Issue Category: Environmental Health

Increasing Access to Breastfeeding Friendly Hospitals: The Iowa Experience

By Jane Stockton, Community Health Consultant, Bureau of Nutrition and Health Promotion, Iowa Department of Public Health & Catherine Lillehoj, Ph.D. Research Analyst, Iowa Department of Public Health

The Iowa Department of Public Health (IDPH) has a long tradition of striving to improve the health and wellness of all residents. Because breastfeeding is a key strategy to preventing obesity among children and youth, IDPH has worked for the past several years to increase rates of breastfeeding initiation and duration.

Five years ago, Iowa ranked 31 out of 53 states and territories on a national survey, the Maternity Practices in Infant Nutrition and Care (mPINC). When we looked a little deeper, we realized that the rural nature of our state made maternal nutrition and care somewhat difficult.

For instance, 89 percent of Iowa counties are considered rural, with hospitals in rural counties having a higher proportion of Medicaid births (40 to 60 percent of births). Sadly, these hospitals often don’t have the necessary resources to truly improve breastfeeding education and provide the appropriate technical assistance. In general, rural hospitals experience unique barriers due to distance between hospitals, patients and other facilities, plus staff are often not dedicated to working in maternity care units.

To get over these hurdles, IDPH targeted hospitals in rural counties with significant numbers of Medicaid births. One of the preliminary activities to improve breastfeeding was to meet with key hospital partners (e.g., OB managers, Chief Nursing Officers, Directors of Nursing, Educators). Along with key partners, hospital policies related to breastfeeding were reviewed and results of the mPINC survey were discussed. Following these initial meetings, 53 hospitals voluntarily completed a pre-assessment using a self-appraisal tool. Subsequently, the IDPH hosted a training, called 6 Steps 4 Success, which we developed specifically to address the Ten Steps to Successful Breastfeeding, a set of evidence-based practices that have been shown to increase breastfeeding initiation and duration.

After receiving technical assistance, resources and staff education, 37 of the 53 hospitals completed a post-assessment. The majority of the hospitals implemented at least three of the Ten Steps and the most widely adopted policy, encouraging breastfeeding on demand, was implemented by 83 percent of the hospitals. After attending the 6 Steps 4 Success training, one nurse stated, “This gave me a lot to think about. I have changed my position and going to change my ideas, way I promote breastfeeding.” Hospitals frequently express their gratitude for the technical assistance and education being brought to them in their rural setting, rather than having to go to the larger cities for these services.

To further enhance statewide breastfeeding initiatives, efforts for the past two years have focused on improving maternity practice in four or five hospitals each year that meet three criteria: rural location, Medicaid birth rate higher than statewide average and an mPINC score of less than the statewide composite score. Using their mPINC survey data, hospitals are given assistance in reviewing the results, determining where the greatest opportunities for improvement are, and developing an improvement plan to address at least two of the dimensions of care. Over the course of one year, hospitals are offered:

  1. Technical assistance related to breastfeeding policy – telephone, face-to-face, electronic messaging;
  2. Resources – desk references such as Hale’s Medications and Mother’s Milk, Continuity of care in Breastfeeding: Best Practices in the Maternity setting; model breastfeeding policy, and a Self Attachment video;
  3. Educational opportunities – funding to send one staff nurse to Certified Lactation Counselor (or comparable) training, Breastfeeding Education for Iowa Communities, a four hour training developed by the Iowa Breastfeeding Coalition, and/or 6 Steps 4 Success training; and
  4. Networking opportunities – Iowa’s Annual Breastfeeding Conference and networking call for all participating hospitals.

The most recent data indicate all participating hospitals demonstrated improvement in several areas including: Labor and delivery practice (an improvement ranging from 3 to 230 percent), Staff Training (63 percent improvement), Breastfeeding Assistance (18 percent improvement), and Structural and Organizational Aspects of Care (94 percent improvement). In addition, staff who became Certified Lactation Counselors are now educating other nurses in their hospital.

