Expansion of blood-sample based newborn screening from a handful to more than 29 conditions in almost every state.
Development of universal newborn hearing screening with diagnosis and intervention. This is not a job completely done, but a dramatic change from beginning to end of the decade.
Folic Acid-Preventable Neural Tube Defects
Worldwide progress occurred in preventing anencephaly and spina bifida through fortification of food sources with folic acid.
More work remains – experts estimate that 20% are now prevented. Experts differ as to whether additional cases in the US could be prevented with increased levels of folic acid fortification.
Mental Health in MCH
The decade brought greater recognition of mental health issues in children. Even more dramatic was the emerging awareness of the importance of maternal mental health, especially perinatal mood disorders and postpartum depression.
Child Lead Exposure
The decade saw continued reduction in the proportion of infants and young children with elevated blood lead levels, and intervention programs became more focused through the use of enhanced databases and geographic information systems analyses.
MCH epidemiology was an established field in 2001, but this decade saw it placed firmly in the pantheon of public health, with dedicated MCHEPI positions in almost every state. The annual MCH Epidemiology Conference grew to 500 annual participants, and the annual MCH Epidemiology awards developed considerable prestige.
The decade saw the development or implementation of numerous vaccines. Several additions to the required schedule for infants and children have resulted in significant reduction in morbidity (i.e. rotavirus, Hepatitis B), while the pneumococcal vaccine has led to a dramatic decline in invasive pneumococcal infection in young children.
It’s been said that what goes around comes around, and that seems to be true. Although there is increasing recognition of the social determinants of preterm birth, at least, 30-40 years after first being introduced we remembered that progesterone is useful for prevention of some preterm births.
Now if we could only figure out how to offer it as a quality product for a reasonable price . . .
The decade saw an emerging focus on quality improvement in obstetrics and newborn care, spurred initially by the Vermont-Oxford Network, then by the Joint Commission and ACOG, and more recently AHRQ’s initiation of safety and quality indicators for pregnant women.
There is much more work to be done, including a focus on quality in prenatal care.
Universal Access to Prenatal Care?
Okay, we didn’t achieve this, but we did get expanded access to health insurance, especially for infants and children and to some extent for women in pregnancy. We also saw the emergence of new models of care such as Centering Pregnancy. And the Affordable Care Act was passed in 2010, though few of its provisions had been implemented by the end of that year.
Beginning in mid-decade, putting preconception and interconception care on the map, and maternal health in general into the framework of well-woman care.
There is still a great deal of work to do, but a promising start occurred in the past decade.
But Just Like Women’s Work, MCH is Never Done…Here’s a partial list of remaining challenges:
- Advancing maternal age
- Limited progress on increasing pregnancy intervals
- Half of all pregnancies are still unplanned
- Few women know about or receive preconception/interconception care
- We’ve made very slow progress on Baby Friendly Hospitals, almost none on the Mother Friendly Hospital initiative
- Data integration is occurring, but the pace is glacial (both in clinical and public health settings)
- Federal and state budget cuts are leading to dismantling of some publicly funded programs
- Malpractice and defensive medicine practices
- Regionalized systems of care losing ground
- High-risk infant follow-up no longer occurs except for lucky infants who enter EI immediately or are enrolled clinical trials
- Public apprehensiveness to child vaccines
- And many more . . .
By Russell Kirby, Ph.D., M.S., Professor, University of South Florida, College of Public Health, Community and Family Health
Dr. Kirby also serves on the UIC MCHP National Retreat Planning Committee.
Inspired by “Ten Great Public Health Achievements—United States, 2001-2010”, MMWR 2011, May 11;60,19: 619-623.
With apologies to David Letterman, and thanks for editorial assistance to Elizabeth Kirby and for their insights to the following contributors:
- Godfrey Oakley, Emory University
- Judith Vessey, Boston College
- Kate Kvale, Wisconsin Department of Health Services
- Mark Walker, University of Ottawa
- Arden Handler, University of Illinois-Chicago
- Lisa Korst, University of Southern California
Click here if you would like to read some of Dr. Kirby’s other Top 10 Lists.