Posted on 07 Mar 2014
When it comes to the time spent in the womb, letting nature take its course is best for most babies and mothers! The Leapfrog Group, an employer-backed organization that tracks hospital safety and quality, published data last week that showed a national decrease in the rate of deliveries before 39 weeks without a medical reason – from 17% in 2010 to 4.6 percent in 2013! We began collecting this data from hospitals nationwide as part of patient-safety efforts under the affordable Care Act.
Potential complications from early elective deliveries (those scheduled for the convenience of doctors, hospital or mothers) may include more cesarean section deliveries, as well as infant breathing and feeding problems, infections, or even death. The rate of infant deaths in the first year rises by 50% for those early births compared to babies who reach full term (39 to nearly 41 weeks). Each week of pregnancy increases the likelihood of delivering a healthy baby.
Unnecessary early deliveries are estimated to increase health care costs by as much as $1 billion annually. Some health insurers have stopped paying for early elective deliveries and many hospitals have adopted “hard stop” policies that ban doctors from scheduling deliveries before 39 weeks without a medical reason. The Midwest Business Group on Health (MBGH) has taken a more proactive role to assure that babies in Illinois are born healthy. Partnering with the Illinois Maternal and Child Health Coalition, America’s Health Insurance Plans, Blue Cross Blue Shield of Illinois, CBS2 Chicago, March of Dimes, and the Illinois Department of Public Health, MBGH is working in Chicago and other parts of Illinois to support adoption of preterm birth policies and programs by hospitals, employers, and health plans. According to Larry Boress, President and CEO of MBGH, the main goal is to reduce the number of early elective deliveries in Illinois below the national average.
Funded by United Health and the Robert Wood Johnson Foundation, MBGH created a community action plan and built the Illinois Perinatal Quality Collaborative to implement: 1) a standard, statewide performance data infrastructure that publicly reports results; 2) adoption of elective delivery policies aligned with best practices by every maternity hospital; and 3) payment reform that aligns financial incentives with best practice and full term births.
MBGH’s communications campaign highlights the importance of full term births and uses employer/health plan communications, television and the internet, and to reach women in the community, those covered by employer/health plan benefits, and physicians and hospitals providing maternity care. A toolkit of programs, materials and policies to reduce early elective deliveries in a covered population is being developed for employers. Being early isn’t always the best advice, especially when you are carrying precious cargo!
For more information:
The Leapfrog Group. (2014). Leapfrog Group Cautions Against Babies Being Born Too Soon, Hits National Target. http://www.leapfroggroup.org/policy_leadership/leapfrog_news/5164214
C. Terhune. Rate of babies delivered early at U.S. hospitals drops sharply. LA Times, March 2, 2014. http://lat.ms/1fLzAvQ
Midwest Business Group on Health. Preventing Early Elective Deliveries – Implementation Phase. http://www.mbgh.org/newitem4/communityintitiativesoverview/newitem1
Posted on 20 Feb 2014
I just finished reading an editorial in our local newspaper (Daily Press, Feb 19, 2014) written by Steven S. Kast, the President and CEO of the Boys & Girls Club of the Virginia peninsula. He referred to the Search Institute’s elements for positive youth development as the keys for preventing and dealing with community violence. I think it is worth revisiting those elements as we think about how to make our communities safer.
1) Provide a safe, positive environment for youth that focus not only on physical and emotional safety, but also on continuity and predictability.
2) Provide a strong sense of belonging and community ownership.
3) Ensure that youth have the opportunity to develop meaningful relationships. That is, they feel connected to one or more adults and are able to forge friendships with peers.
4) Ensure that youth have a sense of hope and real opportunities to succeed.
As Kast says, “the time for talk is over. The best practices for violence prevention already exist and need to be replicated”. The choice for investing our resources wisely is obvious: It costs more than $100,00.00 to incarcerate one juvenile for one year, while a community youth center could serve 50 youth for that same investment. It begins by realizing that the solution to youth violence already exists in our communities; we just need passion and a commitment to action to get started!
Posted on 05 Jan 2014
What is a Culture of Health? At the American Public Health Association’s annual meeting in Boston in November 2013, Dr. Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation (RWJF), stated that the U.S. “spends more on health care than any other country by far, and yet we are not healthy. In order to create a healthier nation, we must not only treat illness, but also create opportunities to pursue the healthiest lives possible.” Lavisso-Mourey defines a culture of health as “a society in which each person has the opportunity to lead a healthy life, with adequate housing, educational opportunities, safety from violence, healthy food options, exercise, and affordable, quality health care.”
