PBH 805 Week 1 Slides

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Week 1
Introduction to
Maternal & Child
Health
Instructor: Gina Crosley-Corcoran, MPH
PBH 805 – Maternal & Child Health

Why take MCH?
 To introduce MCH issues, epidemiology, programs,
and policies in the U.S. and internationally.
 To demonstrate the application of frameworks,
epidemiology and evidence-base in the analysis and
design of MCH programs and policies.

 Describe the historical context of
maternal and child health in the U.S.
and globally.
 Demonstrate understanding of
fundamental concepts in MCH
epidemiology and research.
 Discuss controversial issues in MCH.
 Critique contemporary MCH programs
and policies.
 Apply MCH frameworks in
conceptualizing health programs,
policies, and research.
Course Learning Objectives

What you need
 Headset microphone
 Video camera (webcam with recording software;
smartphone; tablet; stand alone video camera)
 If these requirement post a hardship, please e-mail
me.

Online Expectations
 Week begins Mondays at 12:00 AM and ends on Sundays
at 11:59 PM.
 Initial Discussion Board Posts are due Thursday by 11:59 PM EST
 Follow-up Discussion Board Posts are due Sunday by 11:59 PM EST
 All other assignments/quizzes are due Sunday by 11:59 PM EST
 Review all lecture modules of each week accordingly
 Check grades weekly and reach out early and often with
any concerns
 Complete all course Assignments, Weekly Quizzes, and
Weekly Discussion Board posts on time
 Final assignments will be presented live through
Blackboard Collaborate at the end of the semester

Required Text
 Kotch's Maternal and Child Health: Problems, Programs, and Policy in
Public Health. Jones & Bartlett Learning. 4th Edition, published 2021.
 NOTE: There have been significant changes to the 4th edition. The 3rd
edition has outdated information and will not be relied upon in the
course. All course quizzes are based on the 4th Edition.

Assignments
Category Weight
Weekly Discussion Board Posts 10%
Weekly Quizzes 10%
MCH Framework Paper 20%
MCH Problem Statement 15%
Program/Policy Memo 25%
Program/Policy Presentation 20%

Abbreviations
 MCH = Maternal and Child Health
 MCHB = Maternal and Child Health Bureau
 CHCN = Children with Special Health Care Needs
 HRSA = Health Resources and Services Administration
 WHO = World Health Organizations
 And much more on the MCH Abbreviations and MCH
Glossary documents in the Course Introduction area

Academic Honesty
 MCPHS Academic Honesty Policy (see Student Handbook).
 Plagiarism is a violation of this policy
 This is a research course. You will be citing research and
evidence. Citations are ALWAYS required.
 Citations should be formatted using APA Formatting and Style
Guide, 6th edition:
http://owl.english.purdue.edu/owl/resource/560/01/
 Not knowing is not an excuse! When in doubt, refer to APA rules
and the Academic Honesty Policy.

Chapter 1
Rights, Justice, and Equity

Key Terms and Definitions

Health Disparities and Health Inequalities
Health disparities definition:
• “differences in specific health outcomes that are closely linked with
social, economic, and/or environmental disadvantages, which
adversely affect groups of people who have systematically
experienced greater obstacles to health based on their religion;
socioeconomic status; gender; age; mental health; cognitive, sensory,
or physical disability; sexual orientation or gender identity;
geographic location; or other characteristics historically linked to
discrimination or exclusion” (Braveman et al., 2011)

Racial/Ethnic Disparities
 Black people, Hispanic people, American
Indians/Alaska Natives, Asian people, and Native
Hawaiian or Other Pacific Islanders bear a
disproportionate burden of disease, injury,
premature death, and disability compared to
White people.
 Race and Ethnicity are constructs but are often
proxy for other factors: preterm births, which are
a leading contributor to the unacceptably high
infant mortality rate in the U.S., are 60% more
common in Black babies than in White babies.
 People frequently use these constructs
interchangeably, but they are separate
designations. Both designations are invaluable in
the study of health disparities since they do
predict differences in the quality of health care
and access to health services. Dr. Joia Crear Perry: President of
National Birth Equity Collaborative
“(Being) Black isn’t a risk
factor, racism is.”

