Department of Maternal and Child Health

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MCH/Public HealthMilestonesPart X 1980-1989
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Greg R. Alexander, MPH, ScDCathy Chadwick, MPH
Donna J. Petersen, MHS, ScDMaryAnn Pass, MD,
MPH Martha Slay, MPHNicole Shumpert, BS

• Department of Maternal and Child Health
• The MCH Leadership Skills Training Institute
• University of Alabama at Birmingham

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Acknowledgement

• Supported by funding from the Maternal and Child
  Health Bureau

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1980
New Federalism
Reorganization of Health, Education, and
Welfaredivision to Department of Health and
Human Services and Department of
Educationmajor cuts in social services
Onset of AIDS
Increased morbidity due to chronic diseases and
behavior
Healthy Mothers, Healthy Babies Coalition
Introduction of various legislature concerning
Title V and Medicaid
Baby Doe Rules Preventing Low Birth Weight by IOM
Crippled Children Services renamed Children with
Special Health Care Needs
Early Intervention and Preschool Programs for
Children with Disabilities included in
legislature
Future of Public Health
1989
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The 1980s

• Reaganomics and Deficit Spending
• Block Grants
• Incremental Medicaid Expansions
• Intense interest in infant mortality
• Interest in children
• Expansion of PL 94-142, preschool, 0-3
• Healthy Mothers, Healthy Babies

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President Ronald Reagan
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1980 Select Panel for the Promotion of Child
Health

• Through the enactment of P.L. 95-626, a Select
  Panel for the Promotion of Child Health was
  established.
• The Panel, which was comprised of 17 members
  from the public and private sectors, issued a
  report, Better Health for Our Children A
  National Strategy, in December 1980.

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(No Transcript)
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Reorganization DHEW

• One of the first moves of the Reagan
  administration was to reorganize the Department
  of Health, Education and Welfare.
• The Departments responsibilities were divided
  among the newly named Department of Health and
  Human Services and the Department of Education.

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Department of Health and Human Services
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1981 AIDS

• Publication in MMWR regarding a killer strain
  of pneumonia targeting homosexual men.
• Onset of greatest public health disaster.
• Pediatric issues involved for children living
  with HIV and those left behind by parents who die
  from AIDS.

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AIDS Era Introduction of Universal Precautions
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1981 Omnibus Budget Reconciliation Act P.L.
97-35

• Title V of the Social Security Act was amended
  drastically in 1981 through the Omnibus Budget
  Reconciliation Act of 1981 (PL 97-35). (OBRA)
• Although the Act did not change the programs
  focus on services to high-risk mothers and
  children, it modified the method of supplying the
  money to the states (block grants), as well as
  the role of the federal government.
• The Act was based on the premise that states
  had greater knowledge and expertise to assess the
  priority health needs of their women and
  children, and were better able to apply the
  resources appropriately.

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(No Transcript)
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1981 Healthy Mothers, Healthy Babies Coalition

• The National Healthy Mothers, Healthy Babies
  Coalition (HMHB) began in 1981, prompted by the
  U.S. Surgeon General's conference on infant
  mortality.
• American College of Obstetricians and
  Gynecologists, March of Dimes, American Academy
  of Pediatrics, American Nurses Association,
  National Congress of Parents and Teachers, and
  U.S. Public Health Service helped establish this
  coalition to improve the quality and reach of
  public and professional education related to
  prenatal infant care.

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Healthy Mothers, Healthy Babies National Coalition
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1983 Select Committee on Children, Youth and
Families

• This committee was formed in the U.S. House of
  Representatives to advise the House of
  Representatives on the problems and needs of
  children, youth, and families.

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1984 Baby Doe Rules

• Increasing concern that newborns with
  handicapped conditions were being denied
  life-sustaining treatment led to the development
  of Baby Doe Rules.
• These rules, issued by the Department of Health
  and Human Services in January 1984, were
  developed to ensure that the withholding of
  treatment to these infants would no longer occur.

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(No Transcript)
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DEFRA

• The Deficit Reduction Act of 1984 mandated state
  Medicaid coverage for
• all children under the age of five (including
  children in two-parent families), whose families
  incomes and resources meet the States AFDC
  financial eligibility test, and
• all pregnant women with their children living
  with them who would qualify for either the AFDC
  or AFDC-Unemployed Parent programs .

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(No Transcript)
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1984 Child Safety Seats

• State laws requiring all children under the age
  of 4 years to be in a child safety seat when
  riding in any vehicle were passed throughout the
  country.

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(No Transcript)
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1985 Preventing Low Birth WeightInstitute of
Medicine Report

• The Institute of Medicine convened an
  interdisciplinary committee in 1983 to study the
  causes and prevention of premature birth and
  intrauterine growth retardation, the twin
  contributors to low birth weight.
• The conclusion of the committee was that
  preventing low birth weight in the United States
  would significantly reduce infant mortality rates
  and improve child health.

