DHMIC 9 th Annual Summit 4/9/13 David A. Paul, MD Chair, Delaware Healthy Mother and Infant Consortium Professor of Pediatrics, Thomas Jefferson University Interim Chair, Department of Pediatrics, Christiana Care Health System Attending Neonatologist, Kent General Hospital

#DHMICsummit

Delaware Progress u 13.5% drop in infant mortality since inception of DHMIC u 10.5 % drop in premature birth rate

Delaware Progress u Beebe Medical Center Certified as Baby Friendly u Christiana Hospital Established Center for Women’s Emotional Wellness u DOSE Program u Every Birth Hospital with 39 week initiative

Delaware Challenges u Disparity ratio of 2.5 u Root causes of disparity? u How far can we go with medical model?

Income/Longevity Gap NYT, March 16, 2014 Fairfax, VA u Population 1 million u Household income $107,000 u Adult obesity 24% u Unemployment 6.3% u 1/8 adults smokes u 6/10 adults with college degrees McDowell, WV u Population 22,000 u Household income $ 22,900 u Adult obesity 30% u Unemployment 8.8% u 1/3 adults smoke u 1/18 adults with college degrees

Income/Longevity Gap NYT, March 16, 2014 Fairfax, VA u Male life expectancy 82 y u Female life expectancy 85 y u Similar to Sweden McDowell, WV u Male life expectancy 64 y u Female life expectancy 75 y u Similar to Iraq

Housing u 4498 women in low income census tract randomized to: –Vouchers/move to higher income tract and counseling –Vouchers/move and counseling (no change in census tract) u Prevalence of BMI > 35, HgB A1C >6.5% lower in group moving to higher income census tract Ludwig, NEJM, 2011

Proportion of Delaware Children Living in Poverty %

White African American Puberty Pregnancy 05ys The Racial Gap in Reproductive Potential: A Life-Course Perspective Lu and Halfon,MCHJ, 2003 Reproductive Potential Risk Factors Life Course Protective Factors

DHMIC Next 5 Years uReduce Disparities uSafe sleeping campaign uBreast feeding u Mental health u Life course approach u Community health workers