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Association of State and Territorial Public Health Nutrition Directors June, 2004

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab

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Association of State and Territorial Public Health Nutrition Directors June, 2004

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  1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. Association of State and Territorial Public Health Nutrition Directors June, 2004 Health Resources And Services Administration Maternal And Child Health Bureau Peter C. Van Dyck, MD, MPH

  2. MCH BUREAU LEADERSHIP

  3. MCHB Strategic Plan Goals • Provide National Leadership for Maternal and Child Health by creating a shared vision and goals for MCH, informing the public about MCH needs and issues, modeling new approaches to strengthen MCH, forging strong collaborative partnerships, and fostering a respectful environment that supports creativity, action, and accountability for MCH issues.

  4. MCHB Strategic Plan Goals • Eliminate health disparities in health status outcomes, through the removal of economic, social and cultural barriers to receiving comprehensive timely and appropriate health care

  5. MCHB Strategic Plan Goals • To assure the highest quality of care through the development of practice guidance, data monitoring, and evaluation tools; the utilization of evidence-based research; and the availability of a well-trained, culturally diverse workforce

  6. MCHB Strategic Plan Goals • To facilitate access to care through the development and improvement of the MCH health infrastructure and systems of care to enhance the provision of the necessary coordinated, quality health care

  7. The MCH Budget for 2003 and 2004(millions) FY2003 FY2004(PB) • MCH Block Grant1…$730.0…...$750.8 • State Block Grant….…$599.0……….$622.4 • SPRANS(General).…..$105.7………..$109.1 • CISS………………..….…$ 15.9………..$ 19.3 • SPRANS(Earmark).....$ 9.4…….....$ 0.0 1-numbers will not add due to rounding

  8. The MCH Budget for 2003 and 2004(millions) FY2003 FY2004(PB) • Healthy Start……………..…$ 98.3…………...$ 98.7 • Hearing Screening…….….$ 9.9……….….$ 0.0 • EMSC…………………….….…$ 19.4………..….$ 18.9 • Poison Control Center…...$ 22.4………..….$ 21.2 • Trauma/EMS…………………$ 3.5 ….…...…$ 0.0 • AbEd Community…….…….$ 54.6…….…….$ 73.0 • AbEd State……………….…..$ 50.0…….…….$ 50.0 • Bioterrorism………………….$ 514.6…………..$ 518.1 • Traumatic Brain(TBI)*…..$ 9.4……….….$ 7.5

  9. MCH BUREAU PROGRAM STRENGTHS

  10. MCHB Program Strengths • Genuine partnership between federal government, states, and communities • Statement of priorities consistent with the healthy people 2000 and 2010 goals • Commitment to both federal and state financing evidenced by match of 4 federal to 3 state dollars

  11. MCHB Program Strengths • 5 year needs assessment planning • Framework that targets states’ expenditures to the entire MCH population--infants, children, adolescents, women, pregnant women, CSHCN

  12. MCHB Program Strengths • Flexibility for states’ to tailor programs • Commitment for coordination with all other major children’s programs--idea, WIC, medicaid, SCHIP, nutrition, headstart, early intervention

  13. CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES DIRECT HEALTH CARE SERVICES (GAP FILLING) Examples: Basic Health Services and Health Services for CSHCN MCH CHC EPSDT SCHIP ENABLING SERVICES Examples: Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, Coordination with Medicaid, WIC and Education POPULATION--BASED SERVICES Examples: Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Counseling, Oral Health, Injury Prevention, Nutrition and Outreach/Public Education INFRASTRUCTURE BUILDING SERVICES Examples: Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care and Information Systems

  14. MCH BUREAU ACCOUNTABILITY

  15. MCH Bureau Performance Measurement System PRIORITIES AND GOALS MCHB MCHB PROGRAM AND RESOURCE ALLOCATION MCHB PERFORMANCE MEASURES MCHB OUTCOME MEASURES MCHB NEEDS ASSESSMENT HEALTH STATUS INDICATORS PERINATAL MORTALITY STATE BLOCK GRANT STATE/ NATIONAL INDICATORS I. DECREASE DISPARITIES INFANT MORTALITY DIRECT HEALTH SPRANS HEALTHY PEOPLE 2010 NEONATAL MORTALITY II. INCREASE QUALITY ENABLING SERVICES HEALTHY START POSTNEONATAL MORTALITY LEGISLATIVE PRIORITIES POPULATION BASED EMERGENCY SERVICES FOR CHILDREN CHILD MORTALITY III. IMPROVE INFRASTRUCTURE PARTNERSHIPS INPUT TRAUMATIC BRAIN INJURY INFRASTRUCTURE SERVICES INFANT DEATH DISPARITY

  16. Title V SPRANS Performance Measurement System SPRANS NEEDS ASSESSMENT HEALTH STATUS INDICATORS SPRANS PRIORITIES AND GOALS SPRANS PROGRAM AND RESOURCE ALLOCATION SPRANS PERFORMANCE MEASURES SPRANS OUTCOME MEASURES PERINATAL MORTALITY DSCSHCN STATE/ NATIONAL INDICATORS I. DECREASE DISPARITIES INFANT MORTALITY DIRECT HEALTH DCAFH HEALTHY PEOPLE 2010 NEONATAL MORTALITY II. INCREASE QUALITY ENABLING SERVICES DRTE POSTNEONATAL MORTALITY LEGISLATIVE PRIORITIES DPSWH POPULATION BASED CHILD MORTALITY DSCH III. IMPROVE INFRASTRUCTURE PARTNERSHIPS INPUT INFRASTRUCTURE SERVICES ODIM INFANT DEATH DISPARITY

  17. Criteria For Selecting Performance Measures • Relevant to state Title V activities • Understandable to policy makers and the public • Process and capacity measures should link to the outcome measures

  18. Criteria For Selecting Performance Measures • Measurable change expected within 5 years • Consideration for measures which are prevention focused • Data generally available from majority of state

  19. The 18 National Performance Measures • 10) The rate of deaths to children aged 1-14 caused by motor vehicle crashes per 100,000 children. • 11) Percentage of mothers who breastfeed their infants at hospital discharge. • 12) Percentage of newborns who have been screened for hearing impairment before hospital discharge.

