By Ruth Lubic. The release this week of Amnesty International’s new report, Deadly Delivery: The Maternal Health Care Crisis in the USA,  highlights the poor outcomes of African American women in particular. 

When I set up The Developing Families Center in Washington DC’s Ward 5, it was with the goal of addressing this very issue, particularly from the point of view of infant mortality.

At a rate of 12.22 per thousand live births, the District has the highest infant mortality of any of the states, with only Mississippi, at 10.74 also experiencing a double digit rate.

I’ve grown weary of the public continuing to rate nurses as the most trusted profession (annual Gallup polls every year of this decade except 2001 when fire fighters understandably led the ratings), only to have leaders in health care agree but ignore us.

The Robert Wood Johnson Foundation released a Gallup poll that surveyed over 1500 opinion leaders in health care, including government officials, health care and insurance executives, and university faculty.

The survey found that:

• Doctors (54%) and nurses (42%) are the information sources about health and healthcare in whom opinion leaders have a great deal of confidence.
• Government (75%) and health insurance executives (56%) are viewed as most likely to exert a great deal of influence on health reform, compared to only 37% for doctors and 14% for nurses.
• 51% say nurses have a great deal of influence in reducing medical errors and improving patient safety
• 18% say nurses exert a great deal of influence on increasing access to care, including primary care.
• 39% say nurses will not have much influence on reforming health care over the next 5 to 10 years, compared with 10% of MDs.

Nothing new here to most nurses. We continue to have to be vigilant about whether nurses are included at decision-making and advisory tables, as speakers at national and regional conferences on quality and safety in health care, and on boards of health-related organizations. The next time you’re in a meeting on health care, look around the table and ask whether nurses are included — and not just a token RN. If they aren’t, ask why not and call for RNs to be appointed. Organizations and the nation are missing out if we don’t all change our expectations about who is at the table.

As we all know, children can’t speak for themselves, but if they could, they’d probably point out the obvious: they need more attention.    There have been some great strides over the years and some compelling examples such as those shown in Bill and Melinda Gates’ Living Proof project and the Measles Initiative.  In the recent installment of Raj Shah, the new USAID Administrator, he touts the progress that his new agency has already made in preventing unnecessary deaths.  He is pragmatic and encouraging as he also says that much more should be done.  To save more lives, we need to make sure the US investments are there. Look at the numbers: More is needed to ensure two leading childhood killers are addressed.  More global funding is needed for new vaccines such as pneumococcal and rotavirus vaccines offered through the GAVI Alliance to prevent much of the disease in these at risk children.  Vaccines can’t do the whole job, so inexpensive treatments such as antibiotics or oral rehydration therapy are also needed along with training of health workers to prescribe or education of parents to seek care – certainly not impossible, but requiring some effort and focus.

Sources: US Global Health and Child Survival Budget, 2009 and UNICEF, State of the World’s Children, 2008

Now is the time to speak up and insure that the right investments will be made.  Please Call to USAID to take action on pneumonia and diarrhea.  You can submit a letter to Dr. Shah both welcoming him and asking for him to speak up for children.  Visit: http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea.

Why is it that you can buy a Coke or mobile phone refill cards in a remote African village but in these same villages, you cannot consistently get basic lifesaving medicines? Why are pneumonia and diarrhea still the biggest infectious disease threats for children when effective and affordable solutions to prevent and treat a large portion of deaths already exist?  What is the contribution of vaccines in creating a more productive society and wealth of nations?  These are just a few of the questions asked at the new International Vaccine Access Center (IVAC), launching on Monday December 7th at the Johns Hopkins Bloomberg School of Public Health. IVAC seeks to translate evidence into policy, and policy into access to life-saving vaccines for all children.

