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.

Editor’s note: This past December, the Disruptive Women in Health Care blog launched a series on The Value of Health: Creating Economic Security in the Developing World. In addition to Disruptive Women’s own pool of experts, a number of guests were invited to post on this critically important topic. We invite you to download the ebook or read the original posts.

By Lois Privor-Dumm. It’s really simple.  8.8 million children die every year.  Not here in the US, but in developing countries where they don’t have access to the same care that we do here.  How much of our global health budget goes to address these basic needs?  Less than $1 of every $10.

Children are the future of every country.  Providing them with basic care to ensure they survive until their fifth birthday doesn’t seem to be that much to ask.  And, it’s a good investment.  Simple antibiotics or oral rehydration solutions along with the basic vaccines that children receive in the US every year are available at a cost that is around many people’s co-pay for a single prescription.

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First Lady Michelle Obama recently launched a nationwide campaign to lower childhood obesity, citing that one-third of U.S. children are overweight. NHMA is proud to be invited to partner with the First Lady and the White House in this effort.

The Let’s Move campaign will combat childhood obesity by focusing on four main strategies: helping parents make health family choices, providing healthier food options in schools, promoting physical activity and ensuring that low-income urban and rural areas have access to healthy and affordable food.

One in four Latino youth is overweight, and the result has been an alarming increase in Type 2 diabetes and high blood pressure among children. The causes are numerous and range from a lack of supermarkets in Hispanic neighborhoods to disparities in access to health services. But regardless of the barriers, this growing trend must end.

The mission of Let’s Move is to solve the childhood obesity epidemic within a generation. That’s an ambitious goal, and one that is going to require cooperation between governments, organizations, companies, schools and families at every level. NHMA is committed to doing our part to fight childhood obesity and will be working with the White House and our other partners to educate Latino communities on healthy lifestyles for children – everything from learning how to make smart grocery purchases to finding safe outdoor options for physical activity.

I’d love to hear your ideas for lowering childhood obesity too. What healthy lifestyle measures have worked in your family or community? Let me know!

Kids learn best when they are having fun.  This should come as no surprise to anyone.

When I go into schools with my new program: “Creative Core Curriculum”^TM and we learn through story and song, writing and rapping, music and movement – the kids have no clue that I am just following their curriculum, with a little creative spin.  Why?  Because, unfortunately, students are don’t equate fun and learning.

Time to shift that outdated paradigm. In today’s world, children are experiential learners.  They learn by doing, creating, moving — diving into topics and exploring them, firsthand.  That’s why the worksheet mentality of the 1950’s just doesn’t make sense anymore (if it ever did). And, yet when our school system and government needed to “teach” our children the life or death lesson of staying healthy through flu season, they sent home a one-page flyer with the information.  Handing them a piece of paper and assuming they wouldn’t ball it up, or create a paper airplane or fortuneteller is wishful thinking, at best.

Why not have a little skit at school with one kid sneezing in another’s face and the child that got sneezed on gets just as sick as “Sneezy”? Or what about creating a game on a website where children could go to play a flu game.  If they do the wrong things, their character would get sick.  If they stay healthy, they advance to harder levels – challenging their understanding of the rules to staying well.

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During this blizzard of 2010, I thought about the difficulties an ambulance would have reaching someone in need on an unplowed street—let alone if the person were significantly obese and hard to transport on even an ordinary day.  Then today I read an astounding Washington Post article that noted “a patient between 400 pounds and 600 pounds is part of every workweek for many crews throughout the [DC metro] region.”  Really? I thought this only happened on occasion in select areas shown on the Discovery Channel.  Apparently, not the case.

Emergency medical crews are making hefty investments (no pun intended) in super-sized, ambulatory equipment.   According to the article, “sales of stretchers designed specifically for very large patients were expected to reach $50 million in 2012, up from $29.6 million in 2004, while sales of specialized lift systems were projected to rise from $75 million to $193 million.”

And, it is interesting that just as healthcare spending is rising at a faster rate than the U.S. economy overall, the rate of morbidly obese patients who are at least 100 pounds overweight is increasing faster than obesity as whole, according to a RAND study.

What is more alarming is that, for the first time ever in U.S. history, children may have a shorter lifespan than their parents, and much of the reason is due to obesity and its related health problems.  More than 23 million children (one third of all children and adolescents in the country) are overweight or obese and at greater risk for Type II diabetes and other chronic, life-threatening health conditions.

So, how can we keep our children from ending up in super-sized stretchers one day?

In a previous post, I discussed environmental factors that hinder our ability as a nation to stay un-obese, so I’ll expand on that with some ideas I’ve heard in the classroom.

One suggested strategy has been a soda or sugar-sweetened beverage tax.

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According to the non-profit organization Vitamin Angels, one in three children across the globe are malnourished. Just think of how much that percentage has increased by the Haitian crisis Indeed, Vitamin Angels has already shipped one million childrens’ multivitamins to Haiti since the earthquake.

A viable and invaluable solution to malnourishment is to provide these children with essential nutrients both here at home and abroad.  According to research, one, high-dose Vitamin A capsule can reduce the risk of mortality among children under age five by 23%. Moreover, it can provide a sufficient dose to boost immunity for as long as six months, at a cost of only $.02 per capsule.