Layers of
Inequities
Religious
identity
Queer identity
Transgender
parenting
Immigrant
populations
Paid leave
Intersectionality

Roots of Inequity: Social Determinants of Health (SDoH)
 SDoH are the conditions in which people are born, grow, live,
work, play, pray, and age. These circumstances are shaped by
the distribution of money, power, and resources at global,
national, and local levels.
 Social determinants lead to health disparities or inequities—
the unfair and avoidable differences in health status seen
within and between different groups.
 https://www.who.int/gender-equity-rights/understanding/sdh-
definition/en/#:~:text=Social%20determinants%20of%20health%20%E2%80%93The%20social%20determinants%20of,and
%20resources%20at%20global%2C%20national%20and%20local%20levels

Figure 1-2

Figure 1-3

Children’s Rights
 Children are humans and should be entitled to fundamental,
universal human rights, such as the right to life, equity, and
dignity.
 Children are influenced and largely at the mercy of outside
influences that determine their health and well-being.
 UN Convention on the Rights of Children has defined those
under 18 to have the same rights as adults such as the right
to life, equality, and dignity.

Demographic Changes
 In 2045, people who are from minoritized ethnic and racial
groups are expected to make up 50% of the U.S. population.
 In 8 U.S. states, the majority of children are children of color.
 Despite this shift in demographics, people of color still face
great health inequities and policies that have limited their
access to wealth and opportunity.
 Disparities cost $93 billion in excess medical care costs and
$42 billion in lost productivity per year as well as economic
losses due to premature deaths.

Figure 1-1

Minority Health to Health Disparities
 W.E.B. Du Bois, in 1899, documented Black people suffered from some diseases at higher
rates than White people. Moreover, he posited that the differences did not reflect physical
“Black inferiority” but rather represented “an index of a social condition,” meaning the result
of social and economic conditions.
 However, the U.S. didn’t devote official attention till the publication of Report of the
Secretary’s Task Force on Black and Minority Health (1985), commonly known as the Heckler
Report
 This report showed that six causes represented more than 80% of mortality among Black
people and other minority populations.
 Furthermore, it outlined several recommendations to reduce the differences in health status,
identified areas in which data were limited or lacking, and revealed the need to improve data
collection among Hispanic, Asian American, and American Indian/Alaska Native populations.
 It did not provide recommendation for narrowing the gaps nor address the reasons why, but
it was a starting point reshaping the discission to the disparities of health outcomes.

The Impact and Legacy of the Heckler Report
 Helped establish Minority Health Programs within the
National Institutes of Health (NIH), the Centers for Disease
Control and Prevention (CDC), and the Health Resources and
Services Administration (HRSA)
 Coincided with the establishment of the Healthy People
Report, where finally in 2010 the report included the
elimination of health disparities
 The Affordable Care Act that was signed into law in 2011 also
had focus areas in health disparities.

Connecting the Past to the Present
Disparities can be
understood through events
and trends that created the
social inequities for African-
Americans and other racial
and ethnic groups.
It is important to understand
the events of the past and
how they continue to
influence the health of the
current U.S. population.

Moving Toward Health Equity as a Frame
 Researchers, communities, and equity advocates have since created
more robust frames to examine health equity, particularly within the
MCH field.
 Women of African Descent for Reproductive Justice, understood that
the principles espoused by mainstream women’s rights and
reproductive health movements were largely ignoring marginalized
women’s and communities’ needs, women’s bodily autonomy, and
human rights frameworks.
 SisterSong Women of Color Reproductive Justice Collective carried the
torch for the social justice, policy advocacy, and cultural movement of
reproductive justice.

Strategies for MCH Policy & Programs
Decolonize funding
and research
Propose policies
and legislation to
close equity gaps
Prioritize learnings
from communities
experiencing
burden of inequities
Adopt an antiracist
stance as an
organization
Employ respectful
maternity care
Improve data
collection and
analysis processes
Provide visionary
leadership

Chapter 1 Conclusions
 MCH has foundational roots in social justice as well as a history that has
furthered health inequity.
 Birth equity and reproductive justice provide MCH advocates with
frameworks to acknowledge the historical wrongs caused by a White-
dominated culture.
 Racism drives racial inequities in MCH outcomes and it is racism that
created race. We need to be actively antiracist and anti-incrementalist
(Kendi, 2019; Levmore, 2010).
 MCH has a critical role to play in ending racism, classism, and gender
oppression.

Chapter 4
Overview of Maternal and Child Health History

Chapter 4 Introduction
• Major MCH problems, and the policies
and programs that have evolved to
address these challenges
• The political context in which specific
policies and programs emerged to
address perceived needs for children
and families
This chapter focuses on:

Some Key Events in MCH History in the U.S.
1855: Founding
of the Children’s
Hospital of PA
1869: State
board of health
established in
MA
1935: SSA,
including Titles
IV and V was
enacted
1965: Title XVIII
(Medicare) and
Title XIX
(Medicaid)
2010: Patient
Protection and
Affordable Care
Act to expand
health
insurance
coverage is
signed into law.
2015: Title V
Maternal and
Child Health
(MCH) Services
Block Grant
Program
transformed

