Integrating the Life Course Perspective into a Local Maternal and Child Health Program
- 922 Downloads
For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs.
KeywordsLife Course Perspective Birth outcomes Social determinants of health Health equity Local health department
The authors want to thank the following individuals for their insights, suggestions, and critical review of this article: Wendel Brunner, MD, PhD; Debbie Casanova, MPH; Dawn Dailey, RN, PhD; Chuck McKetney, PhD, MPH; Michael C. Lu, MD, MPH; Milton Kotelchuck, PhD, MPH; the Contra Costa Health Services Writers Group, Meredith Minkler, DrPH, MPH, and Amy Fine, MPH. Funding for the writing of this article was provided by the Public Health Institute’s Adeline Hackett Innovation Award; Contra Costa Health Services; and California Department of Public Health, Maternal, Child and Adolescent Health Program.
- 5.Kogan, M. D., Alexander, G. R., Kotelchuck, M., & Nagey, D. A. (1994). Relation of the content of prenatal care to the risk of low birth weight: Maternal reports of health behavior advice and initial prenatal care procedures. JAMA: The Journal of the American Medical Association, 271, 1340–1345.CrossRefGoogle Scholar
- 7.Institute of Medicine. (1993). Access to health care in America. Washington DC: National Academy Press.Google Scholar
- 8.Kaiser Family Foundation. (2007). Medicaid’s role for women. Menlo Park (CA): KFF.Google Scholar
- 9.National Center for Health Statistics. (2010). Health, United States, 2009: With special feature on medical technology. Hyattsville (MD): NCHS.Google Scholar
- 10.Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Births: Preliminary data for 2008. National Vital Statistics System, 58(16), 1–17.Google Scholar
- 11.Heron, M. P. (2010). Deaths: Leading causes for 2006. National Vital Statistics System, 58(14), 1–100.Google Scholar
- 13.National Partnership for Action to End Health Disparities [Internet]. (2010). Rockville (MD): Office of Minority Health, US Department of Health and Human Services; c2010. The National Plan for Action, Draft as of February 17, 2010: Changing outcomes—achieving health equity, [cited 2010 April 12], [about 2 screens]. Available from http://minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=1&lvlID=31.
- 14.Robert Wood Johnson Foundation. (2008). Overcoming obstacles to health. Princeton (NJ): The Foundation.Google Scholar
- 15.Adler, N. E., Stewart, J., et al. (2007). Reaching for a healthier life: Facts on socioeconomic status and health in the US. San Francisco: The John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health.Google Scholar
- 16.National Partnership for Action to End Health Disparities [Internet]. (2008). Rockville (MD): Office of Minority Health, US Department of Health and Human Services; c2008. A strategic framework for improving racial/ethnic minority health and eliminating racial/ethnic health disparities, [cited 2010 April 12]; [about 26 screens]. Available from: http://minorityhealth.hhs.gov/npa/images/78/PrintFramework.html.
- 35.Kotelchuck, M., & Fine, A. (2010). Rethinking MCH: The life course model as an organizing framework. Washington (DC): Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.Google Scholar
- 36.Lu, M. C., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the black-white gap in birth outcomes: A life-course approach. Ethnicity and Disease, 20(1 Suppl 2), 62–76.Google Scholar
- 37.California Department of Health Services Birth Statistical Master Files 2000–2007. Prepared by Contra Costa Health Services—Community Health Assessment, Planning and Evaluation (CHAPE).Google Scholar
- 39.Pies, C. A., & Parthasarathy, P. (2007). Photovoice: Giving local health departments a new perspective on community health issues. Martinez (CA): Contra Costa Health Services, Public Health Division.Google Scholar
- 40.Rattray, T., Brunner, W., & Freestone, J. (2002). The new spectrum of prevention: A model for public health practice. Martinez (CA): Contra Costa Health Services, Public Health Division.Google Scholar
- 41.Family, Maternal and Child Health Programs’ Life Course Initiative, Overview [Internet]. Martinez: Contra Costa Health Services; c2010 [cited 2010 Sept 7]. Available from: http://cchealth.org/groups/lifecourse/pdf/lci_fact_sheet.pdf.
- 42.Family, Maternal and Child Health Programs’ Life Course Initiative, 12-Point Plan to Close the Black-White Gap in Birth Outcomes [Internet]. Martinez: Contra Costa Health Services; c2008 [cited 2010 Sept 7]. Available from: http://cchealth.org/groups/lifecourse/pdf/12_point_plan_fact_sheet.pdf.
- 43.Family, Maternal and Child Health Programs’ Life Course Initiative, Building Economic Security Today [Internet]. Martinez: Contra Costa Health Services; c2010 [cited 2010 Sept 7]. Available from: http://cchealth.org/groups/lifecourse/pdf/best_fact_sheet.pdf.
- 44.Unnatural Causes [Internet]. San Francisco: California Newsreel; c2008 [cited 2010 May 26]. Available from: http://www.unnaturalcauses.org/.
- 49.Danes, S. M. (1994). Parental perception of children’s financial socialization. Financial Counseling and Planning, 5, 127–146.Google Scholar