Remarks to the National Healthy Start Association Annual Spring Conference

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by HRSA Administrator Mary K. Wakefield

March 8, 2011
Washington, D.C.

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Thank you for inviting me here today during the 20th Anniversary of the Healthy Start Program.  And special thanks to Howard Koh – one of the Obama Administration’s health care leaders – who always has generous words to share about others.

It’s an incredible privilege to have him as the Assistant Secretary and to have a few moments of his time this morning.

Healthy Start began in 1991 as a 5-year demonstration project at 15 sites nationwide, designed to test service-delivery models in some of the most challenging settings, in one of our most fragile populations: pregnant women and their infants.

From 15 sites then, today HRSA now provides grant support to 104 Healthy Start locations in 38 states, the District of Columbia and Puerto Rico.

The reasons for the success of Healthy Start are well known, and well documented. Put simply, the program stands on five time-tested principles of effective public health and primary care practice.  These are:

1. Outreach and Early Intervention;
2. Access to Primary Care as a means of prevention;
3. Data collection and analysis to improve health outcomes – which is critically important because we have to know what works;
4. A commitment to improve cost-effectiveness, efficiency and outcomes; and
5. A strong focus on community-based partnerships

These same principles undergird the Affordable Care Act.

As Dr. Koh mentioned, I’d like to tell you a bit about it.  This historic legislation, signed into law on March 23, 2010, recalibrates health care in this country in ways that are essential if we are going to decrease financial and other burdens, even as we improve the health of children, families and communities.  Some of the long-overdue changes that eliminate barriers which too often stand between families and good health include:

• Preventing insurance companies from canceling health insurance policies when people become ill – with breast cancer, for example -- except in cases of intentional misrepresentation or fraud;
• Allowing young adults – a demographic group with some of the highest rates of un-insurance – to stay on a parent’s plan until they turn 26;
• Making certain that preventive benefits, such as immunizations and screenings, are available as part of packages – and at no out-of-pocket cost to policy holders; and
• Removing pre-existing condition exclusions for children.  As of last September, children under the age of 19 cannot be prevented from buying insurance because of pre-existing medical conditions. And this benefit extends to the entire citizenry when the law is fully implemented in 2014.

So the Affordable Care Act continues President Obama’s deep commitment to the health of America’s children.  

Many of you will likely recall that one of his first actions upon taking office was to push for and sign the reauthorization and expansion of the Children’s Health Insurance Program.  That act has boosted insurance coverage for children from low-income families from 7 million then, to 11 million children now.

And by overseeing passage last year of the Affordable Care Act, he has continued to guide U.S. health care into a new focus on expanding access, improving quality, and promoting wellness and prevention for all Americans, including the youngest among us.

All of America benefits from the Affordable Care Act, but parts of the legislation contain a clear focus on the health of mothers, infants and school-aged children – and does so through some of HRSA’s programs.

• For example, the legislation authorizes $1.5 billion over five years for the Maternal, Infant, and Early Childhood Home Visitation Program – led by the Maternal and Child Health Bureau.

Under this program, nurses, social workers and others will visit expectant mothers and their families in high-risk communities.  There, they will provide counseling and intervention services designed to improve health outcomes for mothers, infants and families, school readiness for children, parenting skills and economic self-sufficiency.

The evidence behind the program clearly indicates that providing these interventions sooner decreases the need for more costly clinical care and social services later.  That theme runs throughout much of the Affordable Care Act.

It’s your mother or grandmother saying: “An ounce of prevention is worth a pound of cure.”

• In addition to Home Visitation, the Affordable Care Act also extends annual funding of $5 million until 2015 for 41 Family-To-Family Health Information Centers.  The centers are staffed by parents of kids with special health needs. So far, the centers have linked more than 170,000 families to federal and state programs, clinics, special insurance pools and rehabilitation services for children with disabilities.
• And HRSA is just about to unveil a new $5 million effort to establish the Healthy Weight Initiative.  It’s another pro-child element of the Affordable Care Act, designed to help children live healthier lives by eating better and being more physically active.  

