Remarks to the Keeping Kids Alive Symposium

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by HRSA Administrator Mary K. Wakefield

May 21, 2009
Washington, D.C.

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Welcome to all of you attending this important national symposium on the causes -- and ways to prevent -- injury and death among our nation's most precious residents, our children.

It's good to be here with:

• state maternal and child health officials;
• injury- and violence-prevention experts and program directors;
• child death review program leaders; and
• child health and safety leaders from across the country.

I'm told this gathering is the first national meeting that brings together all of the partners working on these child health and safety issues. Congratulations! That's a very important step forward.

We work with some of you directly as grant recipients, and with others – Emergency Medical Services directors, representatives from state attorneys' offices and social services departments – as partners, and I have great respect for and highly value your work. You face the daunting task of participating in child death reviews in your states and communities, and in developing injury and violence-prevention programs to keep kids alive.

Before I go any further, I want to offer a few formal thank yous.

Thanks to Jon Nelson for his leadership in MCHB.

Through her commitment and hard work, Captain Stephanie Bryn leads HRSA's injury and violence-prevention efforts. Thank you, Stephanie.

And thanks to Dr. David Heppel, director of MCHB's Division of Child, Adolescent and Family Health, where our injury- and violence-prevention program is located. David has been a champion for children throughout his Federal career.

We have a terrific team at HRSA and it's a privilege to work with them.

Special thanks to HRSA grantees: the National Center for Child Death Review and the Children's Safety Network for their work organizing this groundbreaking meeting.

And thanks also to the Department of Justice's Coordinating Council on Juvenile Justice and Delinquency Prevention for its support of this symposium, and to the Centers for Disease Control and Prevention, which works with HRSA staff to strengthen and improve data collection.

Your efforts to protect children are vital to the work we support at HRSA through our Maternal and Child Health Bureau. MCHB, in fact, got its start as the Children's Bureau nearly a hundred years ago, in 1912, with this charge:

to “investigate and report... upon all matters pertaining to the welfare of children and child life among all classes of our people, and... especially investigate the questions of infant mortality, the birth rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, [and] legislation affecting children in the... states and territories."

Enactment of Title V of the Social Security Act in 1935 pledged the Federal government's support of state efforts – your efforts -- to extend and improve health and welfare services for mothers and children. And now our Title V block grants provide health services that reach six out of 10 women who give birth in the U.S. and their children.

Few pieces of legislation can match the deeds and duration of Title V, which has instructed several generations in public health.

So you can see that HRSA's involvement in “all matters pertaining to the welfare of children” makes us your natural partners in this important work, and this history provides a platform for our important work going forward. Our much more recent history – the start of the new administration's work – provides a platform as well.

Related to this, in terms of HRSA, I also want you to know that there's a shift in how we operate and how HRSA is perceived at the White House and on Capitol Hill. You can sense it. There is a boatload of new energy in the agency. You can read major newspapers and trade press and start to see references to our agency. Along with this, HRSA senior staff is increasingly called upon for their expert opinions on a whole range of subject germane to health care and health care reform.

This Administration is committed to our programs, and I want you to know that you can expect a lot from us. As I often tell the HRSA staff since I arrived just over two months ago – we're pushing the refresh button. It's a new day.

We're following the lead set by President Obama. In children's issues, for example, he proved early on his commitment to improving their health and well-being.

President Obama proclaimed a “new day” in America on Feb. 4, just two weeks after taking office, when he signed the Children's Health Insurance Reauthorization Act of 2009. That action expanded health care coverage for children from low-income families from 7 million to 11 million – a crucial advance in the struggle to ensure that all children have access to life-improving and life-sustaining health care.

I'm also calling for a “new day” for public health at HRSA. I intend to re-energize our public health and safety activities by hiring a public health expert as my advisor. That person will sit in the Office of the Administrator and report directly to me. I want him or her to review all our programs and policies, and see what needs to be dusted off and polished or rebuilt from the ground up. I also plan to put this individual in charge of making sure HRSA's 10 regional offices work more closely with state and local health departments to promote policies that prevent disease and injury and help people lead healthier lives.

You may find yourselves coordinating activities with this new advisor, whom I hope to bring on board this summer.

Well, focusing more specifically on your work, as some of you know, HRSA's involvement in Child Death Review (CDR) issues began almost two decades ago. In 1992 we convened an advisory group which recommended that the primary purpose of CDR should move from investigating deaths to preventing them. The advisory group called on CDR teams to implement “the most expansive and comprehensive approach for identifying cases.”

During the 1990s, HRSA's MCHB staff continued to participate in Federal and state initiatives to promote CDR, and in 2002 we funded the National Center for Child Death Review.

By 2004, 37 states had expanded reviews to include deaths from injuries, suicides and homicides. Today, all states but one have active CDR programs.

The Center has supported state and local efforts by providing technical assistance to improve reviews, and by helping translate CDR findings into policies and prevention programs.

The work is heart-wrenching. Each year in the U.S., 54,000 children die, from newborns up to the age of 18. Every day, almost 150 children lose their lives. Almost half that number are babies who die before reaching their first birthday!

With those alarming statistics in mind, we need to determine here and today to pull together, leverage our collective expertise, and align our efforts even more tightly to save children's lives.

For the first time, we're all here:

• public health professionals in Maternal and Child Health, and injury and violence-prevention;
• social service professionals;
• first responders;
• pediatricians and other health care providers;
• law enforcement; and
• medical examiners and coroners – the bridge between issues of public health and the concerns of justice; and
• child advocates.

Let's pledge to link our energy and our efforts in a new level of commitment. Some of you already know each other, and I know some of you. Others will have just met or will meet over the next couple of days. Either way, you will develop new or deepen existing professional relationships.

And I want you to know HRSA appreciates your efforts to be here and engage in a spirit of cooperation and, hopefully, innovation – even in the recognition that your work is not easy.

But by identifying how children die, we will learn how to make childhood injury and sudden infant deaths less likely to occur.

At HRSA, we are invested, literally, in helping you make those advances. Our role in CDR is really that of a facilitator. We've become a “hub,” an organization whose mission is to bring together the work of the state and local CDR partners into a more coherent whole.

We want to continue to help you gather and interpret data and make the connections that enable you to build programs that protect children.

We want to help your states and communities design programs unique to their needs – programs that respond to the challenges of trauma or domestic violence, and efforts to help families take better care of their children.

Parenting education – to name one type of prevention – is critical!

In addition, we want to help you intervene at the right time... at the right place... through social service or public health programs, as they overlap and as they function independently.

On top of that, I want you to know -- as the Federal agency that oversees organ donation – that we at HRSA understand how extraordinarily difficult it is to approach families after the death of a loved one. Bringing sensitivity as well as expertise to bear is, of course, essential.

We want to help you conduct investigations in the least intrusive way -- to get the best information possible for the best programs imaginable.

I urge you to take advantage of opportunities during this symposium to learn from each other, and tell us how we as a federal agency can be more effective in our work by helping you to be more effective in yours.

Working together, as your meeting program says, we can “help states maximize their injury and violence-prevention capacity, utilize data effectively, and implement best practices…to reduce unnecessary injury, death, hospitalization, and disability” among children.

I can't think of a higher purpose in public health.

I hope you find this symposium a vehicle that encourages your efforts and fortifies your work. We CAN make a difference and “keep our kids alive, safe and healthy.”

Let me close by thanking all of you for coming today. I wish you all the best as you continue to work for the health and safety of our nation's children.

Thank you.