How can coalitions help? We know that businesses, communities and organizations around the country are using coalitions to mobilize, plan and initiate strategies to confront some of these issues. They know that health is connected to community, opportunity, and safety, as well as medical care. Look at what a sample of coalitions have accomplished this past year:
In Virginia, two rural counties created the Eastern Shore Healthy Communities Coalition to combat obesity by initiating Smart Bites to teach teens to eat healthy, healthy menu options in 15 restaurants, an annual fitness challenge for more than 1700 residents, walking trails in 5 towns, and wellness policies in 10 major businesses.
The Healthy Lifestyle La Plata (HLLP) coalition in Colorado used farm-to-school efforts to facilitate policy and purchasing practices that resulted in local producers providing the school district’s 6,800 students and staff members with more than 480 pounds of micro greens; 380 pounds of carrots, squash, tomatoes, broccoli, mixed greens and potatoes; 100 pounds of wheat cereal and 650 pounds of ground beef annually. These changes reduce the unnecessary importation of food and decrease the carbon footprint of food transport.
In Chicago, the Midwest Business Coalition on Health, major health plans, hospital systems, perinatal directors, Il Maternal Child Health Coalition, Childbirth Connection, March of Dimes, Chamber of Commerce, and Northwestern University created the Illinois Perinatal Quality Collaborative to focus on data sharing, appropriate perinatal standards and policies. Partnering with CBS and NBC, they are engaged in a major communications campaign to educate employers and consumers about why full term delivery is the healthy choice for mothers and babies.
The Violence Prevention Coalition of Greater Los Angeles is a critical resource for organizations, policymakers and opinion leaders who are engaged in violence prevention work. Their “Tuesdays at 10” peer learning workshops use a structured format to share knowledge among members. Their Community Safety Scorecard, Breaking the School-to-Prison Pipeline project, and Gun Safety Summit to improve gun safety and reduce lethal violence underscored their prevention efforts.
These are just a few examples of how community coalitions and partnerships are involved in creating a culture of health. While one person (e.g., Nelson Mandela) or one organization (e.g., RWJF) can certainly have an impact, the power of the combined voices and actions within a given community really drives change. And it usually requires a convener organization or coalition to coalesce those voices and encourage the more difficult policy, systems and environmental actions that lead to substantive, lasting change. I submit that building and sustaining those organizations will go a long way toward creating a culture of health.
Posted on 10 Dec 2013
Autumn has been beautiful in Virginia. The days were sunny and clear. The nights were crisp with a hint of the winter chill to come. I love to watch the battlefields in Yorktown turn from green to gold as the low lying morning fogs and frost overtake them. Of course, the deer are plentiful, as they are protected by the National Park.
And since it is a time of harvest, I am happy to announce that I did get my book Ignite! published. I have great empathy for the farmers who plant and nurture their crops thorough drought and plenty – as usual, I experienced both in writing this book! But I am very excited about it and hope you will be too! Check it out at Author House, Amazon or Barnes & Noble.
I’ve been doing a lot of consulting with business coalitions on health and have learned so much about nine of these coalitions through my work with the National Business Coalitions on Health (NBCH). I even had the wonderful opportunity to help showcase their work at the annual NBCH conference in Phoenix in November. I have had the pleasure of watching them grow and take on more difficult policy work which is natural for mature coalitions.
In the autumn phase of coalition work, you should consider the following tasks:
- Keep members and organizations engaged; review/renew member agreements
- Keep membership growing and informed; replenish or expand if needed
- Address organizational needs within coalition and revise structures/procedures as needed
- Rotate and develop leadership
- Continue to revise/implement action plans and keep projects moving ahead
- Assess changes and accomplishments
- Build on past successes to move to new goals and strategies
Finally, a word about the cabin. We moved in on Thanksgiving day with the help of our family – it was a very cold day for here (20 degrees at night) but it kept the ground frozen for moving all the heavy stuff. I have to say that after all the work and worry, it turned out exactly as we had hoped. It is cozy and feels very authentic. Our builder who grew up in these mountains just said, “It’s alive again”, referring to the fact that the cabin had been moved from Bacon Hollow rebuilt again . Is it really done? No, just like your coalition, there is still much to do – caulking, the mantle, the rock overlay on the chimney, and so on.