Starting in May, the initiative will begin to organize teams in all 50 states to implement and test a set of evidence-based interventions designed to reduce obesity.
In June the initiative will begin to organize teams in all 50 states to implement and test a set of evidence-based interventions designed to reduce obesity.

One intervention being promoted by First Lady Michelle Obama and U.S. Surgeon General Regina Benjamin: breastfeeding. MCHB has already provided extensive training and technical assistance in 30 states and jurisdictions, targeting state breastfeeding coalitions and Healthy Start sites.

This is particularly important, given that a growing body of evidence has documented the significant health benefits to babies and mothers of breastfeeding for at least the first six months of life. Yet the CDC notes that 75 percent of moms start out breastfeeding, but only 13 percent are exclusively breastfeeding at the end of 6 months. And the rates are particularly low for African-American mothers.

One reason is that a mother’s return to work is an obstacle to continued breastfeeding.

HRSA has developed a resource kit entitled The Business Case for Breastfeeding that provides a wealth of information about this important initiative. It’s available at www.womenshealth.gov/breastfeeding. Hard copies will be available soon through the HRSA Information Center. And if you want to access other tools, it’s easy to get them by calling 1-800-CDC-INFO.

The Act also authorizes $200 million over the next four years to build, renovate and expand school-based health centers.  These are part of the network of 8,100 HRSA-supported health center sites across the nation that provide preventive and primary care to all who enter their doors.  With the additional school-based sites, even the most disadvantaged kids can get care conveniently – and before major health problems take root.

School-based health centers represent just part of the Administration’s total investment in primary health care – and just one component of HRSA’s responsibilities through the ACA.  

One of the ACA’s important provisions that HRSA administers is a five-year, $11 billion appropriation to expand the number of health centers and health center sites and the range of services they offer.  This is an investment that has the potential to significantly improve access to high-quality, primary and preventive health care in every corner of the nation.

By 2015, HRSA’s health center grantees are expected to nearly double the number of patients they serve from 19 million patients in calendar year 2009. To give you some idea of what the impact of this expansion may be on women’s and children’s health, let me share a few benchmarks:

• Of the 19 million patients served, about 6.8 million are children ages 19 or younger – and more than half of that population was 9 years old and younger (3.75 million). In all, 233,000 kids under the age of 2 were immunized by health centers.
• In terms of women’s health, more than 11 million patients served in health centers were women and girls – or about 6 of every 10 patients.
• Health Centers administered PAP tests to 3 million women at some point in the preceding two years; 320,000 received mammograms; 480,000 received prenatal services – 67 percent of them in the first trimester. And 265,000 gave birth – including 178,000 in either a health center, or under health center supervision.

If these trends hold, a near-doubling of the health center system over five years will extend these benefits and others to several million more women and children. We know that many Healthy Start grantees are already actively partnering with Health Centers, but the time has never been better to re-double those efforts to bring more people into the system.  

We’re talking about millions of young people who currently have, at best, spotty access to health care.  So we have the chance to make progress on an epic scale, a scale not seen since the passage of Medicaid.

And for your patients and others, they can go to “Find a Health Center” on www.hrsa.gov, put in their zip code and locate the nearest health center, where folks can’t be turned away as a result of inability to pay or lack of health insurance.

Too few Americans recognize the game-changing nature of this expansion, especially as it concerns the health of our children.

To better make that case in the health center program, we track a great deal of data that speaks to access and to care – provided to us by the health centers – and HRSA this year is adding four more clinical performance measures to the six we already collect annually from our health center grantees, including children’s weight assessment counts, and asthma treatment rates.

To staff this expanding primary care infrastructure, the President has charged HRSA with more than doubling the ranks of the National Health Service Corps.

The Corps is comprised of advanced practice nurses, physicians, dentists, psychologists and others who agree to provide primary care in medically underserved areas for at least two years.  

