Department of Maternal and Child Health

1
Philosophy ofMaternal and Child Health

• Greg R. Alexander, MPH, ScDDonna 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.

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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.

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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?.

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What is MCH?
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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?

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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?

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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?

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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?

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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?

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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?

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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?

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Special Issues
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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?

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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?

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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?

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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?

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Historical Quotes about MCHIts Basis, Purpose,
Role and Philosophy
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• 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

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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,

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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,

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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

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Our Thoughts about What is MCH?andthe
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.

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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.

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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.

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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.

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Basic Tenets

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

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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.

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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.

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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.

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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.

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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.

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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.

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MCH Leadership

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

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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.

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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.

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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?

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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.

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MCH Exists to Help Us from Here
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To Here . And Beyond
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Maternal and Child Health PhilosophyPhoto
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/