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Low Birth Weight/Premature Infant
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1986 CCS Renamed Children with Special Health
Care Needs

• In 1986, Surgeon General C. Everett Chick
  Koop coined the phrase Children with Special
  Health Care Needs to replace of the old Crippled
  Children Services (CCS).

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C. Everett Koop
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COBRA

• The Consolidated Budget Reconciliation Act of
  1986 (COBRA) extended Medicaid coverage to all
  pregnant women with family incomes below AFDC
  eligibility levels.

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(No Transcript)
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SOBRA

• The Sixth Omnibus Budget Reconciliation Act of
  1986 provided states the option of extending
  Medicaid to pregnant women and children under age
  five (on a year-by-year phased-in basis) whose
  family incomes exceeded AFDC eligibility levels,
  but were less than the federal poverty level.

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(No Transcript)
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Education of All Handicapped Children Act Amended
P.L. 99-457

• The new Early Intervention and Preschool
  Programs under P.L. 99-457, were part of the
  re-authorization of P.L. 94-142, Education of All
  Handicapped Children Act (EHA).
• This new Federal mandate was established to
  assist states in the development and
  implementation of a comprehensive program of
  early intervention.
• It also provided incentives for states to serve
  all children three-to-five years of age with
  handicaps.

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(No Transcript)
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1987 Surgeon Generals Report onChildren with
Special Health Care Needs

• The Surgeon Generals Report on Children with
  Special Health Care Needs addressed the unique
  health care needs of certain children.
• The report made specific recommendations to
  define the scope of the problem, develop
  standards, develop systems of care, improve
  methods of financing, support research, and
  support training for health professionals.

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OBRA

• The Omnibus Budget Reconciliation Act (OBRA)
  covered children up to age seven up to 100 of
  poverty, and pregnant women and infants up to
  185 of poverty.

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(No Transcript)
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1988 The Future of Public Health

• Core Public Health Functions
• Assessment
• Policy Development
• Assurance

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The Future of Public Health Report by Institute
of Medicine
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OBRA 1989 Amendments to Title V

• Reintroduced Accountability
• Needs assessments required
• Annual reporting required
• Earmarking of expenditures
• Explicit focus on family-centered,
  community-based, coordinated care
• Focus on assurance and on population

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Maternal and Child Health/Public Health
Milestones 1980-1989 Photo Acknowledgements

• Slide 6 www.encarta.com. Ronald Reagan was
  elected president of the United States in 1980
  and again in 1984. In his campaigns for office,
  Reagan stressed themes of self-reliance,
  traditional values, family, and patriotism. He
  was also a strong opponent of Communism. He
  launched a global crusade against governments
  that he believed were influenced by the USSR.
  Reagan is speaking on Communism in a speech he
  delivered in 1983.
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• Slide 8 Microsoft Design Gallery Live.
  http//dgl.microsoft.com
• Slide12 www.cdc.gov. Health worker obtaining
  blood samples from a patient. CDC photo.
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• Slide 14 www.cdc.gov. Woman with child. CDC
  photo.
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• Slide 16 www.hmhb.org
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• Slide 18 Microsoft Design Gallery Live.
  http//dgl.microsoft.com
• Slide 20 DHEW book.
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• Slide 22 Family Planning Perspectives
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• Slide 24 www.nhtsa.dot.gov/people/injury/childps
  /csr2001/csrhtml/index.html
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• Slide 26 www.neonatology.org/

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Maternal and Child Health/Public Health
Milestones 1980-1989 Photo Acknowledgements

• Slide 28 American Obesity Association.
  www.obesity.org
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• Slide 30, 32 Family Planning Perspectives
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• Slide 34 www.encarta.com
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• Slide 36 Vernon Heath, a former Gillette
  patient, and his wife Iona share a special moment
  with Ben Harbst, a current patient who has
  cerebral palsy. Vernon, chairman of Rosemount
  Office Systems, Inc., contracted polio as a child
  and came to Gillette for treatment. Ben currently
  receives Botox injections to help reduce his
  spasticity. www.gillettechildrens.org
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• Slide 38 www.encarta.com
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• Slide 40 National Library of Medicine
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• Slide 42 National Academy Press. www.nap.edu
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• DHEW book U.S. Department of Health, Education,
  and Welfare, Public Health Service, Health
  Services Administration. Child Health in
  American.

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CREDITS

• This work builds upon the earlier efforts of
  Dr. Allan C. Oglesby, Cindy Camberg, EdD, and
  Cathy Chadwick of the Maternal and Child Health
  Institute to Increase Leadership Skills Project,
  San Diego State University, and draws upon their
  Manual of the History and Philosophy of Maternal
  and Child Health as a foundation for this
  multi-volume series.