View From Washington

Using Data and Assessment to Improve MCH Policy

In public health school we are taught that epidemiology is the fundamental science of public health practice. Furthermore, the concept of assessment is so important that the Institute of Medicine declared it the first among three core functions of public health—followed by assurance and policy development. After all, if we do not have data to understand the causes and distribution of disease across the population, how can we even begin to develop the programs and policies needed to fight disease and promote health?

Unfortunately, Washington too often generates examples of where the science and data are clear, but the policy languishes. This is sometimes because of divergent ideology, and often complicated by a lack of political will and available resources. 

Perhaps no other issue so clearly represents the disconnect between science and policy than our national approach to injury prevention. While injury continues to be the leading preventable killer of children, the U.S. spends literally tens of billions of dollars every year to provide health insurance to children—in part to treat injuries. Meanwhile, last year the entire budget of the CDC’s National Center for Injury Prevention and Control was only $134 million. At this level the CDC is able to fund only 30 states for basic injury prevention programs.  There are few better illustrations of where our public policy favors treatment over prevention.

Consider also our national approach to health insurance. Despite an abundance of research demonstrating how health insurance helps people get timely access to medical care and protects against the risk of expensive and unanticipated medical events, our nation continues to tolerate close to 47 million of our citizens going without coverage. Furthermore, the ongoing national debate over health coverage completely overshadows the growing body of research that argues for policies addressing the social determinants of health in areas such as poverty and income, education, unemployment, housing, transportation, the environment, and nutrition.

The problem is finding a way to make the leap from assessment to policy development. In other words, how can we navigate between what science shows and what politics will allow?   I think part of the answer lies in improving our communication about how data and policy should interact.  This issue is so important that Dr. Pat Nolan, a former Rhode Island State Health Official, often says communication should be the fundamental science of public health. 

Our goal at AMCHP is to find better ways to communicate data and assessment results to policymakers, and to use compelling examples and stories to illustrate the connections. In the past year, we have been spreading the word on Capitol Hill that all state Title V programs conduct thoughtful and in-depth assessments every five years to identify their most pressing MCH needs and have data to demonstrate tremendous un-met needs, but have been hampered by limited and declining resources to implement proven programs and policies. 

We are also asking Congress to consider how eroding funding in MCH programs is coinciding with alarming new data demonstrating our lack of national progress in infant and maternal mortality, teen birth rates, childhood obesity, and other important MCH indicators.  We are trying to make sure that policymakers understand the impact of over $60 million in cuts to the Title V Maternal and Child Health (MCH) Services Block Grant over the past six years. 

While the House Appropriations Committee recently proposed a modest increase ($9 million) for Title V in FY ’09, we must now carefully adapt our message to communicate how this modest investment will only begin to rebuild what has been lost in recent years.  And although it is an uphill battle, we will continue to advocate that fully funding the Title V MCH Block Grant at $850 million is critically needed to enhance MCH.