The 19th Century: A “Pre-MCH” Era
State and federal
government not
particularly
concerned with
matters associated
with health during
the 19th century
Early 1900s: the
function of vital
registration of births
and deaths routinized
nationally
Prior to ~1915: no
annual statistics on
infant mortality were
available nationally
1890–1920 referred
to as the Progressive
Era because of the
many social,
economic, and
political reforms that
emerged

20th-Century Attention to MCH Issues
1912: the creation of
the Children’s Bureau,
the first federal
agency focused
explicitly on MCH in
the U.S., headed Julia
Lathrop
1921: the Maternity and
Infancy Care Act, later
known as the Sheppard-
Towner Act
•Perpetuated structural racism
even as it advanced the formal
organization of MCH in the U.S.
(Menzel, 2021)
1930: formation of the
American Academy of
Pediatrics (AAP)
The coming of the Great
Depression saw many
state MCH programs
dismantled.

U.S. Black and White Infant Mortality,
1915–2017
<Insert Figure 4-1>

Title V of the Social Security Act of 1935
 1930s: New Deal Legislation, to help the nation recover from the Great
Depression
 While the Sheppard-Towner Act had provided federal funding for MCH
services, it gave states considerable discretion in how to use those
funds.
 The Social Security Act of 1935 greatly expanded federal funding for
state MCH programs and services.
 States required to provide a portion of the program’s funding from
their own revenues

The 1960s:
A Time of Significant Growth for MCH Programs
 During Kennedy administration, there was an expansion of programs to
support research and services for persons with intellectual and
developmental disabilities
 1962: the National Institute for Child Health and Human Development
 1965: the Social Security Act was amended to create Title XVIII
(Medicare) and Title XIX (Medicaid)
 Head Start and the Special Supplemental Food Program for Women,
Infants, and Children (WIC) established during this period

Head Start
 Launched as a summer program in 1965 to provide an intellectually
stimulating and healthful environment for preschool children in
established centers
 Head Start and the Children’s Bureau were delegated to a newly
created Office of Child Development
 Controversy over the intellectual benefits, but positive impact on health

WIC Program
 A discretionary program created in 1972, provides supplemental food,
nutrition education, and access to medical care for eligible women,
infants, and children
 The key economic risk factor is family income under 185% of the federal
poverty level.
 Nutritional risk is also an eligibility criterion.
 Federal government sets eligibility guidelines and provides funds.

Changes to Foundational MCH Policies
The primary welfare program (Aid to Dependent Children) was replaced by the
Temporary Assistance to Needy Families (TNAF) program in 1996.
The food stamp program (established in 1939) evolved into the Supplemental
Nutritional Assistance Program (SNAP) in 2008.
1981: the Maternal and Child Health Services Block Grant combined seven programs
into a single grant to each state, reducing overall federal funding for MCH programs
The federal Maternal and Child Health Bureau (MCHB) has also evolved in its
organization structure.
Affordable Care Act of 2010

Organizational Structure of the MCH Bureau
<Insert Figure 4-2>

Affordable Care Act of 2010
 Designed to provide access to health insurance for all Americans who
lacked it, through the expansion of Medicaid
 Designed to reform health care delivery and payment, as well as
prioritize health equity
 Provided funding for the Maternal, Infant, and Early Child Home Visiting
(MIECHV) Program
 Provides home visiting services to disadvantaged women and their
families

Equity in MCH History
 African American and Native American mothers, children,
and families have often been overlooked even though they
bear a significant burden of preventable illness and death.
 Social legislation enacted during the civil rights movement
did not focus on reducing disparities in MCH outcomes.
 Hill-Burton Act of 1946
 Intent was to address health care access in general, rather than
identified disparities
 Almost all leadership roles in the MCH workforce were filled
by health professionals of non-Hispanic White origin until the
1980s.

Defining Health Equity

The Political Determinants Of Health
 Create the structural conditions and the social drivers that affect all
dynamics involved in health; serve as instigators of the social
determinants
 The U.S. has a long history of utilizing policy, voting, and governance to
exacerbate disparities.
 It is important to never lose sight of the fact that the political
determinants of health are neutral on their face.
 Leveraging the political determinants of health was the driving force
behind the Affordable Care Act during the Barack Obama
administration.

Chapter 4 Conclusion
The history of MCH
programs and the
policies that
produced them
should be studied
by MCH
professionals and
never be forgotten.
The political
determinants of
health operate at
all levels of
government and
society.
Understanding the
history of policies,
the delivery of
health care, and
their impacts on
communities will
aid MCH.

Week 1 Assignments
Introduction on Discussion
Board
Introduction to Course Quiz
Quiz on Chapters 1 & 4

PBH 805 Week 1 Slides

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