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Public Health leaders know that location matters and has a significant impact on an individual's health—and initiatives that have the highest impact focus on localized conditions and speak directly to community needs. Nicole Alexander-Scott (director, Rhode Island Department of Health) and Katie Lamansky (health program manager, Idaho Department of Health and Welfare) discuss why place-based interventions are a key strategy for health agencies to advance health equity. We examine the Health Equity Zone model and share what states can borrow from it to reimagine how they engage with communities.
Mental health affects how individuals understand, respond and interact with the world around them and evidence suggests that addressing it is key to a healthy mother-child relationship. Maternal mental health can impact how mothers engage with their children, which has a lasting and profound influence on a child's development and overall health (1). During pregnancy, maternal stress can decrease the placenta's capacity and ability to protect the baby from elevated stress hormones (1). Exposure to these elevated stress hormones in utero has the potential to cause issues throughout the lifecourse,including difficulties in learning and developing healthy relationships (2). Parents or caregivers who experience untreated depression, anxiety, and/or significant stress may be less likely to engage with their children in positive and interactive ways which is vital in promoting healthy brain development, behavioral functioning and ensuring protective relationships. The mental health of those caring for the youngest members of a family (parents and caregivers) needs to be a priority to ensure healthy families now and across the generations. In Michigan, on average, about 40,000 mothers per year are affected by perinatal anxiety and/or depression. Effective individualized tools and interventions that can help ensure parents and infants have a healthy start exist but most women with a perinatal mood disorder go untreated (17, 16). Combining interventions like early and frequent screening, relationships with trained professionals through prevention-based activities like home visiting, or interventions such as cognitive-behavioral therapy (CBT) can provide mothers with tools to cope, and the therapy needed, to provide nurturing environments for their children. In this brief we explore measures to help address mental health for the mother or caregiver and infant dyad while highlighting some of the solutions currently in place that help mothers, infants and families start and stay on a healthy track.
While the U.S. spends approximately $111 billion per year on perinatal (prenatal, birth and newborn) care, maternal and infant health outcomes are among the worst of any high-income nation and racial disparities continue. Efforts to improve outcomes generally focus on coverage, health care delivery systems and payments. Many innovations and ideas have emerged in recent years. This brief will help stakeholders concerned with maternal and infant health in Michigan understand the strengths and weaknesses of payment reforms for maternity or perinatal care, costs, and outcomes, including their impact on equity. The role of Medicaid and the beneficiaries it covers are emphasized, including Michigan data and examples from other states' efforts. This work is based on information from published studies, efforts of federal and state agencies, and national expert recommendations. Maternal Child Health (MCH) leaders inside and outside of government can use this information to support the design and development of any proposed perinatal payment reforms.
A diverse maternal and child health workplace is one that has employees of different ages, genders, racial and ethnic backgrounds, sexual orientation, socioeconomic status, and personality bringing a multitude of lived experiences to institutions and organizations. The benefits of having a diverse workforce are far-reaching and include improvements to innovation, increased productivity, increased team communication and engagement (1-3). Overall, the U.S. population continues to become more diverse, and, in some states, there is a majority-minority population. This occurs when 50% or more of the population is composed of racial and ethnic minorities (3). While the population has continued to diversify, the healthcare workforce has not kept pace. These continued changes in the racial and ethnic make-up of the general population makes it likely that health professionals will engage with patients that have different cultural backgrounds from their own. The lack of diversity in the workforce across all health professions has revealed a national public health issue that needs attention. Initiatives and sustainable strategies for all local, state and federal levels and within public and private sectors will help better ensure that the healthcare workforce meets the needs of the diverse patient population and reflects the racial and ethnic diversity across the nation and in Michigan.
Perinatal healthcare is the care a woman receives before, during and after delivery. Prenatal care is the widely used routine source of preventive care, pregnancy education, and support for expectant families in the United States, but the delivery of this care has remained largely unchanged since the 1930s. As a result, standard prenatal care delivery presents barriers to younger individuals, people of color, those living in poverty, individuals where English is their second language, and other marginalized groups (22). Currently, prenatal care focuses on medical interventions such as prenatal screening and managing chronic conditions, without consistent focus on mental health and social determinants of health. Women are generally recommended identical care regardless of risk or their individualized needs and preferences. This one size fits all model has failed to prevent adverse health outcomes such as preterm birth and maternal morbidity, particularly among racial-ethnic minority, low-income and rural women.
The list of W.K. Kellogg Foundation grants approved in December 2020.
The list of W.K. Kellogg Foundation grants approved in November 2020.
The list of W.K. Kellogg Foundation grants approved in October 2020.
In September of 2019, 70 people from across the U.S. came together to learn from each other about the work of coordinating state level food system plans. The initial intention for this gathering was to surface promising practices of developing and implementing food systems plans—meaning guiding documents, such as the Michigan Good Food Charter or the Vermont Farm to Plate Strategic Plan, that are developed with public input, set out a vision for the food system of a particular place, and identify high priority policies and strategies. Over the course of planning and hosting the three day convening, it became clear that a focus exclusively on technical practices was neither practical nor what participants were most interested in. Instead, it was the complex and adaptive process of bringing people together and the way in which we shared our time that most resonated with many participants. To share more about the design and experience of the gathering, we—the facilitation team—first decided to write a reflection shortly after the event. Much has happened in the months that have followed. The urgency of our present moment in time can no longer be downplayed. The tumultuous events of 2020 have brought the long-standing inequities of our society into stark relief. Six months ago, we were prepared to inspire you to bring values and a focus on equity into your food systems work. Now, we are sending out a call to deep care and accountability to our fellow food system practitioners. If you are not actively working to counter white supremacy culture and structural racism, then your food systems work is in vain and you are reinforcing the status quo.
The list of W.K. Kellogg Foundation grants approved in September 2020.
The list of W.K. Kellogg Foundation grants approved in August 2020.
Some of the Kellogg Foundation's journey in health programming is illustrated in this Health Legacy essay. Additionally, three key international and national gatherings on the social determinants of health brought together health experts and community-based leaders to share models and lessons across gender, age, cultures, populations, geographies and institutions.These proceedings highlight a growing understanding of the interdependencies that shape community health:Salzburg Seminar: The Social & Economic Determinants of the Public's Health, April 2000Salzburg Seminar: The Social & Economic Determinants of the Public's Health, October 2001Racial and Ethnic Health Disparities: Schools of Public Health Respond as Engaged Institutions, WKKF's 75th Anniversary Seminar on Public Health, April 2005As COVID-19 crossed the globe and led to closed international borders and stay-at-home orders, it has engendered a public health crisis unlike any other in generations. The pandemic highlights what has long been present yet invisible to many. Now the call for action to address health inequities is gaining traction in ever-widening circles. Given our longtime work with communities, experiences in emergency grantmaking and partnership with researchers and advocates to address health and social inequities, we offer the following framework and lessons from our journey.
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