PUB 460 Lecture 1 - Intro and history of MCH.pdf

Introduction & History of Maternal and Child Health PUB 460 Dr. Gauri Desai About myself & our TA • TA: Tasnim Tarannum 2 Schedule • August 28 – December 11, includes Fall break and Thanksgiving break • No textbook • Lecture slides, readings will be posted to “Brightspace” in weekly modules...

Introduction & History of Maternal and Child Health PUB 460 Dr. Gauri Desai About myself & our TA • TA: Tasnim Tarannum 2 Schedule • August 28 – December 11, includes Fall break and Thanksgiving break • No textbook • Lecture slides, readings will be posted to “Brightspace” in weekly modules 3 Course Activities Course Learning Activities In-class Top Hat Questions Short HWs Case study HWs Exam 1 Exam 2 Group project presentation and peer review Group project paper Total Points 9 weeks X 10 points = 90 points 9 HWs X 30 points = 270 points 7 Case study HWs X 20 points = 140 points 45 points 45 points 20 points 40 points 650 4 In-class TopHat Questions – 10 points/week • In-class TopHat questions totaling to 10 points per week (for 9 weeks) will be asked • The majority of questions will be multiple choice and T/F type; other question types may be included • 50% participation and 50% correctness points • Some lectures may have more/less TopHat questions, but the weekly total will always be 10 points 5 Short HWs– 30 points/HW • Weekly short HWs Brightspace will be based on lectures and readings of that week • Open book • Multiple choice, T/F, short answers • Each short HW will be worth 30 points; a total of 9 short HWs • Single attempt, not timed • Due on Thursdays at 1:00 pm (see syllabus for weekly dates), except in weeks 5 and 10 • No late submissions accepted 6 Case study HWs– 20 points/HW • Read the assigned case studies and respond to prompts/answer questions related to the case studies • Write these in separate word documents and upload those on Brightspace • A total of 7 case study HWs will be given, each will be worth 20 points • Be respectful of the case studies that are being discussed • Due on Thursdays at 1:00 pm (see syllabus for weekly dates), except in weeks 5 and 10 • Case study HWs will be accepted up to 48 hours late, without a documented excuse, but you will lose 10% per day it is late. After 48 hours, a late submission will not be accepted. 7 In-class Exams– 45 points each • Two closed book, in-class exams; 45 points each • Oct. 5 and Nov. 9 • Short answers, multiple choice, T/F • Based on lecture slides and concepts discussed in class • “Question bank” at the end of each lecture • Case studies not included on the exams • Not cumulative (but some key concepts need to be understood for both exams) 8 Group project – paper + presentation – 60 points • Groups of 3 • Select a health issue / disease / condition discussed in class as part of any of the following life cycle stages: pregnancy, childbirth, infancy, childhood, and adolescence • List of potential topics will be given; other topics may be chosen • Professor’s approval of topic required • Paper worth 40 points – instructions will be shared • In-class group presentation worth 20 points (includes peer review) 9 Course Activities Course Learning Activities In-class Top Hat Questions Short HWs Case study HWs Exam 1 Exam 2 Group project presentation and peer review Group project paper Total Points 9 weeks X 10 points = 90 points 9 HWs X 30 points = 270 points 7 Case study HWs X 20 points = 140 points 45 points 45 points 20 points 40 points 650 10 Go over the syllabus • Uploaded to Brightspace 11 Grading Grade Range 92-100 90-91.9 88-89.9 82-87.9 80-81.9 78-79.9 Letter A AB+ B BC+ Grade Range 72-77.9 70-71.9 68-69.9 60-67.9 0-59.9 Letter C CD+ D F • These are hard cut offs • No curving 12 UB Academic Integrity Policy  Aiding in academic dishonesty  Cheating  Above points include ChatGPT  Plagiarizing  Falsifying academic materials  Misrepresenting documents  Purchasing academic assignments  Selling academic assignments  Submitting previously submitted work  UB Office of Academic Integrity: https://www.buffalo.edu/academic- integrity/policies.html 13 Communication • Email all questions and inquiries to [email protected] • Account monitored by professor & TA • Office hours: Zoom • Professor: Tuesdays noon – 1:00 pm https://buffalo.zoom.us/j/97598154498?pwd=aWYzeFhSNkE2RTd2bWNvMllUYW F6dz09 • TA (Tasnim): Fridays 1:00 – 2:00 pm on Zoom – https://buffalo.zoom.us/j/7290113325?pwd=ZU9sMkZhcFU1eUpXaXpBUCtrY2hSQT09 • For one-on-one appointment, email me at [email protected] & we will schedule one 14 Brightspace • Students will not get an email notification when a class announcement is sent on Brightspace • It is strongly recommended that students set the following Instant Notifications to receive notifications when new announcements are available or previously posted announcements are updated in a course: • Announcements - announcement updated • Announcements - new announcement available • The Brightspace Pulse app lets students receive real-time notifications on their mobile devices. The app is available for download from the Google Play Store and Apple App Store. 15 TopHat Trial • TopHat Join Code is 419610 16 History of Maternal and Child Health in the US Timeline of Important Events • 1840: Public School Movement - The movement in the 1840s to organize public, government funded schools laid the foundation for free education for all children in the United States. • 1847: American Medical Association (AMA) established • 1855: First Children's Hospital, Philadelphia • 1872: American Public Health Association (APHA) established • 1888: American Pediatric Society • 1893: Milk Stations - Lack of safe milk was among the most significant child health problems during the 1800s. In 1893, Nathan Straus, a New York philanthropist, established a number of milk stations for the poor in an attempt to decrease infant mortality and morbidity https://mchb.hrsa.gov/about-us/timeline/text Timeline of Important Events • 1910: Pasteurization - By 1910, pasteurization was recognized as the best way to ensure delivery of safe milk to infants and the general U.S. population. • 1916: Establishment of Schools of Public Health • 1921: American Birth Control League • 1935: Title V of the Social Security Act - provided programs for maternity, infant, and childcare, as well as a full range of medical services for children – Key policy • 1946: The National School Lunch Act • 1946: UNICEF established https://mchb.hrsa.gov/about-us/timeline/text Timeline of Important Events • 1946: Center for Disease Control established • 1951: American College of Obstetricians and Gynecologists (ACOG) • 1960: Birth Control Pills Approved for Use - Enovid - the first birth control pill, was