Environmental health and maternal and child health: Healthy Start strategies

1. CityMatCH Conference 2008 September 20-23, 2008 Albuquerque, NM Environmental health and maternal and child health: Healthy Start strategies

2. Why is environmental health critical to maternal and child health? Sub-standard housing is associated with increased risks of infectious diseases, chronic diseases such as asthma, and more injuries and safety problems. (Krieger,Higgins,(2002)Housing and health: time again for public health action, AJPH, 758-768) The life course perspective clearly shows that poor environmental health conditions adversely impact future health of children

3. Environmental health disparities persist �The elimination of disparities in environmental health requires attention to both environmental hazards and social conditions.� (U.S. Environmental Protection Agency, EPA, 2003; Institute of Medicine, 1999)

4. Environmental health disparities and maternal and child health Poor neighborhoods and their residents left out of the �Greening of America� Environmental justice is a key component of elimination of health disparities.

5. Community and home environment of pregnant/parenting families Community-based programs such as Healthy Start use a holistic approach to elimination of health disparities. This approach involves multiple levels of intervention including partnerships with community organizations, advocacy, and case management.

6. Case management: home visiting and environmental health Healthy Start staff make home visits to participants from the period of pregnancy to the second birthday of the infant. Assessment and developing a plan of care about issues in the home environment are ongoing.

7. Home environment assessment items for routine data collection Housing and Violations eviction pending; homeless; inadequate/no appliances; sanitation/ housekeeping; lack of safety/housing code Lead exposure; no telephone; overcrowding; rodents/others pests

8. Fire hazards commonly identified Smokers in household Electrical wiring/overloaded circuits Space heaters, use of stove for heating Candles Clutter No or non-working smoke detectors

9. Air Quality hazards Second hand smoke Danger of carbon monoxide from unsafe furnace/appliances Ambient fumes, chemicals Mold spores, asbestos, lead particles

10. Pests and other animal issues Infestation insects/rodents Inadequate garbage disposal capacity Inadequate food storage Multiple pets may lead to risk of diseases from animal waste, bites, pet food attracts pests Inadequate routine cleaning food preparation areas (floors, counters, dishes)

11. Structural/Heating and cooling Utilities shut-off or pending notice Non-working or poorly maintained furnace Non-working or inadequate cooling/AC Broken windows Broken floorboards

12. Plan of care The Healthy Start staff sets priorities with the participant to address environmental problems Case conferences, referrals and partnerships with community organizations are essential Home visits for follow-up and monitoring of conditions

13. Co-morbidities with environmental health problems Sub-standard conditions in the home also may be markers for other psychosocial problems Clinical depression Serious mental health issues Domestic violence Alcohol misuse Other drug misuse

14. Multidisciplinary team approach Healthy Start uses a comprehensive team with nurses, child development and social work staff Routine screening and assessment of mental health problems Home visits by all disciplines available to address underlying issues such as depression.

15. Role of community partners Healthy Start works with many community partners to address environmental health problems affecting participants and their families. Local and state health departments are primary resources Community tenant organizations and neighborhood associations Fire and police departments

16. Training and Prevention strategies Community partners such as fire, police and health department environmental health provide staff training and updates to Healthy Start staff e.g. available resources such as home inspections, smoke detectors, new safety information Healthy Start provides culturally appropriate health education Healthy Start participates in community events and health fairs in partnership with environmental health organizations

17. Advocacy for environmental health Advocacy is also important in the reduction of environmental health disparities for Healthy Start families. Healthy Start partners with community organizations such as the health department by contributions to reports of adverse health conditions, testimony in public forums for funding for improved home-based services, and safe housing, and education/training of local MCH providers.

18. Case examples Most Healthy Start families with environmental health issues have multiple problems that require long-term case management and multiple levels of interventions. These often involve housing code violations, sanitation, and mental health or family problems may be contributing to the poor home .

19. Healthy Start, Inc. For more information about us, call the Healthy Start Helplines at: (412) 247-1000 or (724) 425-1799 or visit our website at: www.healthystartpittsburgh.org Healthy Start, Inc.� is supported in part by Project No. CFDA #93.926E from the Healthy Start Initiative, Division of Perinatal Systems & Women�s Health, Maternal & Child Health Bureau, Health Resources & Services Administration, and Department of Health & Human Services.