Making the Connection between MCH and Injury Prevention
Show me the data!
In the film Jerry Maguire, Cuba Gooding, Jr., plays Rod Tidwell, an Arizona Cardinals wide receiver. In one infamous scene, Rod is on the phone deal-making with sports agent Jerry Maguire (played by Tom Cruise) when he shouts the now oft repeated phrase, “Show me the money! Show me the money!” As I thought about data and assessment activities for this month’s issue of Pulse I was reminiscing about how we often shout “Show me the data!” in our maternal and child health work.
MCH professionals have an insatiable appetite for data, which makes sense—evidence-based and science-based practices are core to our work. We use data to support our ideas and observations, and gather evidence on the effectiveness of our interventions. We use data to support our hunches, tell our stories, and even to argue for more funding (“Show me the money!”). More importantly, we use data and assessment activities to identify priorities for local, state, and national maternal and child health programs and to focus limited program resources on the places where they are needed the most. Data are core to maternal and child health and assessment is indeed one of the core functions of public health practice.
AMCHP’s current program portfolio supports data and assessment capacity-building for state MCH programs in a number of ways. We have been engaged with AMCHP members and our national partners, including the MCHB and CDC, to determine how to best support state needs assessment activities as we move towards the next required five-year needs assessment in the MCH Block Grant. A result of this joint planning is AMCHP’s role in coordinating four data trainings at the December 2008 MCH Epidemiology Conference in Atlanta, Georgia, one of which is a course on how to conduct statewide needs assessments. AMCHP is also working with partners to support regionally-based needs assessment trainings, and is excited to be working with the Rocky Mountain Public Health Education Consortium, which will be conducting a day-long needs assessment program in Albuquerque on September 19th. We hope to continue developing programs that will support state and local efforts to conduct comprehensive statewide needs assessment for the upcoming five-year assessment, and for the years in between.
AMCHP also incorporates data and assessment activities in our other policy and program work. Our Best Practices program looks for the best evidence available before deeming a practice to be a “best practice” or model program. Our policy team uses the data you provide to us, MCHB and others to illustrate pressing MCH needs at the state and national level, and to make the case for increasing Title V funding. AMCHP staff use data to evaluate the impact of AMCHP’s programs, and we have developed a monthly “data dashboard” to monitor AMCHP’s fiscal health and membership goals.
With all the focus on data and assessment it is easy to say that we truly are “data-driven” in the work we do. But it is important to remember that data and assessment activities are a means to an ends, data collection should never be an ends of its own. Far too often data are collected only to sit on a shelf and never be analyzed. When we develop surveys, we try to make sure that we are not collecting extra data that “we may need someday.” That’s collecting data for data’s sake, and to me that’s a waste of time and money.
Another danger of data and assessment activities is relying too heavily on one piece of data or one type of analysis and failing to notice significant issues or trends that are important to a group, but do not show up “in the data.” I like to tell the story of a community who was told by their health department that septic systems and wastewater regulations should be their highest public health priority given all the development in their area and the challenges growth and new building imposed on their neighborhood. When some community members participated in a focus group and were asked about their priorities, instead of just looking at the environmental data used by the health department, wastewater issues never came up. Instead, residents said they wanted to be sure the new developments included sidewalks and playground in their neighborhoods since the developers were not including those features in their plans. If the health department used just their own survey data, their work would have missed the community’s pressing priority. I wonder what else we are missing when we focus too heavily on “what the data say” without also asking “whose data are these?,” and “what does the community say?” in our analyses.
Even more difficult to address is the issue of ignoring the data because the implications of the data are too controversial, or having to totally revamp a program because the data indicate that it is no longer needed. These cases are tough because they require asking difficult questions, negotiating win-win solutions, and engaging in crucial conversations. If we really are using data to inform our work, how can we be sure that we are also using those data to truly focus on the most pressing MCH problems? One example that comes to mind is health equity and health disparities. We know there are major differences in health status in different populations within our states, but how effectively are we addressing these issues even though we have the data to support increasing our efforts? Data alone cannot solve the problem—we know the problem all too well. Data-driven solutions are what we really need, and we need them soon.
AMCHP is committed to working with partners to strengthen states’ capacities to use data to improve maternal and child health outcomes. Recently, we have been engaged in conversations with a group of MCH epidemiologists looking to develop an organization to promote MCH epidemiology at the local, state, and national levels. Clearly, MCH epidemiologists are important resources in promoting effective MCH practice and AMCHP supports the development of MCH epidemiology capacity in all states and territories. We look forward to working with colleagues to improve the work we do in data and assessment, including our support for MCH epidemiology. Together, we can truly say that we are using data to improve our work, and improve the health of mothers and children nationwide.