approved for use in the U.S. by the Food and Drug Administration. • 1973: Roe vs. Wade Supreme Court Case - After much deliberation, the United States Supreme Court decision in 1973 established that laws prohibiting abortion violated one's constitutional right to privacy, thus legalizing abortion. https://mchb.hrsa.gov/about-us/timeline/text Timeline of Important Events • 1991: Teen Pregnancy Rate Rises - After decades of rapidly declining rates, teen pregnancy rates rose significantly in the late 1980s and hit a high point in 1991. • Influencing factors: inadequate access to family planning services, low rates of contraceptive use, and improved reporting of teen pregnancies. • 1994: Violence Against Women Act - to address the issues of domestic violence and sexual assault • 1996: Abstinence-Only Sexual Education - $50 million in federal funding for states to implement abstinence-only sexual education programs. • After a decade of this, policymakers began to shift support to comprehensive, age-appropriate sexual education and teen pregnancy prevention programs. https://mchb.hrsa.gov/about-us/timeline/text Timeline of Important Events • 2002: Life Course Approach - This emerging science touches on several aspects of public health, including health disparities, fetal origins of adult disease, and outcomes related to prenatal and preconception health and health care. • 2010: Tackling Childhood Obesity - President Barack Obama signed a presidential memorandum establishing the first ever task force on childhood obesity to develop an interagency action plan to solve the problem of obesity among our Nation's children within a generation. • 2022: Overturn of Roe v. Wade; individual states can curtail or outright ban abortion rights https://mchb.hrsa.gov/about-us/timeline/text Title V Maternal and Child Health Block Grant • The Title V Maternal and Child Health (MCH) Block Grant Program is a partnership between the federal government and states • Since 1935, the Social Security Act has provided funding for the Title V MCH Block Grant • Health Resources and Services Administration administers the grants to states https://mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-mch-block-grant Title V Maternal and Child Health Block Grant Funds from the Title V MCH Block Grant help: • Assure access to quality maternal and child health care services to mothers and children, especially those with low incomes or limited availability of care • Reduce infant mortality • Provide access to prenatal, delivery, and postnatal care to women, especially pregnant women who are low income and at-risk • Increase regular screenings and follow-up diagnostic and treatment services for children who are low income https://mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-mch-block-grant Title V Maternal and Child Health Block Grant Funds from the Title V MCH Block Grant help: • Provide access to preventive and primary care services for children who are low income and rehabilitative services for children with special health needs • Implement family-centered, community-based, systems of coordinated care for children with special health care needs • Set up toll-free hotlines and assistance with applying for services to pregnant women with infants and children eligible for Medicaid • YouTube video [3:21]: https://www.youtube.com/watch?v=EcW1IIgpCPY&ab_channel=HRSAt ube https://mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-mch-block-grant Title V Maternal and Child Health Block Grant • In 2021, title V funded 59 U.S. states and jurisdictions to provide access to health care and public health services for an estimated 60 million people. • This grant helped provide services for: • 92% of all pregnant women • 98% of infants • 58% of children nationwide, including children with special health care needs • States and jurisdictions must match every $4 of federal Title V money they receive by at least $3. https://mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-mch-block-grant 20th century achievements • Drastic reductions in maternal mortality and infant mortality • At the beginning of the 20th century: • 6 – 9 women died per 1000 live births • ~100 infants died before their first birthday https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm 20th century achievements • • • Beginning of 20th century: ~100 infants died before their first birthday 1915 – 1997: Infant mortality rate declined greater than 90% to 7.2 per 1000 live births 2020: 5.4 deaths per 1000 live births https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm • The decline in infant mortality is unparalleled by other mortality reduction this century • If turn-of-the-century infant death rates had continued, then an estimated 500,000 live-born infants during 1997 would have died before age 1 year; instead, 28,045 infants died 20th century achievements What were the drivers of these declining rates? • Sewage and refuse disposal and safe drinking water • Declining fertility rates - longer spacing of children • Better nutritional status of mothers and infants • Smaller family size • Discovery and widespread use of antimicrobial agents • Fluid and electrolyte replacement therapy and safe blood transfusions • Technologic advances in neonatal medicine https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm 20th century achievements • • • At the beginning of the 20th century: 6 – 9 women died per 1000 live births 1900 – 1997: Maternal mortality rate declined almost 99% to less than 0.1 per 1000 live births 2020: 24 deaths per 100,000 live births • Poor obstetric education and delivery practices Highest rates of the century • Care provided by poorly trained • At-home births, unskilled birth attendants • Inappropriate and excessive interventions • Improper infection control https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm 20th century achievements What were the drivers of these declining rates? • Institutional practice guidelines developed • Guidelines defining physician qualifications developed • Shift from home to hospital deliveries • Infection control • Medical advances https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm Challenges for 21st century • Racial disparities in maternal and child health care • Reducing the incidence of low birth weight • Deaths due to LBW reduced because of improved survival, not because of reduced LBW incidence • LBW associated with developmental disorders and other conditions later in life • Effective strategies to reduce unintended pregnancy • Approximately half of all pregnancies in the United States are unintended https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm Housekeeping Join Top Hat if you have not already done so