In exchange, the federal government – through HRSA – gives them up to $60,000 tax free over that period to repay student loans.  For a five-year commitment, the loan repayment amount can run as high as $170,000.

Just two years ago, the National Health Service Corps had only 3,600 providers in the field.  Overall, the field strength of the National Health Service Corps has grown by 57 percent in just one year to 7,530 clinicians.

Thanks to President Obama’s leadership, we are planning for the Corps’ ranks to expand to 10,500 primary care clinicians by the end of 2011.   

Most immediately, here’s what that expansion means to maternal and child health providers:

• A 72 percent increase in Service Corps Nurse-Midwives in the past year alone – from 108 to 186;
• A 95 percent increase in Nurse-Practitioners – from 615 to 1,204; and
• A 47 percent increase in Service Corps pediatricians – from 246 to 362.

In addition to the Health Centers and the National Health Service Corps, the agency also serves women, their children, and their families through Part D of the Ryan White HIV/AIDS program.  

The Ryan White program relies on a national network of more than 900 grantees to provide primary care services and life-sustaining medications to about half the people living with the virus in the U.S. About a third of these 550,000 clients are women.

Overall, 80 public and private organizations provide family-centered, community-based primary and specialty care services to about 81,000 clients through Part D– including those in need of treatment to prevent perinatal transmission.

Of course, on a much larger scale, you know that our MCH block grants to states support services for over 40 million women and children, including kids with special health care needs, and their families.

It is the only program that focuses solely on improving the health of all mothers, adolescents and children -- whether insured or not – through a broad array of public health and community-based programs.

Against this backdrop of commitment and activity – from HRSA to the highest ranks of government -- Healthy Start has experience sustained success in the face of many challenges.

In contrast, for example, to the overall national infant mortality rate of 6.7 in 2006, the infant mortality rate for Healthy Start participants was 5.7. In 2007, when the national rate rose slightly, the rate for Healthy Start participants actually declined to 5.1. Healthy start has made similar gains in decreasing low birth weight rates and increasing early entry into prenatal care.

These positive trends have remained constant now for years.

This speaks well of the work that all of you are doing under often trying circumstances. And it also raises a question.

As I ask all of our grantees -- whether it’s rural hospitals, or health care centers, or our Ryan White recipients -- could we be doing more? Could we be doing our work differently to harness greater efficiencies?

We all know that the country faces enormous budgetary challenges.  

So how can we align our resources more effectively? Is there an innovation we haven’t tried? Is there a way to reach deeper into the populations you serve? Can we build even stronger relationships between more of our HRSA grantees, our Healthy Start sites, and health professions training programs at colleges and universities?

Recognizing the challenges before us, we’re pushing different examples of innovations at HRSA.

I’m thinking here of the Text4Baby initiative.  It’s a free mobile information service that provides health-related text messages to pregnant women and new moms to help them care for their own health and give their babies the best possible start in life.  Subscribers receive free text messages each week, timed to their due date or baby’s date of birth. If you’re not familiar with this project, just go to HRSA.gov and type in the word “Text”, the number 4, and “Baby” – all one word. Again, it’s free; it’s easy; and it works. And it’s also available in Spanish.

I hope that some of your moms, or soon-to-be moms, are signed up. There’s no cost for anyone to receive these health messages.

It’s even more important now that we employ innovation and creativity to extend the reach of our work. So if there’s a way to engage more clients, we need to be taking those opportunities very seriously. If you hit on a promising practice, please be sure to share it. If a new innovation seems to be working, please tell us about it. If there’s a way to expand the boundaries of the clients you serve across your communities, then let’s get started.

We know the need exists well beyond those folks that currently walk through your doors. How can we leverage our other assets to help ensure that those standing outside are also able to participate in Healthy Start?

So that’s my “ask” of you today.  And if anyone can do it, I have faith that our Healthy Start grantees can.

Your 20-year record of accomplishment speaks for itself.  Thanks so much for the work you do.

Congratulations on this important anniversary.  And thank you.