To truly make these activities pervasive and sustainable, the IDPH knew it was important to collaborate with key partners with valuable expertise, including:

  • University of Iowa Statewide Perinatal Team – Breastfeeding Guidelines were written and incorporated into the Guidelines for Perinatal Services published by IDPH and distributed by the University of Iowa’s Perinatal Care Program. The Guidelines for Perinatal Services provides the framework to be used in defining and evaluating the level of perinatal services being offered by hospitals.
  • Iowa Breastfeeding Coalition – Breastfeeding Education for Iowa Communities, a four hour training curriculum, is being presented to healthcare communities throughout the state. The training curriculum, based on WIC’s Grow and Glow curriculum, was written as a collaborative effort by IDPH staff and ICBLC members of the coalition.

Over the past five years Iowa hospitals have gone from understanding what the term “Baby Friendly” meant and about the significance of the Ten Steps to Successful Breastfeeding, to having one hospital designated as Baby Friendly and many other hospitals in the process of achieving that designation

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References

Lillehoj, C. & Dobson, B. (2012). Implementation of the Baby-Friendly Hospital Initiative Steps in Iowa Hospitals. http://authorservices.wiley.com/bauthor/onlineLibraryTPS.asp?DOI=10.1111/j.1552-6909.2012.01411.x&ArticleID=1043603.

TFAH Supports the EPA and Obama Administration in Beginning to Address the Serious Health Consequences of Ground-level Ozone

Washington, D.C., October 1, 2015 – The Trust for America’s Health (TFAH) is pleased that the Environmental Protection Agency (EPA) has announced it will finalize an update to the National Ambient Air Quality Standard (NAAQS) for Ground-level Ozone. The following is a statement by Jeffrey Levi, PhD, executive director of TFAH.

“Today the EPA and Obama Administration announced they will finalize a long overdue update to the ground-level ozone standard. TFAH commends EPA for meeting the latest deadline and finalizing a ground-level ozone standard of 70 parts-per-billion (ppb)—far more in line with the current scientific evidence and an important improvement over the flawed 2008 standard.

However, as we have made clear in public statements to EPA, TFAH strongly believes that a standard of 60 ppb would best meet the expectations of the Clean Air Act and would give our nation’s families an ozone standard that protects their health.

EPA’s own science is clear that even healthy adults can experience adverse health effects from ozone at 65 ppb. And, research has told us for years that elevated levels of smog can cause asthma attacks, shortness of breath, trips to the emergency room and even premature death. Now, we are beginning to see research link low birth weight babies, negative neurological effects, and many additional health hazards to ozone.

At a time when obesity levels are stabilizing at an unspeakably high level and we are encouraging more and more Americans to be active, we aren’t providing clean air to breathe. In reality, the Americans—young children, the elderly, and those who already suffer from certain chronic diseases—who are most likely to benefit from being active outdoors are unfortunately those who are most vulnerable to the dangers of dirty air and ground-level ozone.

Improving the standard to 70 ppb is undoubtedly progress towards cleaner air and a healthier nation – however it also represents a missed opportunity for EPA to act on the best available science and truly protect the public’s health.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Trust for America’s Health Releases Letter Detailing Strong Opposition to the Reconciliation Instructions Proposed by the House Energy and Commerce Committee

Eliminating the Prevention and Public Health Fund—which has the support of more than 900 organizations—would set Public Health back by a Decade

 

Washington, D.C., September 29, 2015 – Trust for America’s Health (TFAH) released a letter detailing strong opposition to the Reconciliation Instructions proposed for consideration by the House Energy and Commerce Committee, stating that eliminating funding for the Prevention and Public Health Fund would set public health back by a decade.

The letter also notes that more than 900 state and national organizations have already pledged their support for the Prevention Fund and details the successes of the Fund.

