Prematurity: Taking a Public Health Approach
By Mike R. Fraser, PhD
Several months ago I had the chance to visit our good partners at the March of Dimes at their national headquarters in White Plains, New York. In their offices is a fascinating display on the March of Dimes’ successful history fighting polio and their current campaign to prevent premature birth. At the center of the display is an “Iron Lung” – a reminder of what many patients had to go through to stay alive in their own battles against polio. And next to it, though much smaller, is an “Isolette” machine – an incubator – something many of us are much more used to seeing these days in our hospitals than an iron lung.
The iron lung and the incubator were striking reminders to me of our investments in and hopes for medical solutions to our most pressing health problems. Both machines have saved the lives of hundreds of thousands. Both machines represent the best of the science of their times. We have a lot to be thankful for as we look at the technological advances that have led to the eradication of polio and our expert care of the many babies born prematurely, and their mothers, today.
But also in the display were posters highlighting health promotion messages and sharing public health messages related to both polio (then) and prematurity (now). No plugs needed, no complicated monitoring required, these low-cost health promotion interventions caught my eye. There were photos of people talking to one another and sharing health information in living rooms, in exam rooms, in classrooms. These low-cost techniques highlighted the public health approaches to addressing both polio and prematurity which included population based health information sharing and community mobilization around pressing health issues. While not as flashy, and admittedly without the beeps and blips of medical technology, it struck me that these public health “technologies” were equally important in saving lives and preventing disease.
The Institute of Medicine estimated that an infant born prematurely in 2005 cost the United States $51,600 each for a total annual cost of $26.2 billion dollars. The report also estimates that the average first-year medical costs, including both inpatient and outpatient care, were about 10 times higher for preterm babies ($32,325) than for full-term infants ($3,325). Wow. If we could even reduce prematurity rates by just 10 percent we’re talking about substantial improvements in both quality of life for infants and their families, and significant savings in medical and economic costs related to treating and caring for premature births.
While technological advances improve the way we treat and care for our tiniest citizen and their families, the time is now to recommit ourselves to the low-cost, high-yield interventions that we know are effective in preventing premature birth. We know that late or no prenatal care, using alcohol and illegal drugs, and smoking increase the risk of premature birth. We also know that stress, including the stress of racism, lack of social support, exposure to domestic violence and abuse, increase the risk of a premature birth. These are risks for which we have effective public health interventions but our opportunities to use them are compromised by budget cuts, staffing shortages, and lack of political will to support public health programs serving women, children and families.
Those of us who spend our lives advocating for maternal and child health programs should be concerned by the rising rates of prematurity in our nation. Equipped with public health interventions that work we know we can help reduce the social and economic costs of prematurity. As we look to new ways of preventing premature birth can we imagine a day when an iron lung and an Isolette are both uncommon sights to future generations of Americans? I can, and with all of us working together to raise awareness of and support for public health approaches to prevent premature birth I know we can get there.