President, The Association of Maternal & Child Health Programs
Maternal and Child Health Manager, Title V Director, State of Oregon
In the late 1980s I had the honor of living on a small
island in the outer islands of Micronesia. There were four habited islands on
this lagoon. I lived in Moch, which was
a half-mile by a quarter mile, had 850 residents, and was 5 feet above sea
level at its highest point. It was the tall island. While the other islands
were larger in size and had more residents, none were as tall. Sometimes parts
of those other islands would flood during prolonged storms. The flooding put
the precious taro patches in jeopardy. Taro, the dietary staple, is grown in
the center of these low-lying atolls where there is a freshwater lens. If
saltwater enters the patch, it can ruin the taro crop, which is the main food
source for the residents. This is food insecurity, island style.
I have not been back since leaving 30 years ago. I fear that
due to climate change and the rising ocean levels, Moch is no longer tall. I
fear more for the people who were my friends and family. And what about the
people on the shorter islands? Do they still have their taro patches? Where
will they go when their homes and land are permanently underwater?
The emerging issues we face today are taking on a new
breadth and depth. Many of our needs assessments point to the key drivers of
social determinants of health. But how they present are unique to each
community. For example, housing issues and homelessness look very different in
Oregon than they do in Micronesia. And the destruction Puerto Rico endured due
to Hurricane Maria illustrates yet another version of housing issues and
homelessness. Food insecurity is equally concerning across our communities, but
it looks different at each local level and requires different solutions.
We still face traditional public health issues, both old and
new in all our communities: Zika, measles, and congenital syphilis; tobacco, marijuana,
alcohol, opioid use, and other substance use; obesity; lead exposures; gun
violence; and infant and maternal mortality. Although we have made progress in
some areas, we are slipping in others.
So why is this so hard? We are smart. We have data. We have
solutions. We also are burdened by history, racism, structural racism, bias,
trauma, adversity, and toxic stress. We have urban/rural divide, gender and
identity discrimination, and so many other inequalities. We are learning more
and more about the effects these issues had and continue to have on our
population’s health. These are not new. However, the intergenerational impact on
our families and communities is hopefully getting the appropriate attention .
We keep diving deeper to address the
impact these issues have on the social,
emotional, behavioral, mental, and physical health; and the well-being of our
families and communities. We need to delve down even deeper to get closer to
understanding and addressing the true foundations of lifelong health.
We know the path forward will not be easy. What works in one community may work in
another, or at least spark ideas of what could work to address our emerging issues—old,
new, large, small, and those yet to come. With tools of resilience and
preparedness along with our smarts and hearts, we can accelerate our impact as
we move upstream together.
When I think of my island community, I remember a time of
abundance, before the devastating effects of climate change. My heart breaks
for what this community faces and yet soars because I know they will find the
right solutions that work best for their mothers, children, families, and