Advancing Public Health Surveillance, Practice, and Training to Improve Preconception Health
By Kay Johnson, MPH, EdM
Last month, CDC reported that, while data from the preliminary mortality file suggest a two percent decline in the infant mortality rate from 2005 to 2006, the U.S. infant mortality rate did not decline significantly overall or for any race/ethnicity group from 2000 to 2005 – meaning that disparities by race and ethnicity persisted. (MacDorman and Mathews, 2008) This is one indicator of the need for preconception health and health care, of the need for attention to women’s health beyond prenatal care.
A Public Health Workgroup was launched to help implement the 2006 CDC Recommendations on Improving Preconception Health and Health Care (PCHHC). (Johnson et al., 2006) The activities and priorities of the Public Health Workgroup are focused in three areas:
1) Public Health Data and Surveillance;
2) Public Health Practice; and
3) Public Health Workforce Development (Education and Training).
The workgroup is co-chaired by Magda Peck, Nan Streeter, and Sam Posner. The work is grounded in the assumptions that through leadership they can and must be influential and catalytic for advancing PCHHC in public health and that they must be strategic in our work given the growing number of related forces and efforts. The group shares a common understanding of the aim of preconception health and health care, which includes improving the health of women and infant, and is not just about addressing infant mortality as an outcome.
High priority work in public health data and surveillance includes support for: the reinstatement of preconception objectives for Healthy People 2020; measures of preconception health in MCH Block Grant performance measurement systems; and addition of key questions to relevant surveillance systems (e.g., PRAMS). Development of an open-access library of indicators and a template state public health agencies can use to report preconception health data is underway. CDC leadership is at the core of these efforts. (Posner et al, 2008)
Priorities in public health practice include efforts to collect and disseminate promising and best practices, as well as to define standards of practice. This would under gird efforts to increase the integrate preconception health into public health practice – working with traditional partners such as Title V, Title X Family Planning, WIC, Healthy Start, and STD/HIV programs and non traditional partners such as schools, jails and social welfare agencies.
In terms of Public Health Workforce Development (Education and Training), efforts are underway to incorporate PCHHC into MCH training programs (undergraduate and other graduate education, GED, leadership and continuing education curriculum). Curricula tools, development of model course, and training materials will support these efforts.
Title V programs have a key role to play in advancing public health surveillance, practice and training to improve preconception health. In a forthcoming article, Kent and Streeter describe how Title V programs are maximizing opportunities to promote women’s health, including preconception health. Key approaches include: improving state-level information systems; expanding programs to include preconception services; and leveraging policy change through partnerships. A session at the AMCHP 2009 annual meeting will describe some of the successes of “early adopter” states.
Kent H and Streeter N. Title V Strategies to Assure a Continuum of Women's Health Services. Women’s Health Issues. Supplement (In Press). December, 2008.
Johnson, K., Posner, S.F., et al. Recommendations to Improve Preconception Health and Health Care --- United States. MMWR. 2006, April 55(RR06); 1-23. Available at:http://www.cdc.gov/mmwR/preview/mmwrhtml/rr5506a1.htm.
MacDorman MF, Mathews TJ. Recent Trends in Infant Mortality in the United States. NCHS Data Brief, no 9. Hyattsville, MD: National Center for Health Statistics. 2008. Available at: http://www.cdc.gov/nchs/data/databriefs/db09.htm
Posner SF, Brousard D, Sappenfield B, Streeter N, Zapata LB, & Peck MG. (2008). Where are the data to drive policy changes for preconception health and health care? Women’s Health Issues. Supplement (In Press). December, 2008.