Hot Topics: New and Emerging Initiatives

Peter van Dyck: On Sunday, I introduced Steve Pelivitz to the crowd that was there on Sunday, and I haven’t introduced him to this group yet and I need to. Steve is the new Deputy Associative Administrator, which is the Deputy to me, for the Maternal and Child Health Bureau. Steve is in the back corner there. Prior to assuming his current position, which he did about four, five, six weeks ago, Steve was the Director of Survey and Certification Group in the Centers for Medicare Medical Services. In that role, he was responsible for the over sight of major operations activities such as the development, interpretation, and application of specific laws, regulations, and national policies that directly govern the operations and management of the agency programs and the interactions with the states and the regional offices.

He had responsibilities for planning and coordinating the operations of Survey and Certification, to marshal available staff, budgetary, financial, and other resources to accomplish the program missions. He also directed and coordinated the activities for day-to-day operations in the program, which provides oversight of the quality of care in healthcare providers. During HCFA’s reorganization a couple of years ago, Steve was the Chief Operating Officer of the Health Care Financing Administration. He’s testified at congressional hearings, represented HCFA’s interest to the Secretary of Health and Human Services, as well as to OMB. He’s had years of this kind of program management and administrative experience and brings this experience to the bureau. Steve is on a quick learning curve about the Bureau. He is a very quick study. I’m sure he’s absorbed a lot from this meeting and has been at the meeting the whole time, so join me in welcoming Steve to our family in Maternal and Child Health. I didn’t mention that Steve’s a lawyer, but we won’t hold that against him. Late last week we got a document from downtown, from the Deputy Secretary’s office about a new initiative. And I promised in our briefing with the Assistant Secretary for Health, Christine *Biado, that I would mention this at this meeting to make you aware because there are plans to roll out this effort in November sometime, perhaps around the third week in November. Secretary Tommy Thompson has made the elimination of health disparities one of his priorities, and a plan of action to address these racial and ethnic disparities in health has finally been written. The plan establishes the Closing the Health Gap Initiative and calls for new and expanded activities to address disparities using targeted and coordinated departmental approach.

The Closing the Health Gap Initiative also calls for focused initiatives around six areas that are department priorities: infant mortality, cancer screening and management, cardiovascular disease and stroke, diabetes, HIV-AIDS, and child and adult immunizations. And this effort that was announced and that we have this preliminary document for is for infant mortality, so Closing the Health Gap for Infant Mortality Initiative; actually it’s Closing the Health Gap Initiative on Infant Mortality. The specific goals are to reduce low birth weight and SIDS in African-American communities and two, to reduce SIDS in American Indian and Alaskan native communities. And the Closing the Gap Initiative on Infant Mortality includes three key components: research coordination, risk reduction, and collaboration. Now for the first around research collaboration, in July 2003, Secretary Thomspon established the Interagency Working Group on low birth weight and pre-term birth.

It’s an interagency council among HHS agencies. It’s chaired by myself and Dr. Dwayne Alexander, the director of NICHD, and the purpose of this Interagency Council is to galvanize multidisciplinary research, scientific exchange, policy initiatives and collaboration among all the HHS counterparts, and to assist the department in targeting efforts to achieve the greatest advances in reducing infant mortality. Another goal of this committee is to speed up the translation of research findings into applications in states and in clinics across the United States. So this--it’s actually a subcommittee interagency working group on low birth weight--has had a couple of meetings so far and is making progress on coordination and inventorying research in low birth weight and pre-term birth across the department. The second risk reduction component of this initiative will focus on reducing psychosocial and behavioral risk factors in improving access to health information and health care. Pilot projects will be established in states experiencing the highest infant mortality rates for African-American and American-Native infants, and the pilots will serve as a vehicle for translating key research outcomes into practice.

