Promoting Healthy Women, Infants and Children Action Plan - Introduction

"Improving the well-being of mothers, infants, and children is an important public health goal for the United States. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system." - Healthy People 2020

The health and well-being of mothers and children are fundamental to overall population health. Improving health outcomes for women, infants and children is a priority for the New York State Prevention Agenda, aligning with goals of the State's Medicaid program and Title V/Maternal Child Health Services Block Grant. Of great concern, New York's key population indicators of maternal and child health have been stagnant or worsened during the last decade. Even for measures with improving trends, there are striking racial, ethnic and economic disparities.

Maternal and child health encompass a broad scope of health conditions, behaviors and service systems. There is increasing recognition that a 'life course' perspective is needed to promote health and prevent disease across the lifespan. This perspective approaches health as a continuum and considers the impact of social, economic, environmental, biological, behavioral and psychological factors on individuals and families throughout their lives. This perspective recognizes that more than half of all pregnancies are unplanned, underscoring the importance of promoting women's health across the lifespan, with increasing attention to health during preconception (before pregnancy) and inter-conception (between pregnancies).

As part of the NYS Prevention Agenda and State Health Improvement Plan, the Promoting Healthy Women, Infants and Children (PHWIC) Action Plan addresses three key life course periods - maternal and infant health, child health and reproductive/preconception/inter-conception health - with goals, objectives and indicators for each. The Plan identifies evidence-based and promising practices, programs and policies to achieve these goals and objectives, guided by the five levels described in A Framework for Public Health Action: the Health Impact Pyramid,1 commonly referred to as the Health Impact Pyramid. The Action Plan was created with input from stakeholders representing sectors and organizations with an interest in improving the health and well-being of women, infants, children and families. The Plan should serve as a road map across the public health system to incorporate effective actions into their work, which collectively will help "move the needle" on priority health outcomes and reduce health disparities.

To make this Plan feasible, its development committee identified two to three goals for each focus area. This strategy was guided by goals of reducing racial, ethnic and economic disparities; advancing a life course perspective; and addressing social determinants of health. In addition, the committee considered these criteria in setting PHWIC action plan priorities:

  • Impact on individual and population health.
  • Ability to identify measureable outcomes.
  • Availability of data to track progress, ideally at the community level
  • Existence of an evidence base for action.
  • Need for broad cross-sector collaboration to make progress.
  • Alignment with other priority public health initiatives.

Committee members selected seven priority outcomes for the PHWIC Action Plan and 2013-2018 Prevention Agenda/State Health Improvement Plan:

  • Maternal and Infant Health
    • Preterm birth
    • Breastfeeding
    • Maternal Mortality
  • Child Health
    • Use of comprehensive well-child care
    • Prevention of dental caries
  • Reproductive/Preconception/Inter-conception Health
    • Prevention of adolescent and unintended pregnancy
    • Use of preventative health care services by women of reproductive age

Other sections of the State Health Improvement Plan have overlapping, but aligned, goals, as expected with a comprehensive lifespan perspective. Critical influences on maternal, infant and child health include mental health and wellness, substance abuse/addiction, interpersonal and community violence, environmental exposures and the impact of chronic disease.

For each goal, the Promoting Healthy Women, Infants and Children Action Plan contains the following sections:

Defining the Problem
Background information and statistics on the issue, including information about disparities, provide perspective to help the community determine its focus within the broader public health scope of healthy women, infants and children.
Goals and Objectives
Goals, objectives and indicators are provided for each priority outcome to help set targets, assess current status and track progress. Baseline data, data sources and data availability are provided for each indicator. For each goal and accompanying objectives, one to three tracking indicators will be tracked and reported by NYSDOH at the State (where available) and county levels, as part of the Prevention Agenda implementation. These tracking indicators were chosen because of their relevance to the goal and objectives, data quality and reliability, and data availability at the county level. For some goals and objectives, additional indicators are also provided for reference; these indicators will not be reported and tracked for the Prevention Agenda/SHIP by NYSDOH, but may support the work of its partners. Comparable Healthy People 2020 national objective, targets and baseline data have been included.
Interventions
The Action Plan recommends interventions to address each focus area and related goals. The interventions listed were selected after taking into account the interventions' evidence base, potential to address health inequities, ability to measure success, potential reach, potential for broad partner support and collaboration, and political feasibility. Interventions are summarized in complementary formats:
Interventions for Action
summarizes strategies through the framework of the Health Impact Pyramid, highlighting interventions at each of the five defined tiers: Counseling and Education, Clinical Interventions, Long-Lasting Protective Interventions, Changing the Context to Make Individuals' Default Decisions Healthy and Socioeconomic Factors.
Interventions by Sector
highlights selected interventions and specific actions that various sectors are well positioned to carry out. This approach recognizes that each sector can play unique roles in advancing the overall implementation of effective interventions that collectively 'move the needle' on target outcomes. The selection of interventions, for each sector, serve as a starting point for action planning, not a complete list of potential strategies. It is anticipated that partners representing these sectors will expand and refine these lists throughout implementation.