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Department of Maternal and Child Health

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Title: Department of Maternal and Child Health


1
Philosophy of Maternal and Child Health
  • Greg R. Alexander, MPH, ScD Donna Petersen, MHS,
    ScD
  • MaryAnn Pass, MD, MPH
  • Cathy Chadwick, MPH Martha Slay, MPH
  • Part XII of the MCH Milestones Series
  • The MCH Leadership Skills Training Institute
  • Department of Maternal and Child Health
  • University of Alabama at Birmingham

2
Acknowledgement
  • Supported by funding from the Maternal and Child
    Health Bureau

3
Background
  • Emerging from the child labor abolition and
    progressive reform movements, MCH in the United
    States has undergone a fitful evolution over the
    last 100 years.
  • The mission of the Childrens Bureau (1912)
    provided a fundamental direction for MCH to
    investigate and report upon matters pertaining to
    the welfare of children and child life among all
    classes of people…

4
Background
  • But, the course of MCH throughout the 1900s
    took myriad directions and was notably influenced
    by the major social events of the times,
    including the Depression, World War II, and, more
    currently, the changing political agendas of the
    last 30 years.
  • While adapting to meet the needs and crises of
    the moment, the fundamental purpose and role of
    MCH was open to debate and remains so today.

5
Background
  • As policy discussions now focus on the future
    of public health in a climate of concern about
    bio-terrorism, there continues to be disagreement
    about MCHs purpose, roles and even its name.
  • Moreover, general consensus has yet to emerge
    about what an essential underpinning philosophy
    for MCH would entail.

6
Background
  • The remaining presentation contains 3 major
    sections
  • Part 1
  • First, we pose a series of core questions
    about MCH that have arisen over time and continue
    to be debated by MCH professionals.
  • These questions and some special issues of
    current concern are posed without answers and put
    forth to stimulate reflection and discussion.

7
Background
  • Part 2
  • Next, we provide historical quotes from
    previous MCH practitioners and thoughts about MCH
    that have been expressed by panels of MCH
    professionals brought together in the past to
    grapple with these persisting questions about
    MCH.
  • These quotes are presented to provide insight
    into the diversity and similarity of thinking
    about MCH and how opinions have persisted or
    changed.

8
Background
  • Part 3
  • Lastly, we propose a definition of MCH as a
    professional and academic field and then provide
    some statements that reflect our current thinking
    about the purpose, role and philosophy of MCH.
  • Our thoughts about MCH continue to evolve,
    much as the field itself therefore, we offer
    these to engage our colleagues in this search and
    ongoing debate about What is MCH?.

9
What is MCH?
10
What is MCH?
  • Why does and should MCH exist?
  • Is there a basic philosophy or science that
    underlies what MCH is and does?
  • Are there any basic tenets that are fundamental
    to MCH?

11
What is MCH?
  • What are MCHs priorities and basic functions?
  • Are the functions of MCH different from the core
    functions of public health?

12
What is MCH?
  • Is MCH a profession is it an academic
    discipline?
  • Is it a sub-specialty?
  • Or, is it just legislation, programs, policies
    and agencies?

13
What is MCH?
  • How does MCH differ from Pediatrics, Obstetrics
    or other clinical disciplines?
  • How does MCH differ from Womens Health,
    Minority Health, Immigrant Health, or other
    programs focused on special populations?

14
What is MCH?
  • How does MCH differ from Family Health?
  • Is there something unique about MCH that sets it
    apart from other population-specific fields ?

15
What is MCH?
  • What do State MCH agencies do?
  • What are their mission, goals, objectives and
    values? Do these vary across States?
  • Where should those agencies be located,
    organizationally, either within or external to
    public health?

16
What is MCH?
  • What do State governors think their State MCH
    agencies do?
  • What does the legislature and the public think
    about MCH?
  • Is there a generally consistent view of MCHs
    mission and purpose?