The letter, in part, reads:

“In the first six years since its inception, the Prevention Fund has invested nearly $5.25 billion in resources to states, communities, tribal and community organizations in support of community-based prevention, including tobacco use prevention, healthy eating and active living, as well as childhood immunizations and clinical prevention. Decimating the Prevention Fund in this manner would dramatically impede efforts underway to improve health, including:

  • The Preventive Health and Health Services Block Grant, which was doubled under the Prevention Fund and provides all 50 states, the District of Columbia, two American Indian tribes, and eight U.S. territories with flexible funding to address their unique public health issues at the state and community level.
  • Expanding Access to Cancer Screenings: In FY 2015, the Fund provided $104 million for the National Breast and Cervical Cancer Early Detection Program, which is helping states across the country provide cancer screenings to high risk women who are uninsured or underinsured.
  • The successful Tips from Former Smokers campaign, which in just its first three months inspired more than 1.6 million people to try to quit smoking, and more than 100,000 smokers have quit for good.
  • Funding for the section 317 childhood immunization program, which has been vital to preventing and responding to measles outbreaks, and epidemiology and laboratory capacity in all states, which are key to preventing and containing infectious disease outbreaks.

“These are just a few examples of the work underway thanks to the Prevention Fund. Massively reducing the Fund would set back public health by a decade, and would slash life-saving investments in every state that are desperately needed. For example, chronic diseases such as cancer, diabetes, lung disease, heart disease, and stroke are now responsible for seven out of 10 deaths and account for 86 percent of health care spending in America. An approach to deficit reconciliation that cuts prevention may in fact have the opposite effect – less prevention of illness and disease and increased future health care spending.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Trust for America’s Health Statement on EPA’s Clean Power Plan: Essential for Safeguarding the Climate, Health and Wealth of the United States

Washington, D.C., August 3, 2015 – The following is a statement from Jeffrey Levi, PhD, executive director of the Trust for America’s Health (TFAH) on the final carbon pollution standards for new and existing source power plants, issued today by the Environmental Protection Agency (EPA).

“Today’s announcement finalizing the Clean Power Plan is an important step forward toward turning these proposals into reality and safeguarding our climate, health and wealth.

Climate change poses serious public health concerns — from natural disasters to reduced water resources to new insect-based infectious diseases associated with higher temperatures to worsening air quality to the effects of the extreme weather we’ve seen across the country this summer.

Issuing carbon pollutions standards for new and existing power plants is one essential piece of a strategy – but we cannot stop here.  The 2015 Lancet Commission on Health and Climate Change mapped out the impact of climate change and measures that could be taken to protect the health of humans and the planet – and how, if we work urgently and expeditiously, we can turn the tide and achieve promising results.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

TFAH Releases Issue Brief – The Clean Water Rule: Clearing up Confusion to Protect Public Health

Washington, D.C., July 23, 2015 – Today, the Trust for America’s Health (TFAH) released an issue brief examining the country’s Clean Water Rule and how it will improve and protect Americans’ health and restore guaranteed protections for a range of waters.

The brief, The Clean Water Rule: Clearing up Confusion to Protect Public Health, finds that, despite advances in water management, waterborne illnesses still pose a serious threat to Americans’ health.  Even though water-related illnesses are largely underreported, the United States annually experiences a significant number of waterborne illnesses. In fact, each year around 30 outbreaks and 1,000 reported drinking water-related cases and around 24 outbreaks and 1,300 recreational water-related cases occur.

According to the brief, water pollution affects Americans’ health on a regular basis. In the summer of 2014, the country witnessed a dramatic example of the effects of contaminated waterways when a toxic algal event in Lake Erie shut off the main drinking water supply for 400,000 people in Toledo, Ohio.

In another recent example, in Charleston, West Virginia, hundreds of thousands of people were unable to use their tap water because of toxic substances in the water supply. And, across the country, industrial pollution, animal and human waste, and waterborne pathogens are often found in these headwaters—from which 117 million Americans get their drinking water.

To help resolve these issues, the Environmental Protection Agency (EPA) and the Army Corps of Engineers — which implement the Clean Water Act—held more than 400 stakeholder meetings, sifted through  more than a million public comments (of which 87 percent favored the action), and developed a detailed scientific report, Connectivity of Streams and Wetlands to Downstream Waters, that examined more than 1,200 peer-reviewed publications on the connections between upstream and downstream bodies of water.

