Advertisement

Maternal and Child Health Journal

, Volume 19, Issue 11, pp 2329–2335 | Cite as

Focusing “upstream” to Address Maternal and Child Health Inequities: Two Local Health Departments in Washington State Make the Transition

  • Marni Storey-Kuyl
  • Betty BekemeierEmail author
  • Elaine Conley
Notes from the Field

Abstract

Purpose

Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Clark County Public Health, are transitioning their Maternal and Child Health (MCH) services from an individual-focused (mother–child dyads/family) home visiting model to a population-focused, place-based model. This paper describes the innovative process and strategies these LHDs used in applying existing MCH funding in new ways.

Description

The pilot communities selected in both jurisdictions for the initial transition were communities experiencing disproportionately high rates of maternal smoking, child abuse and neglect, births to single women, and low-income women on Medicaid. Available evidence suggested that the reach and effectiveness of existing, individual-level MCH approaches were not adequately improving these indicators in these communities.

Assessment

Using a population-based approach that addressed policy factors as well as social, organizational, and behavioral change; both counties developed neighborhood level initiatives directed at the root causes of health inequities. The approach included developing meaningful community partnerships, capacity building, and creation of a shared vision for community change. Both LHDs and their partners engaged county-wide groups in neighborhood selection, jointly established priority intervention areas, and actively engaged communities focused on reducing specific health inequities.

Conclusion

With existing funding resources, the two county LHDs dramatically changed their practice to better address underlying conditions that threaten MCH. Early successes from these pilots have contributed to important local and state system-level changes in MCH programming as well as effective community-level efforts to reduce health inequities.

Keywords

Public health MCH Population-based Health departments Life course perspective 

Notes

Acknowledgments

The development of this paper was funded in part by HRSA, under the Nurse Education, Practice and Retention Program, Grant No. D11HP14605.

References

  1. 1.
    Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Suppl 3), S163–S175.CrossRefPubMedGoogle Scholar
  2. 2.
    Adler, N., Stewart, J., Cohen, S., Cullen, M., Roux, A. D., Dow, W., Evans, G. A., Kawachi, I., Marmot, M., Matthews, K., McEwen, B., Schwartz, J., Seeman, T., & Williams, D. (2007). Reaching for a healthier life: Facts on socioeconomic status and health in the U.S. http://www.macses.ucsf.edu.
  3. 3.
    Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378.CrossRefPubMedGoogle Scholar
  4. 4.
    Galobardes, B., Lynch, J. W., & Davey Smith, G. (2004). Childhood socioeconomic circumstances and cause-specific mortality in adulthood: Systematic review and interpretation. Epidemiologic Reviews, 26, 7–21.CrossRefPubMedGoogle Scholar
  5. 5.
    PolicyLink. (2011). Why place and race matters: Impacting health through a focus on race and place. http://www.racialequitytools.org/resourcefiles/WHY%20PLACE%20AND%20RACE%20MATTER.pdf.
  6. 6.
    Hofrichter, R., & Bhatia, R. (Eds.). (2010). Tackling health inequities through public health practice: Theory to action (2nd ed.). New York: Oxford University Press.Google Scholar
  7. 7.
    National Association of County & City Health Officials (NACCHO). (2012). Local health department job losses and program cuts: Findings from January 2012 survey. http://www.naccho.org/topics/infrastructure/lhdbudget/upload/Overview-Report-Final-Revised.pdf.
  8. 8.
    Cawthon, L. (2006). First steps database: The first steps program: 1989–2004. Fact sheet number 9.82, Olympia, Washington. http://www.dshs.wa.gov/pdf/ms/rda/research/9/82.pdf.
  9. 9.
    Lau, C., & Rogers, J. M. (2004). Embryonic and fetal programming of physiological disorders in adulthood. Birth Defects Research Part C: Embryo Today, 72(4), 300–312.CrossRefGoogle Scholar
  10. 10.
    Frohlich, K. L. (2014). Commentary: What is a population-based intervention? Returning to Geoffrey Rose. International Journal of Epidemiology, 43(4), 1292–1293.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Bekemeier, B., Yang, Y., Dunbar, M., Pantazis, A., & Grembowski, D. (2014). Targeted health department expenditures benefit birth outcomes at the county level. American Journal of Preventive Medicine, 46(6), 569–577.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Bekemeier, B., Dunbar, M., Bryan, B., & Morris, M. E. (2012). Local health departments and specific maternal and child health expenditures: Relationships between spending and need. Journal of Public Health Management and Practice, 18(6), 615–622.CrossRefPubMedGoogle Scholar
  13. 13.
    National Association of County & City Health Officials (NACCHO). (2010). Trends in local health department finances, workforce, and activities: Findings from the 2005 and 2008 National Profile of Local Health Departments Studies. http://www.naccho.org/topics/infrastructure/profile/upload/NACCHO_TrendsReport_Final.pdf.
  14. 14.
    McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.CrossRefPubMedGoogle Scholar
  15. 15.
    U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau. (2010). Rethinking MCH: The life course model as an organizing framework: Concept paper. Version 1.1. http://mchb.hrsa.gov/lifecourse/rethinkingmchlifecourse.pdf.
  16. 16.
  17. 17.
    Spokane Regional Health District. (2009). SRHD 2009-2014 Strategic Plan. http://www.doh.wa.gov/Portals/1/Documents/1200/EP5-3-2spokane.pdf.
  18. 18.
    National Association of County & City Health Officials (NACCHO). (2015). Model practice database. http://www.naccho.org/topics/modelpractices/search.cfm.
  19. 19.
    Reyes, D., Bekemeier, B., & Issel, M. (2014). Perceived leadership qualities of public health nursing leaders: Challenges to consider in advancing the field. Public Health Nursing, 31(4), 344–353.CrossRefPubMedGoogle Scholar
  20. 20.
    Benner, P. (1984). From novice to expert excellence and power in clinical nursing practice. American Journal of Nursing, 84(12), 1479.CrossRefGoogle Scholar
  21. 21.
    Kendrick, S., Inman, K., & Hoskins, S. (2010). Socio-ecological model of health (unpublished graphic illustration). Vancouver, WA: Clark County Public Health.Google Scholar
  22. 22.
    Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Marni Storey-Kuyl
    • 1
  • Betty Bekemeier
    • 2
    Email author
  • Elaine Conley
    • 3
  1. 1.Washington County Health and Human ServicesHillsboroUSA
  2. 2.Psychosocial and Community HealthUniversity of Washington School of NursingSeattleUSA
  3. 3.Spokane Regional Health DistrictSpokaneUSA

Personalised recommendations