17
What is MCH?
  • Should there be a MCH program in every State and
    in every nation?
  • What should State and national MCH agencies do?
  • Should MCH agencies be within public health
    agencies? Why?

18
What is MCH?
  • What does the future hold for MCH?
  • What are the emerging trends and developments
    facing public health and MCH?
  • How will these impact MCH?

19
What is MCH?
  • Will the mission, goals and values of MCH
    change? Should these change?
  • Should the primary functions of MCH change?
  • Are there alternative ways for MCH to achieve it
    goals?

20
What is MCH?
  • What future MCH programs and policies will be
    needed?
  • What emphasis should be placed on needs
    assessment, monitoring, performance, evaluation
    and accountability?

21
What is MCH?
  • What role is there for leadership in MCH?
  • Who should those future leaders be and where
    will they come from?
  • How will we assure that those future MCH leaders
    are available, trained and ready?

22
Special Issues
23
Special Issue Direct Services or Core Functions?
  • Should MCH continue to provide direct services
    or focus on the core public health functions of
    assessment, assurance and advocacy/policy
    development?
  • Should MCH be the safety net and provider of
    last resort, even if it has inadequate funding
    for the task?

24
Special Issue Is the name MCH outdated?
  • Should we change the MCH name to Family Health?
  • Does changing the name change our purpose?
  • Does Family Health better describe what MCH is
    currently about?

25
Special Issue Is MCH an Academic Field?
  • Is MCH a core function and discipline in public
    health?
  • Does it offer the same essential public health
    services?

26
Special Issue Fathers
  • Fathers play an irreplaceable role in the
    development of children and the success of
    families.
  • How should MCH promote the role and importance
    of fathers and become involved with programs for
    all fathers, not just the issues surrounding
    teenaged males or child-support?

27
Historical Quotes about MCH Its Basis, Purpose,
Role and Philosophy
28
  • Maternal and Child Health is the special area of
    health care that is concerned with society
    fulfilling its responsibility to all children and
    women of childbearing age by assuring full
    appropriate health care services that are
    available, accessible, and culturally and
    ethnically sensitive.
  • Manual of the History and Philosophy of MCH
  • MCH Institute to Increase Leadership Skills
    Project
  • San Diego State University

29
  • Maternal and Child Health is comprehensive,
    coordinated, and family-centered, and is
    organized at the federal, state, and local
    levels.
  • It is holistic, multidisciplinary, and is based
    on principles of growth and development
  • For each individual it nurtures self-esteem,
    develops self-confidence and teaches
    self-reliance and competence.
  • Manual of the History and Philosophy of MCH
  • MCH Institute to Increase Leadership Skills
    Project
  • San Diego State University

30
MCH programs must…
  • Do no harmmust not be degrading and patronizing
  • Recognize individual worth,
  • Insure dignity,
  • Maintain vigilance to identify points of
    breakdown, healthy growth, and development

31
MCH programs must…
  • Utilize/involve diverse providers of services,
  • Go beyond the medical model, to include
    social-psychological frameworks in the study and
    treatment of health problems,

32
MCH programs must…
  • Have trained personnel with a clear grasp of the
    problems affecting mothers and children,
  • Anticipate issues and problems and exhibit
    proactive behavior and advocate for this
    population,

33
MCH programs must…
  • Enhance total growth and development by assuring
    continuity of care throughout the life-cycle so
    that the individual can reach his/her optimal
    potential,

34
MCH programs must…
  • Assure full appropriate services to those women
    and children at increased risk, and those with
    special health care needs,
  • Ameliorate and alleviate those situations that
    impact negatively on the physical, mental, and
    emotional health of all women and children.
  • Manual of the History and Philosophy of MCH
  • MCH Institute to Increase Leadership Skills
    Project
  • San Diego State University

