AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
DOUGLAS PATERSON: You get the Cliff 's Notes version at this point. Everybody stand up, because I see some of you are struggling a little bit. Stand up a minute and stretch for a minute. Meanwhile, I'm going to tell you, this is the Mackinaw Bridge . How many know Michigan has two peninsulas? Very good. I don't know why we call the upper peninsula the UP. But we never call the lower peninsula the LP. But we do.
So it's also time for a small joke about the ‑‑ we call them UPers, the people in UP and a Texan. There's so much expanse in the upper peninsula, you can drive for 50 miles, never see anybody or anything. So these two gentlemen, a Texan and UPer, are in the bar, talking about how much land they own; and finally the UPer talks to the Texan, "Just how much land do you own and how big is your ranch in Texas ?" And the Texan puts it this way: I get in the pickup in the morning, drive all day, and I can't get to the other side of the ranch. The UPer says: "Yeah, I got a pickup just like that."
So I'll give you the Cliff 's Notes version. How many of you think you practice medicine? Right. Not very many. But you actually do. You're deciding every day whether you ought to take a aspirin for the headache and other things. We have the same problem with epidemiology. Unless you're trained in the science of epidemiology, most people don't think they practice it. But the reality is almost everybody is doing some form of epidemiology, betraying quite in the science. But constantly I think everybody in this room, my colleagues and others, are looking at ways we can prevent and do exactly this: Study the distribution, effects and causes of diseases and means by which they can be treated or prevented.
That's really what epidemiology is. And so the roles of public health, I'm not going to go into this, you guys all know them. But in every one of these areas if I had a little bit more time I would have explained to you how Child Death Review actually takes part in all of these. Because it does assess, it does investigate occurrences of things. It does set priorities among needs. It does help; we promulgate laws. In Michigan, we just had a law passed that requires the Department to promulgate a rule that death investigation must be done before a SIDS diagnosis can or a cause of death can be put on their certificate. And that's clearly been because of the Child Death Movement and also assurance, in terms of evaluating programs and what we're doing. I think if you haven't heard anything else, if we did not have the kind of investigation and the movement forward over the last few years, we would probably have stopped with the Back to Sleep Campaign and thought that's all we could do. But I think as you hear these very compelling things, putting babies on their backs has made some difference. Some of that probably, a likelihood of there less likely to be in these less compromised position than physiology. There may be some still physiologic but we're not sure. As Pat will tell you she goes into every one of these if you dig enough you'll find there was. And there's a natural human desire to want to try to take care of the guilt with the family and try to say something this is something that could have happened. I had a brother died of SIDS and my mother from the fact she was comforted by nothing could have been done having the knowledge I have now in 1942 it's very likely that other circumstances nobody else knew about or these situations were in place. I'm glad she didn't have to live with it. But I think if we had done that earlier we would have been further ahead on this today.
The diagnostic shift sometimes we think of as bad. In this case I think it's great, because as long as we continue to think that SIDS is something we can't do anything about and aren't given real causes we'd still be trying to give out apnea, you know you're all part of that movement where everybody was doing the apnea monitors and so on. What a waste of money and time.
So, anyway, quickly why CDR and Title V should be tied to each other? If you don't already know this, probably been in a cave for the last ten years, but there are 19 national performance measures and ten state negotiated performance measures. Two of them are very specific to death, the rate of death to children under age 14 due to motor vehicle crashes and the rate of suicide deaths among youth age 15, but all six of the outcome measures deal with infant death. You've got the handouts. I won't read those to you.
Actually, I first did this speech when I was talking to Child Death Review saying: Why should they be tying to Title V, I'm telling them that we have a common mission; we usually have human and money resources more limited all the time. We're often doing things already, such as SIDS prevention, infant mortality and those types of things. But importantly for all of you to know why should we tie the CDR. It's basically because it does have valuable epi information.
And my best story about qualitative information is about the survey that was done one time to determine how many people felt safe living in their neighborhood. And 70% of the people in this neighborhood felt that they were safe, and yet it had these crime rates and all kinds of things going on. When they finally went back and they asked a woman: Why do you feel safe? She said because I don't go out after 5:00 at night. It's that kind of information that the Child Death Review can give us that puts something behind these numbers and helps the Title V programs and others that are interested in prevention put preventive, the real prevention strategies to work.
We have the CDR can provide input for our needs assessment. Clearly. It brings the community perspective. I think that's the most useful information is that we have Child Death Review teams in Michigan in all of our counties and the county people are looking at this and telling us, you know, in each community what could have prevented each of these deaths. Extremely valuable. And it can help us meet our accountability and reporting needs but most of all it's like everything else we do in life. It's simply the right thing to do. So I will leave you with the famous philosopher Henry Ford, who, as I learn more about him, really did not much but take advantage of other people. But because he's a Michiganian, I quote him, "Whether you think you can or you can't, you're right." Thank you.