Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003

What is MCH EPI?

ARDEN HANDLER: Thank you very much for inviting me to this, this morning, and I just want to apologize ahead of time.  I am going to give us history from my rendition of what I think has happened over the last 20 years, and I apologize ahead of time if I have forgotten any important milestones or any important people, and actually I need to start moving this.  Let’s see how this work?  Okay.  From my point of view and from what I can figure out MCH Epidemiology emerges as distinct field for Public Health Practice in the mid-to-late 1980s.  And in the case of academe we are really trying to meet the needs of practice almost a decade later MCH EPI emerges as a distinct field for public health academe.  The field of MCH EPI really has developed in response to specific historical events, which I will try to delineate in the next few slides.  In 1981, if you remember, with the MCH block grant there really became a new emphasis or de-emphasis in Maternal and Child Health at federal level, was really a strong hands of approach by the Federal Title V on the agency with respect to the states.

In that time, and in that vacuum, many states took the initiatives on their own to begin to analyze vital statistic status such as they were at the time and still being one of the most readily available data sets.  And the focus became on low birth rate and mortality in members of southern governors’ regional task force, and of mortality as an example.  In the mid 1980s-1986, CDC and HRSA officially launched the MCH EPI program, and I should say though that when I was trying to put this together, I e-mailed my colleagues.  And Dr. Roger Roche gave me a long, long e-mail and let me know, how in fact, prior to DRH, that was the office of Family Planning Evaluation, and they had a history of placing the EIS officers in State Local Health Department to do Family Planning work. 

And when Carol Hogue and Bill Stephenfield came to DRH that sort of the focus for Family Planning became broader, and the idea of higher level assignees, as opposed EIS level of assignees came in to play.  But the purpose and you will see this is similar to our definition at that time was to support state efforts to develop their analytic capabilities, thereby, giving state program managers the tools and long-term capacity to make improved decisions for MCH activities.  In 1988, we have the release of the future Public Health Report and as you know Public Health Agencies began to evaluate their capacity to implement the core functions of assessment policy development and assurance and they overcame this increased switch in emphasis from Personal Health Services to population approach.  And with an increased focus on population approach, came an increased demand for denominator data for not just the count of women and children served by Title V, therefore, the population served.  And there was a new drive for new data sets, for link data sets, and for increased analysis of the available data. 

In 1989, thank God, in response to the sort of reckless years of the 80s, we had over in 1989 and the reaction to the hands-off approach from Maternal Child Health Care and from the advocates from the health who demanded these things was that we have a new increased accountability for  Title V agencies and they came in November 1989.  The requirement for an annual application to the secretary of the DHHS, the five-year needs assessment, some of you dread it, but it is very important.  The plan for meeting year 2000 and now the year 2010 goals and objectives for women and children, and the important requirements that reflect the health of the entire MCH population not just the individual served.  Knowing that the States would need help in trying to meet this new data requirements, Maternal Child Health Care had foresight and began to fund training programs to enhance the analytical skills of the MCH professionals.  Four training programs were funded in 1989, only one of those at UIC was really focused though on the field, the other three really focused on the students in academe in graduate education programs. 

It was also pretty early on in 1992 with Graduate Student Internship Program, which we called GSIP began to place students from State Local Health Agencies to be involved in a variety of analytic projects.  In the mid 1990s, building on the East approach of doing continuing education to enhance the analytic skills of the fields, MCHB again funded three different universities to enhance analytic skills in continuing education projects FHAC, UCF, DLA, UIC, and University of North Carolina.  In 1996, my colleagues and I, and John Connelly, and Stacey Galore and also I was in concert with Debra Rosenberg, we began an evaluation, we were asked to do the CDC HRSA MCH Epidemiology Program evaluation and we focused our evaluation in four distinct areas.  We based some of this on work done on evaluation of chronic disease epidemiology, vision and planning, infrastructure analysis, and utilization of MCH data, and translation and dissemination of MCH data, and importantly that worked.  The evaluation of the CDC HRSA MCH Epidemiology Program led us to the definition that we will see today at the MCH Epidemiology.  I want to say though that we do not develop this alone, but we were doing this codifying the work of our team colleagues, particularly Bill Stephenfield, Roger Roche, Gail Charles, and Honey Estrous as well as others.  We took the definition, it came from practice, we have not been sitting in academe we wrote it up, but it was clearly the work of practitioners. 