35
  • Grants-in-aid constitute the most effective
    basis for national and state cooperation in
    promoting child welfare and in securing the
    establishment of that national minimum of care
    and protection which is the hope of every
    citizen… . Maternity and infancy aid is of
    fundamental importance in the social welfare
    field as well as in the health field.
  • White House Conference on
  • Child Health and Protection, 1930

36
  • The utter futility of providing means of
    assessing the health and welfare of children and
    of mothers, and of not providing the means to
    maintain them in health or restore them to health
    if sick, or in the case of maternity to make
    available complete medical and nursing care of
    the mother and infant, has forced itself upon
    health and welfare workers and upon the people.
  • - M.M. Eliot, J. Bierman, A.L. Van Horn

37
  • Children, it should be repeated, are not pocket
    editions of adults. Because childhood is a
    period of physical growth and development, a
    period of preparation for adult responsibility in
    public and private life, a program for children
    cannot be merely an adaptation of the program for
    adults, nor should it be curtailed during periods
    of depression or emergency expansion of other
    programs.
  • -Grace Abbott

38
  • There is very little genuine perception that
    mature people come from small beginnings and that
    they have had a perilous passage every moment of
    the way
  • All of the population, everybody of every age,
    were all at one time children and they bring into
    their maturity and old age the strength and scars
    of an entire lifetime
  • -Pauline Stitt

39
  • MCH does not raise children it raises adults
  • All of tomorrows productive, mature citizens
    are located today someplace along the MCH
    continuum and they are at some point in their
    creation, either being conceived or born or
    nurtured for the years to come
  • -Pauline Stitt

40
  • Every single component of public health is part
    and parcel of MCH.
  • The principle difference between MCH and the
    rest of public health is that MCH is general
    public health brought into focus on a population
    with special characteristics that pose potential
  • -Pauline Stitt

41
  • The essence of MCH is protection and
    strengthening humane services for people in
    periods of active growth and development.
  • The principles of growth and development
    underlie all rational MCH service
  • There are things that can be done in MCH that
    can not be introduced, not even with a crowbar
    and cleaver, after those days of receptivity are
    passed
  • -Pauline Stitt

42
  • Sometimes when I get home at night in
    Washington, I feel as though I had been in a
    great traffic jam, the jam is moving toward the
    Hill where Congress sits in judgment on all the
    administrative agencies of the government. In
    that traffic jam there are all kinds of vehicles
    moving up toward the Capitol… There are all of
    the conveyances that the Army can put in the
    street… There are the hayricks and the binders
    and the ploughs and all the other things the
    Department of Agriculture manages to put into the
    streets… I stand on the sidewalk watching it
    become more and more congested and more
    difficult, and then because the responsibility is
    mine and I must, I take a very firm hold on the
    handles of the baby carriage and I wheel it into
    the traffic.
  • -Grace Abbott, Childrens Bureau, 1935

43
(No Transcript)
44
Our Thoughts about What is MCH? and the
Components of a MCH Philosophy
  • Greg R. Alexander, MPH, ScD
  • Donna Petersen, MHS, ScD
  • MaryAnn Pass, MD, MPH
  • Cathy Chadwick, MPH Martha Slay, MPH

45
What is MCH?
  • MCH is the professional and academic field that
    focuses on the determinants, mechanisms and
    systems that promote and maintain the health,
    safety, well-being and appropriate development of
    children and their families in communities and
    societies, in order to enhance the future health
    and welfare of society and subsequent generations.

46
What is MCH?
  • MCH is the collaborative discipline within public
    health that, using the tools of all the other
    public health disciplines, focuses on assuring
    the conditions that allow each child to be
    healthy and to reach full potential.

47
Basic Tenets
  • MCH recognizes that health and optimal
    development comprise the foundation for later
    educational attainment, employment, productivity,
    financial security and success on a variety of
    levels.

48
Basis Tenets
  • MCHs application of public healths preventive
    philosophy illuminates why MCH has its origins in
    child development from conception to adulthood
    and has its continuing focus on assuring that the
    myriad systems designed to support the optimal
    growth and development of children are
    coordinated, cost-efficient, and effective.