These actions resulted in the creation of the Clean Water Rule, which clarifies the scope of the headwaters that are protected under the Clean Water Act. According to the brief, by providing protection for these waters, the Clean Water Rule will safeguard headwaters, better hold industrial polluters of headwaters accountable and greatly improve the nation’s health.

“We want to un-muddy the waters – the Clean Water Act’s legacy has been to ensure Americans have sustainable access to a healthy water supply,” said Jeffrey Levi, PhD, executive director of TFAH. “Moving forward, the Clean Water Rule will further the Act’s great successes by strengthening protections for our nation’s water supply and reducing instances of waterborne illness. The Rule should be administered—without delay or further changes—to avoid putting the public’s health at further risk.”

The brief also notes that protecting America’s headwaters is popular across political lines. A recent poll found that 80 percent of American voters favor the Rule, with half of voters saying they strongly favor it. Support for the rule cuts across party lines, with large majorities of Democrats, Independents and Republicans in favor.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

TFAH Statement: Lancet Commission and White House Summit Highlight Urgent Need to Address Climate Change Health Threats

Washington, DC, June 23, 2015 – The following is a statement from Jeffrey Levi, PhD, executive director of the Trust for America’s Health (TFAH) on the White House Climate and Health Summit and release of the 2015 Lancet Commission on Health and Climate change report this morning.

“For too long, the country has buried its head in the sand when it comes to the threats climate change poses to our health.

The new Lancet Commission on Health and Climate Change report raises the stakes, clearing defining the consequences of inaction – but also presents a silver lining of how action now can help mitigate the problems of tomorrow.

That is why the White House Climate and Health Summit on Tuesday is so critical – bringing together U.S. Surgeon General Dr. Vivek Murthy, Environmental Protection Agency Administrator Gina McCarthy and leading experts to help build a path forward. But, to have a real ongoing impact, we need more than a one day forum. We need a sustained approach—across agencies—that strategically aligns programs and policies to address climate change and health.

This sustained approach should include the U.S. Department of Health and Human Services committing to ensuring that all its programs address the impact of climate change on health and the White House mobilizing every federal agency to consider the health implications of climate change when performing their duties.

We know that, as climate and weather patterns shift, they contribute to the emergence of new diseases and the reemergence or spread of diseases that were nearly eradicated or thought to be under control. As changes in temperature and weather patterns allow pathogens to expand into different geographic regions, some vector- and zoonotic-borne diseases may increase along with foodborne and waterborne diseases. Excessively high temperatures, heavy downpours, wildfires, severe droughts, permafrost thawing, ocean acidification, sea-level rise and other extreme weather events all have implications for public health.

In the Trust for America’s Health annual Outbreaks: Protecting Americans from Infectious Diseases report, we found that only 15 states have complete climate change adaptation plans – including planning for the impact of climate change on human health.

We know that climate change is affecting every sector of American society, making addressing this issue the urgent responsibility of every government program and agency. There’s no time like the present to safeguard the future health and wealth of the country.”

 

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Trust for America’s Health’s Statement on the Environmental Protection Agency’s Latest Clean Water Act Rule: Important for the Nation’s Health

Washington, DC, May 27, 2015 – The Trust for America’s Health (TFAH) is pleased the Environmental Protection Agency (EPA) has released a final rule clarifying the definition of Waters of the United States under the Clean Water Act. This will enable relevant agencies to better safeguard our nation’s headwaters, streams and wetlands and ensure the water we drink is free from pollution.

The following is a statement by Jeffrey Levi, PhD, Executive Director of TFAH.

“TFAH applauds the EPA and the Obama Administration for advancing this final rule, which applies to the headwaters that supply more than 117 million Americans with their drinking water. It is vital for the nation’s health to ensure everyone has access to safe and clean water.

Because these headwaters are one source of many rivers and streams, they are a precious health resource. Yet, today carcinogens, crude oil and harmful bacteria are still being dumped upstream—with little oversight—and flowing down to our communities and into one in three American’s drinking glasses.

With this final rule, we are one step closer to ensuring one of our nation’s largest supplies of water is safe to drink.

TFAH looks forward to working with federal, state and local governments, the public health community, and other critical partners to monitor ongoing implementation of this rule.