They may also address critical gaps in date collection. Now there’ll be an attempt to use existing grantees and existing grants that are across HHS in these particular high area states, which I’ll talk about in a second. And the third is collaboration; collaboration among operating divisions within federal agencies, with medical associations, and other public and private organizations will be critical to the success of the initiative. So there are two components to the collaboration. One is to build upon these existing opportunities, partnerships, and to explore opportunities. And two, to implement a long term national media strategy to educate expectant mothers and those who care for infants about steps one can take to improve an infants health, and then these will be targeted specifically to African-American low birth weight and SIDS and to American-Indian, Alaskan Native efforts around SIDS. I don’t have to go through the statistics that are cited in the report around low birth weight. I mean it fits perfectly with what we heard this morning. Other than to say in 2000, racial and ethnic minorities continue to experience the highest rates of infant mortality from low birth weight and SIDS. Infants of black and Puerto Rican mothers had the highest infant mortality rates for low birth weight, which we all know, and those rates were approximately four and two times that of infants born to white mothers. For SIDS, infants of black mothers had a rate 2.4 times that of white, and American-Indian mothers had a rate of 2.3 that of white mothers.

In September, just a month ago or so, the National Center for Health Statistics released the infant mortality statistics for 2001 for the linked birth-death set. The largest decline in cause specific infant mortality rates for that year was for SIDS, which declined by 11 percent, continuing it’s rapid decline since the 1990s or during the 1990s and largely is an effort by many of you to put babies to sleep on their backs. When examined, though by, race and ethnicity, SIDS decline by 12 percent for white mothers, 21 percent for Hispanic, 27 percent for Mexican mothers, but for black mothers only 7 percent, which was not statistically significant and not at all for American and Alaskan Native mothers. So clearly we’re behind in those two particular areas, and that’s what’s prompted this rather fairly targeted initiative. So the goals for the project: to reduce African-American infant deaths from low birth weight, to reduce African-American infant deaths from SIDS, and three, to reduce American-Indian, Alaskan native infant deaths from SIDS. And the types of objectives people are looking at are to increase the number of those populations who receive preconceptional and prenatal care, to do better about tobacco cessation programs for this population, to increase those women participating in cessation programs for alcohol and illicit drug use, to decrease the number of infants born to young or unwed mothers, increase the number of women and their families who understand the benefits of putting the baby to sleep on their backs, and to increase the number of African-American and Native American infants placed to sleep on their backs.

So not just make parents and day care centers and others aware, but actually increase the number as well. In this document, there’s a small table and I can’t share the document with you yet, but will be able to shortly. For the African-American initiative to reduce low birth weight and SIDS, the following four states are recommended as potential sites for pilots: South Carolina, Michigan, Mississippi, and Illinois. And the reason those four states are chosen is because they have consistently high rates for African-American infant mortality, low birth weight, and SIDS rates. Just to say those states rank second, fifth, 16^th, and 11^th for African-American mortality, 13, 5^th, third and sixth for low birth weight rank African-Americans, and they have the four highest percentages of African-Americans dying from SIDS as a cause of infant death than all other states. And for the American-Indian Alaskan Native SIDS Initiative, the following Indian health service areas are recommended as potential sites for pilots: the Aberdeen area and the Billings area. And for those of you who aren’t aware of the Aberdeen area, I believe it’s Iowa, Nebraska, North Dakota, and South Dakota, and Wyoming and Montana probably make up the Billings area, and that area has the highest rates of American-Indian SIDS death rates. We think this Initiative is being reviewed now. We are giving some input. We think it will be rolled out sometime in November.

I’m not sure what these pilot projects will represent. I know what we will be doing from a research standpoint, but stay tuned and be alert, and be aware, and I think it’s something, whether you’re in the four states or not that you’ll see some significant activity, probably over the next several months coming from the Secretary’s Office. So that is my hot topic and priority list. I’d just like to say it’s been wonderful to meet up with many of you again and talk to many of you again. It’s been wonderful to share some of my thoughts and ideas with you during this meeting. We have important work to do. I’m always impressed by the articulateness, the depth of the presentations, the well thought-out presentations. I’ve enjoyed all the presentations. I’ve learned from them. We have a lot to offer collectively and let’s lead together and go onward. Thank you very much for listening to me, and Cassie, I’ll turn it over to you for a few last words. Thanks, folks, very much.