National Healthy Start AssociationThe
Healthy Start Program
In 1991, the Health Resources and Services Administration (HRSA) of the U.S. Department
of Health and Human Services (HHS) funded 15 urban and rural sites in communities
with infant mortality rates that were 1.5 - 2.5 times the national average to
begin the Healthy Start Initiative. The program began with a
five-year demonstration phase to identify and develop community-based systems
approaches to reducing infant mortality by 50% over the five-year period and to
improve the health and well-being of women, infants, children and their families.
Since its inception, the Healthy Start Program has been located in HRSA. Healthy
Start is a component of the Maternal and Child Health Bureau and resides in the
Division of Perinatal Systems and Women's Health.
Originally funded under the authority of Section 301 of the Public Health Services
Act, Healthy Start was recently authorized by the Congress as part of the Children's
Health Act of 2000.
The common principles underlying the Healthy Start program are:
• Innovations in service delivery;
• Community commitment and involvement;
• Personal responsibility demonstrated by expectant parents;
• Meeting basic health needs (nutrition, housing, psychosocial support);
• Reducing barriers to access; and
• Enabling client empowerment.
An additional seven sites were funded in 1994 as special projects with the goal
of significantly reducing infant mortality through more limited interventions.
In the second, or "replication," phase, Healthy Start added 75 projects in 1998,
19 in 1999 and three more in 2000. In 2001, Healthy Start entered its third phase,
and added nine new grantees. Twelve existing projects that were categorized as
"approved, but not funded" in 2001 received new funding early in 2002. Presently,
there are 96 federally-funded Healthy Start projects, and five main types of Healthy
Start grants: Perinatal Health, Border Health, Interconceptional Care, Perinatal
Depression and Family Violence, the last just awarded by the MCHB in May 2002.
Some projects have more than one grant type.
(Source: Telling the Healthy Start Story: A Report on the Impact of the 22
Demonstration Projects, National Center for Education in Maternal and Child
Health, 1999.)
Click Infant Mortality, Low Birthweight and Racial Disparity in Perinatal Outcomes
or visit www.hrsa.gov (Maternal and Child Health Bureau) for more information
about infant mortality and low birthweight.
The Healthy Start Message
Infant mortality and low birthweight remain major public health issues in the
U.S. Infant mortality among African American women is more than twice that of
white women. Low birthweight among African American women is more than twice that
of white women. For Hispanics and Native Americans, the infant mortality and low
birthweight rates are significantly higher than that of the white population.
Although infant mortality has decreased in the last decade, clearly the gap between
whites and minorities has not been closed. Minority families, therefore, need
special attention, focus and priority in perinatal health services.
Less attention has been paid to the problem of low birthweight and very low birthweight
babies. In contrast to infant mortality, the last decade saw no significant drop
in the rate of low birthweight. In fact, low birthweight now appears to be on
the rise. The medical and social services that are required by low birthweight
and very low birthweight infants are significant and the costs are high to society
and the American taxpayer. Those babies that survive the first year incur medical
bills averaging $93,800. First year expenses for the smallest
survivors will average $273,900.
Significant savings can accrue from enabling mothers to add a few ounces to a
baby's weight before birth. An increase of 250 grams (about 1/2 pound) in birth
weight saves an average of $12,000 to $16,000 in first year medical expenses.
Prenatal interventions that result in a normal birth (over 2500 grams or 5.5 pounds)
saves $59,700 in medical expenses in the infant's first year.
(Source: March of Dimes Perinatal Data Center. Rogowski, J. (1998) Cost-effectiveness
of Care for Very Low Birthweight Infants. Pediatrics 012(1):35-43.)
The long-term cost of low birthweight infants includes re-hospitalization
costs, many other medical and social service costs and, when the child enters
school, often large special education expenses. These public expenses can go on
for a lifetime. Decreasing infant mortality rates are frequently the result of
dramatically improved medical technology keeping of low birthweight infants alive
who would have died 10 or 20 years ago.
Improving the low birthweight rate, on the other hand, requires improvements in
the practices and behavior of the women themselves while pregnant. Risk-taking
behaviors or inattention to good health practices while pregnant is undoubtedly
the single major cause of low birthweight. The most effective way to change these
behaviors is to engage women early in their pregnancies and to find ways to encourage
them to make changes in their lifestyles and lives. Without ongoing, extensive
community-based programs like Healthy Start, it is unlikely that the rate of low
birthweight or the gap in racial disparity will be affected.
Healthy Start to the Rescue
Healthy Start programs are community-driven and located in the poorest neighborhoods
in the United States. Since its initiation in 1991, Healthy Start has served hundreds
of thousands of families. Over 90% of all Healthy Start families are African American,
Hispanic, or Native American. Healthy Start specializes in outreach and home visiting
— the surest way to reach the most at-risk women.
Healthy Start focuses on getting women into prenatal care as early in the pregnancy
as possible. It is generally accepted by the medical and research community that
early entrance into prenatal care is the single most critical factor in improving
birth outcomes.
Healthy Start has pioneered the use of women living in the community as outreach
workers and home visitors. This approach has three important advantages:
• It saves money (nurses' salaries are at least twice that of a paraprofessional
or lay worker).
• Minority pregnant women respond better to women who have "walked in their
shoes."
• It has given real jobs to hundreds of unemployed women, particularly those
on welfare.
Every Healthy Start project has developed a consortium, composed of neighborhood
residents, clients, medical providers, social service agencies, faith representatives
and the business community. This ensures that not just Healthy Start but the whole
community is committed to fight to reduce infant mortality and low birthweight.
Major U.S. cities as well as urban counties have a disproportionate number of
poor and minority families living within their boundaries. Yet, the amount of
federal discretionary dollars going directly to these cities and counties has
decreased dramatically in the last 20 years. Healthy Start represents one of the
few health and social services programs that is funded directly to the localities
by the federal government. Major urban cities desperately need the programs that
Healthy Start provides.
Summary
The fact that African American and other minorities continue to have enormously
increased rates of infant mortality and low birthweight poses a major public health
issue for the U.S. The rate of low birthweight has not decreased significantly
in the last decade and now appears to be rising. Low birthweight costs significant
dollars, both short-term and long-term, and these costs are not well understood
by the American public. Low birthweight can only be decreased by changing behavior
— and behavior can only be changed by intense, ongoing interventions at the
community level.
If you have questions or comments contact:
The National Healthy Start Association, Inc. 2030 M Street, NW, Suite 350, Washington, DC 20036 Phone: (202) 296-2195 | Fax: (202) 296-2197
E-mail: kduncan@nationalhealthystart.org
Thanks for visiting the National Healthy Start Association online at:
www.healthystartassoc.org