1. Missouri Association of Local Boards of Health (MALBOH) Presents

2. TEN GREAT ACHIEVEMENTS OF PUBLIC HEALTH (WHY WE DO THE THINGS WE DO)! Modules developed by Ross McKinstry, MPH; Sheila Guice, MPH; and Mahree Skala, MA

3. ACHIEVEMENT #4: Maternal and Infant Health

4. Tombstone

5.  Infant mortality decreased by 90% Life expectancy went up 62%, from 47 years to 78, largely because more people survived childhood In 1900, only 41% of newborns survived to age 65; in 1991, 80% survived to age 65

6. Improvements Better hygiene and nutrition Safe drinking water and waste disposal Safe milk supplies, pasteurization Longer spacing of pregnancies, smaller families Early entry into prenatal care Management of pregnancies Safe delivery in general hospitals

7. Improvements Introduction of antibiotics, electrolyte replacement therapy, and safe blood transfusions Social benefits, maternity leave, living standards Greater access to health care Advances in technologies for maternal and neonatal care Advances in maternal and neonatal medicine Public health measures (new vaccines, Back to Sleep, folic acid supplementation)

8. Maternal Deaths Maternal mortality decreased by 99% in the 20 th century Shift from home births to hospital births (90% in hospitals by 1948) Medical advances and changes in policies and practices

9. Progress 2000-2010: 36% fewer infants born with neural tube defects such as spina bifida, due to folic acid fortification of cereal grain products Expansion of newborn screening for metabolic and other hereditary disorders Early diagnosis of infant hearing disorders

10. WIC Program

11. Well Child Check-ups

12.  The US still has higher maternal and infant mortality rates than other countries do, and rates are higher for black women and infants  Incidence of low birth weight (LBW) has not decreased in recent decades  LBW, preterm births, and birth defects must be reduced to lower neonatal mortality and reduce disparities

13. We need to encourage early entry into prenatal care, infant immunizations, and parenting classes Encourage participation in the Women, Infants, and Children (WIC) program Expand home visitation programs for young, first time parents

14. ACHIEVEMENT #5: Family Planning

16.  Fertility decreased as couples chose to have fewer children (trend began around 1800)  More people are able to achieve desired birth spacing and family size  Smaller families and longer birth intervals contribute to better health of infants, children and women, plus improved economic and social status of women

17. Safe and effective methods developed Access to family planning and contraceptive services increased Smaller families Longer intervals between births, resulting in higher birth-weight babies Fewer abortions

18. Increased opportunities for prenatal counseling Pre-conceptional counseling and screening Increased awareness of sexually transmitted disease identification and prevention Altered social and economic roles of women Fewer women, infant and child deaths!

19. Prenatal/Preconception Counseling

20.  Even today, about half of all pregnancies in the US are unintended (49% in 2011)  4 out of 5 pregnancies among women under 19 are unintended  Unintended pregnancies are a higher risk for mothers and infants

21. Make sure teens get access to good information about pregnancy prevention and their health.

22. ACHIEVEMENT #6: Fluoridation of Drinking Water to Prevent Dental Caries

24.  Dental caries (cavity) is an infectious, communicable disease in which bacteria dissolve the enamel surface of a tooth  Dental caries can result in loss of tooth structure and discomfort  Untreated cavities can lead to severe pain, bacterial infection, pulpal necrosis, tooth extraction and loss of dental function  May progress to an acute systemic infection

25. Due to regular check-ups, dental sealants, fluoridation of water and fluoride treatments

26. Water fluoridation began in 1945 with a study of four cities Now reaches an estimated 204 million people in the US (in 2010), or 73.9% of those on community water systems Safely and inexpensively prevents tooth decay ⁻(regardless of socioeconomic status) Reduction of tooth decay in children by 40-70% Reduction of tooth loss in adults by 40-60%

27. More than 3.9 million citizens (79.8%) have access to fluoridated water. Missouri ranks 23rd in the nation for fluoridation of water.

28.  Despite the overall decrease in prevalence and severity, dental caries is still common  67% of 12- to 17-year-olds and 94% of people 18 and older have caries  although the average number of cavities per 12- year-old decreased from 4 in 1970 to 1.3 in 1994  Other factors, such as dietary changes, still contribute to caries formation

29.  Since the 1950’s, opponents of water fluoridation have claimed it causes many different health problems  Safety and effectiveness have been studied frequently, and there is no credible evidence of adverse health effects  Small community water systems may find the cost of fluoridation per person served too high

30. Children on Medicaid (CHIP) can’t get access to dentists because of low payment rates The number of dentists in Missouri is declining because we don’t train enough Low-income adults have no access to care (Springfield’s new FQHC filled 3 years’ appointments within 2 weeks of opening). More ER visits, lost productivity, and caries contributes to heart disease

31.  Ten Great Achievements of Public Health in the 20 th Century Morbidity and Mortality Weekly Report April 2, 1999 / 48 (12);241-243 http://www.cdc.gov/mmwr/preview/mmwrhtml/0005679 6.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/0005679 6.htm  Ten Great Public Health Achievements— United States, 2001-2010 May 20, 2011 / 60(19);619-623 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5.ht m

32.  Achievements in Public Health, 1900-1999: Healthier Mothers and Babies October 01, 1999 / 48(38);849-858  http://www.cdc.gov/mmwr/preview/mmwrht ml/mm4838a2.htm http://www.cdc.gov/mmwr/preview/mmwrht ml/mm4838a2.htm  Achievements in Public Health, 1900-1999: Family Planning December 03, 1999 / 48(47);1073-1080  http://www.cdc.gov/mmwr/preview/mmwrht ml/mm4847a1.htm http://www.cdc.gov/mmwr/preview/mmwrht ml/mm4847a1.htm

33.  Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries October 22, 1999 /48(41);933-940  http://www.cdc.gov/mmwr/preview/mmwrht ml/mm4841a1.htm http://www.cdc.gov/mmwr/preview/mmwrht ml/mm4841a1.htm

34. Thanks! Questions