By Lori Tremmel Freeman, BS, MBA
Chief Executive Officer, AMCHP
This issue of Pulse is an inaugural theme focused on Emerging Issues. By definition, the word 'emerging' according to Merriam-Webster is "newly created or noticed and growing in strength or popularity: becoming widely known or established." Similarly, the word 'issue' means "something that people are talking about, thinking about, etc.: an important subject or topic."
I'm slightly surprised we've not had this theme in the past. Although it appears to be a period of calm in public health, most of us know that the reality is that public health emergencies and crises are occurring almost every day across the country and happening to our most vulnerable populations. The media (and sometimes even those on the front lines) can just have a short attention span as we move from one crisis to the next.
It wasn't even a year ago that AMCHP published a special edition of Pulse on Emergency Preparedness and Reproductive Health. At that time, the articles focused on things like natural disasters (Katrina was at the forefront), the Ebola outbreak, and Anthrax exposure and their impact on maternal and child health. As you read this issue of Pulse focused on Emerging Issues, you'll find that all of the topics meet the definitions above for emerging issues including the Zika virus, opioid abuse, and lead exposure articles. And, these are truly different issues than were in play a year ago today – at least in the public's eye.
With perhaps the exception of Zika, we know in our hearts that these are not modern nor are they emerging issues necessarily. They only meet this criteria because they have become 'noticed' and they are what we are now 'talking about.'
For example, abuse of prescription pain relievers by pregnant women which can result in a number of problems in newborns (e.g. neonatal abstinence syndrome), increased by almost 300 percent in the United States between 2000 and 2009 (CDC. Vital Signs http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/index.html).This increase was driven in part by the high rate of opioid prescriptions being given to pregnant women. In the United States, an estimated 14.4 percent of pregnant women are prescribed an opioid during their pregnancy. [Bateman, B.T. et al. Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States. Anesthesiology. in press (2014)]. Data around NAS were beginning to trend 10 to 15 years ago!
In terms of lead poisoning, we all know and understand that childhood exposure to lead can have lifelong consequences and that there are significant differences in lead exposure by race/ethnicity and income indicating a persistent disparity. These disparities can be traced to differences in housing quality, environmental conditions, nutrition, and other factors. Even though the level of lead exposure in children tested today has declined over time, there are still far too many children with lead poisoning with many in vulnerable populations once again. In January 2012, the CDC changed its "blood lead level of concern" based on a growing number of scientific studies that show that even low blood lead levels can cause lifelong health effects. This new level is based on the population of children aged 1-5 years in the U.S. who are in the top 2.5% of children when tested for lead in their blood. Currently, that is 5 micrograms per deciliter of lead in blood. CDC's "blood lead level of concern" was previously 10 micrograms per deciliter. Although the Flint water crisis has certainly brought lead poisoning once again to the forefront of concerns – and created an 'emerging issue' as a result – we should all remember that every day pregnant mothers and children are exposed to lead poisoning across the country and that the overall impact is significant with devastating results that last forever for families.
So while emerging issues are with us – and they may be very familiar to those working the front lines of public health – they are often in the forefront of the public eye and that of Congress for the first time due to enhanced media attention. Nevertheless, we can absolutely seize an opportunity for maternal and child health to take advantage of the added attention and fight harder for public health funding and support for states in order for these issues that frequently require reprioritization of existing concerns.