49
Basic Tenets
  • Preventive measures directed at children have the
    greatest potential for positive health
    achievements therefore, assuring the optimal
    growth and development of children, detecting
    their health problems early, and instilling in
    them an appreciation for positive health seeking
    behaviors all have payoffs, not only during
    childhood, but into adulthood.

50
Basic Tenets
  • Given prevention is a hallmark of public health,
    public healths focus on children is inevitable,
    appropriate and necessary.

51
What Distinguishes MCH?
  • What distinguishes MCH from other
    population-defined fields like womens health,
    gerontology, or minority health is its
    multi-disciplinary public health approach to the
    prevention of disease, disability and early death
    in all populations, including the MCH population
    of today as well as adult populations of the
    future.

52
MCH and the Future
  • MCH isnt just for those who have or are
    interested in children now.
  • MCH is for those who are interested in the
    future, who care about sustaining their society
    and culture, who want to use resources wisely to
    nurture a healthy future population that will
    work toward assuring vibrant society for us, our
    children and their descendents.

53
The Role of MCH
  • The role of MCH is somewhat akin to that of
    parents, only the focus of MCH is on an ongoing
    population of children and their development into
    healthy future adults and leaders of our society.

54
The Role of MCH
  • Most of the services needed by our nations
    children and families are well beyond the
    capacity of MCH to provide.
  • Therefore, MCHs job is to be vigilant in
    keeping track of what services are needed, to
    arrange for children and families to get access
    to those services, and to work toward the
    development of services when they are unavailable.

55
The Role of MCH
  • To fulfill its mission, MCH must be involved in
    assessing, evaluating, promoting and improving
    health care and social systems in order to assure
    the receipt of essential services by children and
    their families in communities and to further
    foster culturally appropriate systems of care
    that encourage family involvement in
    decision-making.

56
What Should MCH Do?
  • The daily functions of MCH are varied and may
    change with the times but, the basic purpose of
    its efforts remains.
  • The essential criteria for assessing MCHs
    performance and activities is still whether it
    successfully promoted, maintained and improved
    the health, safety, well-being and appropriate
    development of children and their families.

57
MCH Leadership
  • MCH entails developing a vision for a better
    future for tomorrows children and adults.
  • MCH is about leaving a legacy.

58
MCH Leadership
  • The functions of leaders are many and include
    maintaining consistency of purpose, a key element
    to MCH as each day brings new children and
    families.
  • The ongoing challenge to leadership in MCH is
    to assure the preparation of others with the
    knowledge, the skills, the conviction, the will,
    and the sense of purpose and hope to carry on its
    mission.

59
Should MCH Exist?
  • One expression of a societys view of itself and
    its accomplishments can be found in its creation
    of programs, agencies, policies and systems to
    assess, plan and guide for the health and
    development of children.

60
Should MCH Exist?
  • If a mark of civilization is when a society
    looks beyond the present and invests its labors
    and capital to ensure that it will endure and
    offer even brighter prospects to the next
    generation, then MCH, in one form or another,
    should and will exist.
  • For where best to make that investment, than
    the health, safety and optimal development of
    children?

61
Should MCH Exist?
  • To the extent that a nation views itself with
    pride as a people and a society that are worthy
    of celebration and continuation, then MCH should
    exist to nurture children and families through
    the bleak times and help pave the way to a more
    prosperous and hopeful future.

62
MCH Exists to Help Us from Here
63
To Here …. And Beyond
64
Maternal and Child Health Philosophy Photo
Acknowledgements
  • Slide 9 http//www.jacqueslowe.com/
  • Slide 22 http//www.jacqueslowe.com/
  • Slide 43 http//dgl.microsoft.com/
  • Slide 62 http//memory.loc.gov
  • Slide 63 http//www.jacqueslowe.com/
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