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Raising the Flag for Collective Impact in MCH

By Brent Ewig, MHS
Director, Public Policy & Government Affairs, AMCHP

Each year around this time I start thinking about the upcoming Fourth of July holiday. The parades, cook outs, fireworks and flags will all be on display soon. And when I think about these patriotic celebrations, I'm reminded that nothing is more American than baseball, motherhood and apple pie. Here at AMCHP, we see our job as raising the flag for all moms (and we like our Washington Nationals baseball team and a good slice of pie too – but I digress).

Recently I was raising this flag at a meeting of public health advocates and federal officials who oversee the entire budget of the U.S. Department of Health and Human Services. The meeting was following the predictable script with advocates highlighting the relentless onslaught of budget cuts, sequestration, and job loss. Our partners were confirming that the uncertainty is likely to continue for the foreseeable future.

So it was a bit jolting to many in the room when I spoke up to say that despite this gloomy situation, the Centers for Disease Control and Prevention (CDC) had recently released data showing that the U.S. infant mortality rate declined 12 percent from 2005 to 2011. This, I said, translates into thousands of saved lives, and is a substantial public health victory that deserves to be celebrated.

I thought I was taking the high road when I went on to say that while we think the Title V MCH Services Block Grant has contributed to this success, we recognize that other critical programs have contributed to this success, including Medicaid, the Children's Health Insurance Program, WIC, Healthy Start, Home Visiting, the Personal Responsibility Education Program and evidence-based Teen Pregnancy Prevention Grants, Community Health Centers, Title X Family Planning and critical efforts of the CDC and the National Institutes of Health.

Around the room there were nods of agreement and a general sense of pride that this example indeed illustrated that public health is best when working as a system, and not a series of siloed categorical grants. The bubble burst, however, when one of the budgeteers indicated that while they get systems thinking, they still are charged with asking the tough questions about what each program specifically contributed to this progress so they can increase funding for evidence-based programs and end funding for what's not.

In that moment, it became clear to me that the theory of collective impact, which intuitively appeals to so many of us in public health because it recognizes there is no silver bullet solution to complex problems, will run into considerable interference as long as our budgeting process is premised on an isolated impact model that holds out for scaling up single programmatic solutions.

So, here's where we need your help. How are you educating your budget officials on collective impact? What's working, and what should be avoided? Let me know what you are thinking ( , and we'll share the best ideas in a future column.