Per Child Expenditure by Age Group as % Per Child (6-18) Expenditure US GA Per child (0-2) Exp as % Per 7% 6% Child (6-18) Per Child (3-5) Exp as % Per 25% 27% Child (6-18) Per Child (0-5) Exp as % Per 16% 17% Child (6-18) BUILD Initiative. Early Learning Left Out (2013).

3a. Child Health is in Jeopardy For the first time in our country’s history, children face the prospect of growing up less healthy and living less long lives than their parents– not because of medical care but due to demographics, social determinants, and exercise, nutrition, and obesity.

3b. This Jeopardy Affects a Large Propor8on of Children

4a.Health Dispari/es are Profound … Select Child Health Dispari/es by Race and Income Infant mortality • • Low birthweight Prevalence of lead poisoning and asthma • Developmental disability or delay • Food insecurity and malnutri=on • Obesity • Mental/behavioral health disorder •

4b. … and Reflected in Family Demographics Georgia Family Demographics 25-34 year-olds with Associates Children in Child Degree or Single Parent Teen Birth Rate Race/Ethnicity Poverty1 Higher2 Families3 (per 1,000)4 43% 13% 28% 59 Hispanic 15% 42% 20% 29 White, non-Hispanic 40% 29% 57% 48 Black, non-Hispanic * = estimates based on sample sizes too small to meet standards for reliability or precision S = estimates suppressed when the confidence interval around the percentage is greater than or equal to 10% points 1. http://www.childrensdefense.org/child-research-data-publications/state-of-americas-children/ 2. http://dashboard.ed.gov/statecomparison.aspx?i=o&id=0&wt=40

4c. … in Family Concerns and Stressors … Georgia Family Concerns and Stressors Parents are Live in an Fair/Poor Usually or Unsupportive Maternal Always Stressed Race/Ethnicity Neighborhood Mental Health about Parenting 25% 10% 16% Hispanic 11% 8% 9% White, non-Hispanic 26% 9% 16% Black, non-Hispanic http://www.childhealthdata.org/browse/survey

4b. … and in Child Outcomes. Georgia Child Outcomes Percent Proficient or above on 4th Concerns About Grade Reading Child’s Low – NAEP Race/Ethnicity Development1 Birthweight2 Assessment3 57% 6% 24% Hispanic 35% 7% 45% White, non- Hispanic 38% 13% 20% Black, non- Hispanic *= estimates based on sample sizes too small to meet standards for reliability or precision 1 http://www.childhealthdata.org/browse/survey 2 http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf 3 http://nces.ed.gov/nationsreportcard/naepdata/report.aspx

5. Affec(ng the Health Trajectory of Young Children is Essen(al Source: BUILD Ini0a0ve and the Child and Family Policy Center (February 2013

Summary of Part One: What We Know About Health Equity Improving children’s health and reducing health, social, and educational disparities is key to Georgia’s future development and well-being. It is critical important to look to the earliest years of life for oppor- tunities to improve health equity.

What We CAN DO: Realizing the Opportunity The mother comes in with her child for the 36-month well-child visit. Her daughter is looking forward to coming, knowing she will receive a free book and excited to tell the nurse she will be going to Head Start next month with her best friend from the Hispanic family center. The mother has an ASQ form, completed at her family day-care home, and a set of questions for the practitioner about her daughter, who’s already starting to read but mixing up letters, and is wondering if there might be dyslexia. The mother is in a mutual assistance group with other parents and wants help from the practitioner in getting more dentists who will serve children in their community.

6a. Health Prac--oners Are Key to Early and Timely Response …

6b. … and Have a Recognized Role in Responding to Health Inequi:es EXPECTATIONS FOR WELL-CHILD CARE, TO IDENTIFY AND BE AT LEAST FIRST RESPONDERS TO: Physical health and development • Emo:onal, social and cogni:ve • development Family capacity and func:oning • ACA: The law of the land.

7a. There Are Exemplary Programs on Which to Build … Health Leads

7b.…That, for Best Results, Involve Doing All of the Following. Child Health Prac..oner Developmental surveillance and screening An.cipatory guidance Referral for “medically necessary” services Referral to care coordina.on Care Coordinator/Networker Mo.va.onal interviewing and whole child/family approach to iden.fy further needs/opportuni.es Iden.fica.on of available services and supports which can meet those needs Connec.on to services (referral/scheduling/follow-up/prac..oner no.fica.on of ac.ons) Community Service Maven (Community u.lity) • Community networker and builder across “medically necessary” and other community services