  20. The State Performance Measures—Keyword Search • Nutrition/Physical activity • 34 States with 49 performance measures • Obesity • 19 States with 20 performance measures

  21. The 9 Health Systems Capacity Indicators • 09C) The ability of States to monitor overweight or obesity among children and youth (as reported in the 2002 Annual Block Grant Report)

  22. The 9 Health Systems Capacity Indicators • YRBS • 51 of 59 States participate • 36 (61%) sample size is large enough for statewide estimates • 15 (25%) sample size too small • 8 (14%) do not participate

  23. The 9 Health Systems Capacity Indicators • Pediatric Nutrition Surveillance System • 40 of 59 States participate • 35 (59%) sample size is large enough for statewide estimates • 5 (9%) sample size too small • 19 (32%) do not participate

  24. The 9 Health Systems Capacity Indicators • WIC Nutrition Survey • 54 of 59 States participate • 49 (83%) sample size is large enough for statewide estimates • 5 (9%) sample size too small • 5 (9%) do not participate

  25. The 37 Discretionary Performance Measures • 08) Percent of graduates of MCHB long-term training programs that demonstrate field leadership after graduation • 33) The degree to which a State system for nutrition services has been established for MCH populations

  26. The Children’s Health Survey • Height and Weight • Food allergy or digestive problem • Breast feeding(0-5) • How concerned are you about eating disorders(6-17)

  27. MCHB’s ERP Printed Reports Electronic search Across States and Years and retrieval Title V IS State ERP Automated updating Automated search and error checking and sorting Printed Forms Title V Information System Data Data Other Data Sources Database Searches on the Internet

  28. Focus Area 19:Nutrition and OverweightProgress Review January 21, 2004

  29. Impact of Nutrition and Overweight on the Health of Americans • Dietary factors are associated with 4 of the 10 leading causes of death (CHD, some types of cancer, stroke, and type 2 diabetes) • These diet-related conditions are estimated to cost society over $200 billion annually in medical expenses and lost productivity • Dietary factors are associated with osteoporosis, which affects over 25 million persons in the U.S.

  30. Improving Getting worse Little or no change Cannot assess (limited data) Nutrition and Overweight Objectives Weight Status and Growth Iron Deficiency and Anemia Healthy weight in adults Obesity in adults Overweight or obesity in children and adolescents Growth retardation in children Iron deficiency in young children and in females of childbearing age Anemia in low-income pregnant females Iron deficiency in pregnant females (dev.) Schools, Worksites, and Nutrition Counseling Food and Nutrient Consumption Fruit intake Vegetable intake Grain product intake Saturated fat intake Total fat intake Sodium intake Calcium intake Meals and snacks at school (dev.) Worksite promotion of nutrition education and weight management Nutrition counseling for medical conditions Food Security Food security

  31. Highlighted Objectives 19-1. Healthy weight in adults 19-2. Obesity in adults 19-3. Overweight or obesity in children and adolescents 19-5. Fruit consumption 19-6. Vegetable consumption 19-7. Grain consumption

  32. Trends in Child and Adolescent Overweight Percent Percent Males 12-19 Males 6-11 Females 12-19 Females 6-11 1963-67 1971-74 1976-80 1988-94 1999-2000 1966-70 Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC. Obj. 19-2

  33. Child and Adolescent Overweight by Race: 1988-94 to 1999-2000 2010 Target 1988-94 Total White Black Mexican American Female Male 0 10 20 30 Percent Note: Overweight is defined for ages 6-19 years as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-3c

  34. Fruits and Vegetables: Average Number of Daily Servings by Race: 1999-2000 White Black Mexican American Average number of servings Total Minimum Recommended Vegetables Fruits Note: Data are age-adjusted to the 2000 standard population for ages 2 years and over. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Objs. 19-5 19-6

  35. Fruit Consumption by State, 2002 D.C. N Proportion with 2+ fruit servings a day (14) (17) (20) 25.0% + 20.0 -24.9% <19.9% Note: Data are for ages 18 years and over. Source: Behavioral Risk Factor Surveillance System, NCCDPHP, CDC. Obj. 19-5

  36. Fried potatoes Fried potatoes 22% Other 46% Tomatoes potatoes 11% 13% Tomatoes Legumes Other Dark green/ 9% 8% potatoes orange 10% Legumes Dark 11% 6% All others All others green/ 22% 35% orange 8% Proportion of Vegetable Servings 1999-2000 Children 2-19 years Adults 20 years and over Target = At least 1/3 dark green/orange Note: Data are age adjusted to the 2000 standard population for adults 20 years and over. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-6

  37. Proportion of Grain Servings 1999-2000 Children 2-19 years Adults 20 years and over Target = 1/2 whole grain Note: Data are age adjusted to the 2000 standard population for adults 20 years and over. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-7

  38. Important Information • All grantee meeting--October 3-6 • Child Health Day--October 4 • CSHCN survey ‘easy’ web site • WWW.CSHCNDATA.ORG • Stopbullyingnow.hrsa.gov

  39. Contact Information Peter C. van Dyck, MD, MPH pvandyck@hrsa.gov Data Site https://performance.hrsa.gov/mchb/mchreports

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