Multivitamins too, can help combat severe vitamin deficiencies and related diseases among the under five set, while also boosting cognitive and physical performance. In fact, according to a UNICEF Global progress report, almost 600,00 deaths from iron and zinc deficiencies could be prevented with proper supplementation coupled with food fortification. Another 18 million lives impaired by iodine deficiency could also be prevented.

These data are dire and the needs great. Supplements aren’t the only answer and better government coordination, food fortification, awareness and education are needed.

When most people think “global,” they don’t think “home.” But in order to be most effective globally, we also need to consider our own and our children’s wellness needs. I’ve been fortunate to become part of an Advisory Board for the Council for Responsible Nutrition Foundation’s Life Supplemented initiative.  Late December 2009, they launched America’s Wellness Campaign, which is a three-tiered program aimed at helping individuals here at home take charge and monitor their health through diet, exercise and supplements. By offering people an opportunity to gauge and monitor the areas in which they need improvement and in turn, providing research-based informational strategies, Life Supplemented aims to help improve the nation’s health.  But the effort extends beyond our borders as well; Life Supplemented has recently teamed up with Vitamin Angels to provide much needed funding for the programs by offering to donate one dollar for every individual who completes a Wellness Scorecard. Pretty simple; improve your own health and help improve others’ at the same time.

In 2009 alone, Vitamin Angels’ efforts reached approximately 11,000,000 infants and children in 40 countries  (including the United States) by providing them with  vital nutrients needed as a foundation for good health.  I’d like to think that we help them exceed this milestone in 2010 and perhaps even reach some of our own.

Perhaps you’ve seen it: the grocery-shopping mom, complaining about a sugar tax, saying it’s hard enough to raise a family in these times.

I saw it, and could not believe it. Was this ad actually claiming that families need sugared sodas to make it through tough times?

It took watching it on line at http://www.nofoodtaxes.com/ads/ several times to see that yes, indeed, that’s what it claimed.

I’ll agree that a soda and other sugared items are a nice occasional treat, but I see no evidence that they’re necessary to keep a family happy – or that there are no alternatives.

I’ve begun talking to kids about what they drink. Here is what I got:

• I used to drink apple juice, now I drink water.
•  I drink water; that’s good for you.
•  I drink milk when I eat and water other times.
•  I used to drink (naming a brand soda) but now I drink water. The (soda) made my feel icky and I did not know how much until I stopped drinking it all the time.

Personally, I’m not a huge fan of plain water. I like a slice of lemon in it.

What about you?

Do you have a favorite alternative to sugared drinks?

Do you have any recipes for the beleaguered Mom trying to keep her family happy in these tough times? Do you have any tricks for weaning a family off sugared drinks?

In the midst of furious showdowns on health care reform at town hall meetings, a moment of peace surfaced in Montana when President Obama drew bipartisan applause after calling a mother heroic.  This mother of two had voiced her concern about the Medicaid program she relied on for her child who has multiple chronic conditions.  The president reassured her and went on to discuss how our disease-care system does not proactively manage chronic conditions.

Children and young adults with chronic medical conditions and disabilities (CMCD) need proactive management now and for their entire lives.  Our health care system fails to serve the young people who need it the most.

Children with CMCD are completely dependent on adults for their health care.  Poor health management negatively affects their growth and development, education, and socialization – and drags the entire family down.  As the mother of a young adult with CMCD and the founder of a non-profit created because of our experiences with poor quality health care, I cannot understand why this population is not a major focus of health care reform.

One path to start on is to build on successful programs to create a comprehensive system of care.  Take a look at the 35% of children with CMCD covered by SCHIP/Medicaid. Medicaid provides a specialized set of comprehensive services known as EPSDT, Early Periodic Screening, Diagnosis, and Treatment Program. The current model of care in favor for chronic conditions is the medical home. First conceptualized by the American Academy of Pediatrics for children with CMCD in the 1960s, the medical home has yet to become the standard of care for children with CMCD in Medicaid.  Pairing EPSDT with the medical home would be a step forward in developing a system of care for children covered by Medicaid.    Another step is to expand EPSDT and medical homes to cover the remaining publicly covered children with CMCD enrolled in SCHIP.

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The call came around 7 p.m. on a languid July evening as I was settling in with a good book and a big glass of iced tea. My teenage daughter was at a sleepover and the Friday evening stretched ahead quiet and uneventful. And then an Arlington County, Virginia social worker was on the other end of the line, gently pressuring me to provide emergency foster care for a seven-year-old boy who had abruptly been removed from his family because of signs of abuse. It was Friday evening, after all, getting late, and the child needed a place to sleep. It was only for the weekend as a more permanent placement was sought, one that could provide the specialized therapeutic care he needed. He was currently at a hospital being evaluated, no one knew if he’d been fed dinner, it was getting late…

When he arrived two hours later, J was excited to meet our cat and explore our house. Of his bedroom, he asked, “Who else sleeps in there?” No one, I replied. It’s just for you. “I’ve never slept alone before,” he said with wonder. He didn’t appear to be tired or scared, even when the social worker beat a hasty retreat after explaining he needed medication but I would have to pick it up myself the next day. The social worker had given him a radio controlled car and he was clearly more interested in assembling and playing with it than with sleeping or talking. A friend of mine came over to get the car working. J was wound up but didn’t talk about the weirdness of the circumstances. He played, he ran around, he picked up the reluctant cat, he marveled at the plethora of cable stations on our TV and the fact that I had a brand new toothbrush for him. I couldn’t get him to sleep until sometime around 1 a.m. and then only by sitting by his bed and repeating soothing words.