But we lit a fire in the fireplace, threw on heavy down comforters and had the most wonderful cozy sleep after more than two years of planning. I guess the old adage is true,“Anything worth having is worth waiting for.” Happy holidays to all!
Posted on 09 Dec 2013
My earlier textbook, Coalitions and Partnerships in Community Health, a 600-page tome, was written primarily for an academic audience. I tried to bridge the gap between the academic and practitioner community by including a number of helpful appendices and tools, but it is still a daunting text. However, as I train, speak and consult around the country, I find that my audiences are clamoring constantly for practical tools and ideas for building and sustaining community partnerships that can be used in their own backyards. So, I knew I needed to write a different kind of book with them in mind.
As I was gathering wood for a campfire in the Shenandoah Mountains of Virginia last fall, I was struck by the magnetic power that fire has to attract us. Fire provides warmth, protection from wild animals, light in the darkness, and heat for cooking. Fire has a magnetic power that attracts us. The dancing flames of fire inspire romance and legendary stories, generate uplifting discussion, and build camaraderie among those circled around them. And camping just isn’t camping without a campfire … the smell, the warmth, the crackle, the glowing coals, the smoky taste of campfire-cooked meals, the songs and stories, and, of course, the s’ mores. Campfires provide a deep connection with nature, time for reflection, and feelings of peace.
While conjuring up these positive images, I began to reflect on how much constructing and feeding a campfire was like building and sustaining a community coalition. We have to find the best place to build one, gather the right kinds and amounts of firewood, construct it with solid intention, and carefully nurture it until it provides a constant flame and warmth. Similarly, for a coalition, we need to assess our current collaborative environment, gather the right partners, build an effective structure, and initiate the strategies and nurture the relationships that are likely to change our communities for the better.
Coalitions have the power to catalyze a spark of an idea about how our communities could be healthier. This spark is fed by the imagination and resources of diverse community members and organizations working in partnership until we “fire up” entire sectors of our community for positive change. So, the idea of the book was born around a campfire. And, isn’t that how most good ideas come to us … sudden and unbidden … a flint-like notion that sparks a whole new thought process.
Posted on 03 Dec 2013
I was talking to my neighbor’s 17 year old daughter the other day and the conversation went something like this:
“So, Allie, how are college plans going? Any idea about where you’d like to go or what you might study?”
“I’m planning to go to college in state – hopefully Virginia Tech or UVA. I’m not very worried about where …it’s just that I have no idea what I want to do with my life. You’re so lucky – you have a career that you love – you’ve even written books. Must be nice to have everything all planned out from the start.”
At that moment, I laughed and told her, “Nothing could be farther from the truth. My life has been full of stops, starts and detours. If you have a few minutes, I’ll tell about how far-from-planned it’s been.”
She enthusiastically nodded yes and I began the story that I’ll now share with you.
I grew up in a small town in Connecticut. My mom wanted to be a nurse, but she left school in the eighth grade to help support her widowed mother and 10 siblings. I’m sure this, plus the fact that I was drawn to the helping professions, influenced my desire to become a nurse. I wanted to attend a college that was away from home and was fortunate to receive a scholarship to Penn in Philadelphia, the city of brotherly love. I married my college sweetheart and, after graduation, worked as a public health nurse. I found that I enjoyed the teaching and counseling parts of nursing more than bedside care, so I enrolled at Penn again and earned a Masters in Secondary Education, while my husband attended Dental School under a military scholarship.
Then, we embarked on a 15 year stint with the army dental corps which took us to Italy, Germany, Texas, Pennsylvania and South Carolina. I worked as a nurse or teacher, depending on job availability, and had 3 children along the way. Later, I was told that my resume was “spotty”. Finally, at the age of 39, I had the opportunity to meld my interests and earn a doctoral degree in public health promotion and education at the University of South Carolina. We made our 17th move to settle in Yorktown, Virginia, and I started an academic career as a professor at Eastern Virginia Medical School (EVMS) in Norfolk doing community health research.
After 16 years at EVMS, I was ready for a change. I loved the consulting that I had done to provide training and technical assistance to public health agencies, non-profits and communities on building and sustaining partnerships and coalitions to improve health and well-being. I also enjoyed writing and had authored or co-authored many professional articles and book chapters, as well a textbook, Coalitions and Partnerships in Community Health. I decided to start my own consulting group to be able to do more of both . . . and Coalitions Work was born.
That was more than 5 years ago and I’ve never looked back. I just figure that life, like a coalition, is supposed to be an adventure. And it has been.