Each day we delay is another we put Americans’ health and lives at risk.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. 

Trust for America’s Health’s Statement on the Public Health Aspects of the President’s Proposed Budget

February 3, 2015

Washington, DC, February 3, 2015 – The following is a statement from Jeffrey Levi, PhD, executive director of the Trust for America’s Health (TFAH) and chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.

“If adopted, the President’s budget would take a major step toward building a culture of health in the United States, as it invests in programs and policies that enable Americans to be healthier – and to be better protected from infectious diseases, foodborne illnesses and other threats.

TFAH strongly supports the President’s proposal to end sequestration. Sequestration has resulted in sharp and indiscriminate cuts to public health programs – and ending it shows a commitment to the need for a strong, effective public health system in this country.

We are pleased to see increased support for programs that can improve health in people’s daily lives – where they live, learn, work and play. Mounting evidences shows programs like the Earned Income Tax Credit, the Child Care Tax Credit, early childhood education, family home visiting and the Children’s Health Insurance Program contribute to the long-term health of children and their families and are essential building blocks to a lifetime of wellbeing.

The proposal also recognizes the need for increased resources to fight one of the country’s fastest growing, most troubling and most preventable public health epidemics – devoting more than $100 million in new investments to combat prescription drug misuse and related heroin abuse.

In addition, the budget demonstrates how important ongoing investments into a standardized set of core “foundational capabilities” for all health departments are. All Americans should be assured that their state and local health departments have the same ability to help them be healthy. To this important end, the President’s budget identifies $8 million to start down the path of this kind of assurance.

However, while this is important, it is more than offset by the zeroing out of the $160 million Preventive Services Block Grant, a mechanism that is currently used by health departments to maintain capabilities and services. We recommend restoration of the block grant funding, along with clear direction that the funding be used for foundational public health capabilities and services.

Another low-point of the budget is the proposal to significantly cut chronic disease prevention programs – including some of the most important programs that support preventing obesity, tobacco cessation and related health problems. Given the national priority to reduce healthcare costs, this is particularly ironic since we know chronic diseases are one of the biggest drivers of these costs.

Some key public health highlights in the budget include:

  • A $36 million increase to the Strategic National Stockpile, which provides medicine and medical supplies to protect the American people during a public health emergency;
  • A $264 million investment to help the Centers for Disease and Prevention (CDC) combat antibiotic resistance;
  • A $107 million increase for the Biomedical Advance Research and Development Authority (BARDA) to spark the research and development of new antibiotics, vaccines, medical treatments and medical devices;
  • The creation of a single, independent food agency to provide leadership and prevent and respond to outbreaks of foodborne illness and an increase of $109.5 million to the Food and Drug Administration to implement the Food Safety Modernization Act (though much of this increase is in the form of unauthorized user fees which Congress should enact regardless of a policy decision on user fees). The creation of a single food safety agency has been a long-standing priority for TFAH and we hope it is the start of a broader coordination of public health programs across the federal government;
  • A $31.5 million increase in programs to combat viral hepatitis, almost doubling the nation’s resources;
  • A $10 million increase for the CDC climate and health program to fund 30 additional state and local grantees, though this is offset by an $11 million cut to the National Environmental Public Health Tracking program; and
  • A $128.1 million increase in the Vaccines for Children Program, though this is offset to some degree by a $50 million cut in the discretionary immunizations program.

Some key public health low-lights include:

  • Zeroing out the $160 million Preventive Services Block Grant – which is a key mechanism state and local public health agencies use to maintain capabilities and services;
  • A $20 million cut to the Partnerships for Improving Community Health (PICH), which works to address common risk factors for chronic disease;
  • A $7.5 million cut from the Division of Nutrition, Physical Activity and Obesity for programs focused on reducing obesity in high obesity rate counties; and
  • Elimination of the Racial and Ethnic Approaches to Community Health (REACH), which helps address key chronic disease conditions in the hardest hit populations.

TFAH looks forward to working with the Administration and Congress to ensure strong and sustained funding for public health – to foster a nationwide culture of health and improve the health and wealth of the nation.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.