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MCHB Conference Webcasts - 16th Annual MCH EPI Conference, December 15-17, 2010
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Plenary Sessions

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Plenary I - Social Determinants of Health: How Far Have We Come in the Past Two Decades and Where Do We Go from Here?

Lisa Berkman, PhD, MS

Patricia O'Campo, PhD

Milton Kotelchuck, PhD, MPH
Lisa Berkman, PhD, MS
Director, Harvard Center for Population and Development Studies
Thomas D. Cabot Professor of Public Policy and Epidemiology
Department of Society, Human Development, and Health Department of Epidemiology, Harvard Center for Population and Development Studies, Harvard University
Patricia O'Campo, PhD
Professor, Division of Epidemiology, Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto
Director, Centre for Research on Inner City Health, St. Michael's Hospital
Richard David, MD
Division of Neonatology, John H. Stroger Jr. Hospital of Cook County

The World Health Organization (WHO) defines social determinants of health as the conditions, social and cultural, under which people are born and spend their entire lives. These conditions encompass the systems that impact individuals including the health care system, monetary systems, the political system, and resources. More importantly, the social determinants of health contribute to health inequity most notably in developing countries, but also in post-industrial countries including the U.S. The most recent WHO Commission on Social Determinants of Health report published in 2008 had three overarching recommendations: 1) Improve daily life, 2) Address inequity in quality of life, and 3) Measure and assess the impact of social determinants and understand how projects have moved from data results to programs motivating change.

In the U.S., scientists have focused research on specific social determinants including institutional racism and health disparities, the impact of cultural practices on lifestyle, access to health care, residence, education level, and the impact of the political system. Research on measurement of the social determinants of health and health inequities has offered solutions aimed at addressing these inequities through change of the political and health care systems. Less research has focused on exploring the synthesis of epidemiology and the social determinants of health. The purpose of this plenary session is to present current epidemiologic study of the social determinants of health, methodologies, and the societal/generational impact of these determinants on health in the U.S.

LEARNING OBJECTIVES:

  1. To provide practical examples of the social determinants of health
  2. To describe the populations affected by health inequity and disparity
  3. To describe data sources available for measuring the social determinants of health
  4. To offer multiple measurement techniques of social determinants at the individual, community, and societal levels

Plenary II - Opportunities for Chronic Disease Prevention: Targeting Women with Gestational Diabetes and Hypertension

Patricia Dietz, DrPH

Patrick Catalano, MD

Ellen Seely, MD

Assiamira Ferrara, MD, PhD

Shadi Chamany, MD, MPH
Patricia Dietz, DrPH
Team Leader, Research and Evaluation Team, Applied Sciences Branch, Division of Reproductive Health, Centers for Disease Control and Prevention
Patrick Catalano, MD
Chief, Infant, Child and Women's Health, National Center for Health Statistics
Ellen Seely, MD
Director of Clinical Research in the Endocrinology, Diabetes and Hypertension Division
Vice Chair for Faculty Development in the Department of Medicine
Brigham and Women's Hospital
Assiamira Ferrara, MD, PhD
Senior Scientist, Kaiser Northern California
Shadi Chamany, MD, MPH
Director of the Diabetes Prevention and Control Program at the New York City Department of Health and Mental Hygiene

The intersection of pregnancy and chronic disease encompasses health implications for the woman and for the child. Women with chronic diseases not only face their own health problems, but their infants have increased risks of poor outcomes. Conditions identified during pregnancy, such as gestational diabetes and hypertension, reveal future risk of cardiovascular and metabolic diseases for the woman and immediate risk of poorer outcomes for the infant. Pregnancy provides an opportunity to identify chronic disease risk among women who are in need of education, counseling, and appropriate follow up to address their long-term health risks.

Approximately 30% of women of reproductive age are obese, and one in four women will develop diabetes in their lifetime. During pregnancy, 4-7% of women experience gestational diabetes, a condition that indicates a high risk for future development of type 2 diabetes, and approximately 5% experience preeclampsia, which is associated with increased future risk of cardiovascular disease, the number one cause of death among women in the US. Effective interventions exist for diabetes prevention. For women with a history of preeclampsia, little is known about how to best prevent cardiovascular disease. However, lifestyle interventions to reduce obesity and diabetes may also reduce risk of cardiovascular disease.

The purpose of this plenary session is to provide a state-of –the-art update on the epidemiology of obesity, gestational diabetes and hypertension, their effect on pregnancy outcomes, and how gestational diabetes and hypertension identify future risk of chronic disease. In addition, our speakers will discuss their research on interventions to offset those risks. Participants will come away with an understanding of the epidemiology of these conditions, current clinical recommendations, research on effective interventions, and directions for future research and programmatic needs.

LEARNING OBJECTIVES:

At the conclusion of this plenary session, the audience will have a better understanding of:

  1. The epidemiology of obesity, gestational diabetes and hypertension, and effect on pregnancy outcomes, future disease risk for the mother.
  2. Clinical recommendations for screening before, during, and after pregnancy.
  3. Effective interventions for risk reduction and prevention of diabetes among women with previous gestational diabetes.
  4. Current research on interventions for preventing cardiovascular disease among women with a history of preeclampsia.
  5. Future needs for research with special emphasis on the role of state MCH epidemiologists in addressing these needs.

Plenary III - Challenges to Evidence-Based Public Health Practice

Stephen B. Thacker, MD, MSc, ASG/RADM (Ret.) USPHS

Lauren A. Smith, MD, MPH

Jennifer F. Culhane, PhD, MPH

Pierre Buekens, MD, PhD
Stephen B. Thacker, MD, MSc, ASG/RADM (Ret.) USPHS (Presented by William Sappenfield)
Deputy Director for Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention
Lauren A. Smith, MD, MPH
Medical Director, Massachusetts Department of Public Health
Jennifer F. Culhane, PhD, MPH
Associate Research Professor, Obstetrics and Gynecology
Associate Professor, Epidemiology and Biostatistics, Drexel University
Pierre Buekens, MD, PhD
W.H. Watkins Professor and Dean, Tulane University School of Public Health and Tropical Medicine

The message is clear. With health care being reformed, government agencies being pushed for accountability, and health care dollars becoming tight, public health agencies are needing to demonstrate that their policies and programs are evidence-based and clearly beneficial. However, the task is challenging. The current published literature is complex to summarize because of different approaches and methodological issues. Moreover, the literature is spotty in addressing the necessary issues in a comprehensive systematic fashion. Not all MCH issues have demonstrated effective policy and program solutions. Further research is needed to design and shape potential solutions and maximize the potential. Even when the evidence is clear, evidence-based practices and policies are not always implemented, implemented fully or implemented appropriately. The boundary is not always clear as to what is necessary for fidelity to the effective model versus what is necessary to change to adapt to the culture and environment. Scientific methods and public health practices are available to address these issues. But, there are many challenges... How can we best strengthen the MCH field’s evidence-based practice?

LEARNING OBJECTIVES:

  1. Understand the definition(s) of evidence-based public health practice
  2. Understand the sciences and practices to developing and implementing evidence-based practices
  3. Learn the current challenges and approaches to evidence-based public health practice
  4. Discuss the next necessary steps for strengthening the MCH practice field