The classic definition of epidemiology is the study of the distribution, determinants, and occurrence of disease, and health-related condition in population, most often translated into health behavior interventions and clinical practice interventions.  But in state and local health agencies MCH Health Agencies, production of knowledge alone or production of knowledge for translation to clinical practice is not sufficient.  In our view, MCH Epidemiology is the study of the distribution and determinants of MCH disease and health conditions for the direct and immediate purpose of carrying out the activities of the MCH planning cycle, surveillance and monitoring, assessment, program development, evaluation, policy development, and advocacy.  Our official definition of MCH EPI is “the systematic analysis and interpretation of population-based and program specific health-related data in order to assess the distribution and determinants of the health status and needs of the MCH population for the purpose of implementing effective interventions and promoting policy development.”  Based on this definition in our view, the MCH Epidemiology uses the tools, the prevention framework, and all the other pieces that come from epidemiology and population-based focus of EPI to enhance the ability of State and local MCH programs to carry out the core functions of public health.  Since the prolongation of this definition, but not necessarily because of it, the field has taken off.  In 1995, we began the HRSA CDC MC Annual Conference, which we are doing today.  We saw 1998 and 1999 information of the National Action Agenda, which became the National Action Alliance to promote this kind of work.  In 2000, the MCH EPI awards began, in 2000 also the MCHB sponsored Doctoral awards for the enhancement of the EPI training program. 

Many of our students from that program are here today.  In 2001, HRSA and CDC began to sponsor a training course very much like our original East Program and called the training course at MCH Epidemiology.  We now have our certificate program in MCH Epidemiology at Emory.  We had needs assessment specifically focussed on MCH EPI capacity.  We have an MCH EPI training fellows program.  Wow!  We are doing a lot.  So, here we are, it’s 2003, and we are still asking the question “Is MCH EPI a distinct field?”  Is it different from the repro EPI folks?  Is it different than perinatal EPI from pediatric or injury EPI or adolescent EPI.  For example, why is this not the same exact meeting as the society of pediatric and perinatal epidemiologist some of you go to that meeting, many of you don’t.  Lot of those folks do not come here.  We are somewhat different.  We believe that this is a distinct field, particularly distinct from the ideologic MCH-related epidemiology, and in our mind it is distinct because we embrace both, focus on the analytic skills, but also the MCH planning cycles skills, the planning, the evaluation, the policy analysis, program development, etc.  We use the term epidemiology because epidemiology is the science basis of public health.  We are very broad thinkers though, and we think of epidemiology is embracing field such as sociology in the social sciences and demography.  We use that word though because we come from public health and we are public health folks I mean like that work.  We feel good about it. 

We also though, I want to say view you know there is going to be some discussion here that MCH Epidemiology is everything we want to be an MCH.  We do think from our prospective that these are different.  The MCH program director, and MCH Epidemiologist are not exactly the same person with exact similar set of skills.  There are people in this room, who could do both.  They are sitting here to my right and my left, absolutely, but not everybody can, and not everybody wishes to more importantly.  I personally probably would be better off being the MCH program director than the MCH epidemiologist, but have skills in both directions.  I do not want to shift there and think about programming and coding.  I want to sit there and think about program development.  So, there are different sets of skills, some people have overlapping, but this is a distinct field and we do believe that our affiliation embraces its distinction, but also it is overarching capturing of what people do in the field.  Thank you very much and I look forward to the rest of the discussion.