We filled Saturday with activities — a visit to the nearby playground, a quick run to Target to pick up clothes for him to wear, a viewing of the loud and hideous Transformers movie, a walk around the neighborhood. It wasn’t until we were finally alone and quiet for dinner at a local restaurant that he looked at me and said, “I want to go home.” We both knew which home he meant. And this is where foster parenting becomes the hardest job I know. I gently explained that he would go home when everyone agreed he would be safe there. His eyes teared up as he stroked the large bruise on the side of his face. “This was an accident,” he said.

By Sunday, he was determined to stay with us if he couldn’t return to his own home. I tried to tell him about the contractor who was arriving to tear up the only guest room in our house — the one he currently occupied — and about the student from Nairobi who arrives in early August to occupy the room until Thanksgiving. “I can sleep on the couch,” he said. We went to a minor league baseball game where he didn’t know a pitch from a run and kept saying he couldn’t read the numbers on the scoreboard. He didn’t understand why everyone stood for the national anthem and why I insisted he join us. And he begged me to let him stay with us. We joined friends at a neighborhood swimming pool and then for a backyard barbecue. Keeping him busy seemed like the best strategy.

But by bedtime Sunday, he was again begging to remain with us. “I’ll be good,” he promised. “I’ll keep my room clean and I’ll feed the cat.” It was heartbreaking. Eventually he began asking where he would go when he left us, something I couldn’t answer. I promised he would go to nice people, but really what kind of promises could I make to a boy who just wanted to go home? He wanted to be with the people he loved, even if they hurt him. He wanted to wake up in a bedroom shared with others, with a TV that doesn’t always work, in a home where he says a machete is kept for “protection.” The bruises on his face will fade. He’ll forget about his long weekend in our home. For this little boy, despite the lousy hand dealt him, there is and will always be no place like home.

This piece is cross-posted at The Huffington Post.

As our nation brainstorms the best way to reduce the millions of uninsured, we need to focus on the largest and fastest growing portion: 13.7 million young adults:

• 18-29 year olds make up just 17% of the population but 30% of the uninsured, and
• Entering adulthood triggers a serious risk of becoming uninsured as the rate almost triples from 11% to 29%.

As we look at this age group, it is critical to hone in on young adults with chronic medical conditions & disabilities (CMCD) since they cannot afford a single day without coverage.

Aware of the need to continue care, they, or their parents, are inclined to seek coverage. However, young adults with CMCD encounter many obstacles:

• Only 54% are able to attend college or work, usual prerequisites for insurance;
• Relying on individual coverage is risky because of pre-existing conditions and inadequate benefits;
• Young adults with CMCD are three times more likely than their healthy peers to earn under $15,000 a year and live in poverty, another risk factor for becoming uninsured; and
• A vicious cycle ensues when 54% of young adults with CMCD lack a usual source of care and two-thirds delay or miss care because of costs. Foregoing treatment hinders their ability to maintain the health status needed to go to college or work.

How can we assess the significance of a specific population without appropriate studies?
We had a logical reason for not studying this population – until now. In the past, children with CMCD did not survive to adulthood. Thanks to advances in medicine paralleled by a rise in chronic conditions, we now face a tidal wave of emerging adults with CMCD:

• Every year, over half a million children with CMCD enter adulthood, and
• Extrapolation of child health data reveals 4.5 million young adults aged 18-24 years have CMCD.

Unprepared, we are unable to build on the systems of support designed for them as children. These young adults with CMCD who struggled as children to be like everyone else and gain independence from their parents fall off a cliff, so to speak, when they turn 19. They age out of support systems, they age out of insurance, but what they are unable to age out of is dependence on their parents.

Even if young adults with CMCD are fortunate to have coverage, they experience another major problem with access: the dearth of adult physicians available, willing, and able to care for their childhood onset conditions. Too often, these young adults remain under the care of their pediatric providers, sometimes forever.

We need to ensure young adults with CMCD are included in health care discussions. What role do they play in issues regarding the uninsured, health care costs and resource utilization, poverty, and social welfare? What impact do they have on the workforce and its productivity? Can we afford to keep them invisible?

Beyond numbers, a moral imperative also presents itself. As a nation committed to promising our children good health and education, are we extending this promise to all of our children and young adults? Shouldn’t our children with CMCD have a fair shot of growing up into educated young adults with the best possible health?

As we embark on one of the greatest changes our health care system has ever seen, will we do the right thing and embrace children & young adults with chronic medical conditions & disabilities – the population that has the most to gain from improved access and quality health care over an entire life’s span – and put their needs at the center of the discussion?