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”: Colorado Edition Charles Bruner BUILD Ini1a1ve and Child and Family Policy Center February 2014

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

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 1. in need The first years are the most critical to lifelong 2. health (but where we invest the least) Child health is in jeopardy 3. Health disparities are profound and 4. preventable Affecting children’s health trajectory is 5. essential to improving health

What We Can Do About Health Equity and Young Children Health practitioners are key to early and 1. timely response. There are exemplary programs upon which to 2. build These exemplary practices can become the 3. routine standard Neighborhoods matter too 4. Investments pay off– and must be 5. financed for the long-term

1a. Our Youngest Are Our Most Diverse COLORADO Racial/Ethnic Information By Age United States: Percent of Popula4on Combined Non-white and Hispanic 0 to 5 years: 49.0%; 6 to 17years: 45.2%; 18 to 64 years: 35.7%; 65 + years: 20% Source: United States Census, 2012 American Community Survey

1b. Our Youngest Are Our Most in Need COLORADO Poverty/Income Level by Age Group United States: Percentage of Popula5on Below Poverty, By Age: 0-5 years: 24.8%; 6-17 years: 20.0%; 18-64 years: 14.2%; 65 + years: 9.0% Source: United States Census, 2012 American Community Survey

1c. Our Most Diverse Youngest Are Our Most in Need Poverty/Income Level by Race/Ethnicity: 0-5 Year Olds Source: United States Census Bureau, 2009-2011 Public Use Microdata Sample

2a. The First Years Are Most Critical … • Brain development and toxic stress • Early childhood adversity/ACEs and future chronic health conditions • Epigenetics • The impact of social determinants on health– social gradient, early life, stress, social exclusion and social support – all related to health equity Harry T. Chugani, MD, PET Center Director, Chief of Pediatric Neurology and Developmental Pediatrics, Children’s Hospital of Michigan

2b. … But Where We Invest the Least Per Child Expenditure by Age Group as % Per Child US CO (6-18) Expenditure Per child (0-2) Exp as % Per 7% 5% Child (6-18) Per Child (3-5) Exp as % 25% 13% Per Child (6-18) Per Child (0-5) Exp as % 16% 9% Per 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 Proportion of Children

4a.Health Disparities are Profound … Select Child Health Disparities by Race/Ethnicity and Income from National Survey of Children’s Health Health Indicators : Infant mortality; low birthweight; prevalence of lead poisoning and asthma; developmental disability or delay; food insecurity, malnutrition, obesity; mental /behavioral health disorder Health Response in Relation to Need: • Children with one or more parent-reported concerns about physical, behavioral or social development • Children with no preventive dental care during the past 12 months/since (his/her) birth • Children who do NOT have a usual source for care • Maternal mental health status of children living with mothers in the household is fair or poor

4b. … and Reflected in Family Demographics Colorado Data: 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 31% 16% 32.5% 55 Hispanic 10% 51% 20.7% 18 White, non-Hispanic 41% 32% 51.4% 36 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

4b. … and Reflected in Family Concerns and Stressors Colorado Data: Family Concerns and Stressors Parents are Live in an Fair/Poor Usually or Unsupportive Maternal Always Stressed Race/Ethnicity Neighborhood Mental Health about Parenting 28% 7%* 17% Hispanic 13% 3% 7% White, non-Hispanic 33%* 19%* 3%* Black, non-Hispanic * = estimates based on sample sizes too small to meet standards for reliability or precision http://www.childhealthdata.org/browse/survey

4b. … and Reflected in Child Outcomes Colorado Data: Child Outcomes Percent Proficient or above on 4th Concerns About Grade Reading Child’s Low – NAEP Race/Ethnicity Development1 Birthweight2 Assessment3 46% 9% 23% Hispanic 36% 8% 52% White, non- Hispanic 43%* 14% 19% 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. Affecting the Health Trajectory of Young Children is Essential Source: BUILD Ini0a0ve and the Child and Family Policy Center (February 2013)

Summary of Part One: What We Know About Health Equity • America is becoming more diverse and young children are leading the way. • This diversity can be a strength, but only if America addresses issues of health disparities. • Healthy young child development is key to long-term success. • Addressing health disparities involves issues of equity and responding to family stress, isolation, and exclusion (often the result of discrimination/racism).

6a. Health Practitioners Are Key to Early and Timely Response …

6b. …Across Both Biomedical and Social Determinants of Health Physical health and development • No undetected hearing or vision problem • No chronic health problems without a treatment plan • Immunizations complete for age • No undetected congenital anomalies Emotional, social and cognitive development • No unrecognized or untreated delays Family’s capacity and functioning • Parents knowledgeable about child’s physical health status and needs • No unrecognized maternal depression, family violence, or family substance use • No undetected early warning signs of child abuse or neglect Schor, E. Healthy Child Story Book.

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

7b. …Which Share Common Attributes…

8a. Exemplary Practices Can Become the Routine Standard But Are Not Today Colorado Data: Primary and Preventive US CO Health Services for Children (0-5) Child reported as having some form of health 94.5% 92.4% insurance coverage Child reported as having preventive, well-child 84.4% 84.8% visit in past 12 months Child reported as having coordinated, ongoing 54.4% 55.3% comprehensive care within a medical home Child reported as having been screened for being at risk of developmental, behavioral, and social delays, using a parent-reported screening tool 30.8% 47.0% during a health care visit (10 months to 5 years only) Source: National Survey for Children’s Health 2011-12

8b. Moving From Exemplary To Routine Requires Intentionality Creating Awareness of the Need for and 1. Ability to Change Promoting/Incentivizing New Practice and 2. Investing in Innovators and Innovation Developing Mainstream Management, 3. Financing, and Accountability Systems to Make Exemplary Practice the Norm

8c. States Can Play Key Roles, Particularly Through Medicaid PARTICIPATION IN MEDICAID AND EPSDT BY CHILD AGE (416 FORMS AND ACS DATA) – US and Colorado 2011 US CO 0-2 Medicaid/EPSDT Enrollment of all 0-2 year olds as percent of all children 56.0% 46.5% Average Number of EPSDT Visits Annually for Enrolled Child 2.2 1.78 3-5 Medicaid/EPSDT enrollment of all 3-5 year olds (416/ACS) 51.5% 43.4% Average Number of EPSDT Visits Annually .71 .51 6-17 Medicaid/EPSDT Enrollment of All 6-17 year-olds (416/ACS) 35.6% 28.3% Average Number of EPSDT Visits Annually .42 .29