Indeed, access is a hot topic. When I told several people about IVAC, the most common reaction is great – we really need this! There are many groups working in research or policy or in program implementation, but the bridge to ensuring access remains a challenge. On the surface, solutions can seem simple – show the need, build awareness and provide the solution at a low enough price and it will reach those that need it most.  Some try to help by providing vaccines, medicines or supplies, but that often creates more challenges than benefit because of concerns about sustainability.    Even with country level policies and commitments from donors to fund new interventions, implementation can see many stumbling blocks with uptake not reaching forecasted levels.  Sometimes it is because the health system is not strong enough.  Should that be a reason for delay of a life-saving intervention if the delivery platform is imperfect?  If the implementers are not entirely convinced, it is a strong barrier and one with the potential to impact manufacturers’ willingness to supply or donors’ willingness to fund if countries can’t show that they are appropriately using resources.  This must be played against the potential to save lives, however.

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As a member of the Susan G. Komen for the Cure Advocacy Alliance Board and a breast cancer survivor, I welcome readers of Disruptive Women in Health Care to read the statement below that was released by Komen as a result of the U.S. Preventive Services Task Force “new breast cancer guidelines.” In addition, please visit the Komen website: www.komenadvocacy.org and take a stand and action by signing the petition and help ensure that all women have access to this lifesaving screening.

Susan G. Komen for the Cure® Recommends No Impediments to Breast Cancer Screening

Until Science Improves, Current Screening Recommendations Should Remain, World’s Leading Breast Cancer Organization Reports

Nov. 16, 2009 – Susan G. Komen for the Cure®, the world’s leading breast cancer advocacy organization, has carefully reviewed the data and new recommendations from the U.S. Preventive Services Task Force (USPSTF) concerning mammography screening. Komen for the Cure issued the following statement today from Eric P. Winer, M.D., chief scientific advisor and chair of Komen’s Scientific Advisory Board.

“Susan G. Komen for the Cure wants to eliminate any impediments to regular mammography screening for women age 40 and older. While there is no question that mammograms save lives for women over 50 and women 40–49, there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we would not want to see a change in policy for screening mammography at this time. Komen’s current screening guidelines can be found at www.komen.org and would not be changed without serious consideration.

Our real focus, however, should be on the fact that one-third of the women who qualify for screening under today’s guidelines are not being screened due to lack of access, education or awareness. That issue needsfocus and attention: if we can make progress with screening in vulnerable populations, we could makemore progress in the fight against breast cancer.

Mammography is not perfect, but is still our best tool for early detection and successful treatment of this disease. New screening approaches and more individualized recommendations for breast cancer screening are urgently needed. Susan G. Komen for the Cure is currently funding research initiatives designed to improve screening, and we believe that it is imperative that this research move forward rapidly. Komen also provides funding for more than 1,900 education, awareness and screening programs.

We encourage women to be aware of their breast health, understand their risks, and continue to follow existing recommendations for routine screenings including mammography beginning at age 40.”

This is one of my favorite photographs from a recent trip to Nigeria. I love how happy this little girl is to be with her big brother, as he looks at her with that I-know-so-much-more-than-you attitude of all older siblings. It’s an interaction that could have taken in Philadelphia, Baltimore or Cleveland, but I took it when I was at the University College Hospital of Ibadan.

I was in West Africa to make a documentary on the impact of new vaccines and pneumonia prevention efforts in developing countries.  After years working at a pharmaceutical company where I was fortunate enough to launch these new vaccines, I realized that something was missing.  I was surprised to learn that the percentage of deaths due to pneumonia was so high (almost 1/5 of all post neonatal deaths).  Ninety-five percent of these deaths occur outside of the US, Europe and other industrialized countries, yet it was in the developed world where we did most of our business.  We often forget about children in the developing world.  We see pictures of desperate, hungry children and rationalize well, if I don’t do this one thing, something else will kill them anyway.  But all you need to do is travel to one of these countries to realize that children are the same all over the world.  You forget that they are still grappling with some of the diseases that have long been out of our minds for children in our country.

Pneumonia? Who would have thought that this is such a large problem for young children?  In fact, it is the illness that leads to the most deaths worldwide – over 2 million young lives lost every year, a child every 15 seconds.   We have access to pneumonia vaccines and antibiotics to treat – child deaths due to pneumonia are relatively rare in US and Europe.  These deaths unfortunately occur all too often in the developing world.

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