MCH Timeline

Explore the MCH Timeline from the beginning by scrolling down, or choose a decade to explore:


1798: Marine Hospital Service

BACKGROUND

On July 16, 1798, President John Adams signed an Act that established the Marine Hospital Service (MHS), which eventually became the U.S. Public Health Service. The MHS was established to provide medical care to the increasing numbers of ill merchant seamen traveling to U.S. port cities to ease the burden on public hospitals. The MHS also offered technical assistance on epidemics and matters of quarantine to the states.

IMPACT

Over the next century, the MHS laid the foundation for public health in the United States. In 1912, the MHS was officially renamed the U.S. Public Health Service (USPHS) and was given increased responsibility for health investigation and environmental safety in controlling the spread of contagious diseases such as smallpox and yellow fever, conducting important biomedical research, regulating the food and drug supply, providing health care to underserved populations, and supplying medical assistance in the aftermath of disasters.

Category: Public Health and Medicine


1800: Smallpox vaccination in the U.S.

BACKGROUND

The smallpox vaccination was introduced in the United States in 1800 by Benjamin Waterhouse. In 1855, Maryland successfully passed a law to make the vaccination compulsory for schoolchildren; however, legislative attempts to make vaccinations compulsory in America did not succeed until 1855 and enforcement did not begin until 1872.

IMPACT

The smallpox vaccine, along with the establishment of vaccination laws and improvements in sanitation, water quality, and hygiene, eventually led to the eradication of the deadly smallpox disease and decreased mortality rates due to the disease.

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Category: Public Health and Medicine


1840: Public School Movement

BACKGROUND

In the 1840s, the United States government began to realize the need to organize public schools throughout the country. This movement was intended to unify Americans in the context of increasing urbanization, industrialization, and immigration.

IMPACT

The movement in the 1840s to organize public, government funded schools laid the foundation for free education for all children in the United States. "General education is the best preventive of the evils now most dreaded. In the civilized countries of the world, the question is how to distribute most generally and equally the property of the world. As a rule, where education is most general the distribution of property is most general.... As knowledge spreads, wealth spreads. To diffuse knowledge is to diffuse wealth. To give all an equal chance to acquire knowledge is the best and surest way to give all an equal chance to acquire property." --President Rutherford Birchard Hayes

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Category: Government and Policy


1847: American Medical Association (AMA) established

BACKGROUND

The American Medical Association (AMA) was established in 1847. A year later, an AMA committee assessed the state of medical education in the U.S. and reported several deficiencies in the medical education system. The committee concluded that the U.S. system lagged significantly behind those already operating in Europe.

IMPACT

With the establishment of the AMA, national medical standards and the first code of medical ethics were adopted. The AMA continues to be the largest medical association in America, and over the last century and a half, has continued to set medical guidelines and improve public health care.

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1855: First Children's Hospital

BACKGROUND

The nation's first freestanding children's hospital, established in Philadelphia, began receiving children suffering from acute diseases and accidents on November 23, 1855. This was followed by the establishment of another children's hospital in Boston. By the mid-1890s, most large cities had at least one children's hospital.

IMPACT

The Children's Hospital of Philadelphia was the first hospital dedicated entirely to children. The opening of this hospital influenced other large cities to provide the same concentrated care to children.

Category: Public Health and Medicine


1860: First Children's Clinic

BACKGROUND

Dr. Abraham Jacobi founded the nation’s first children’s health clinic in New York. During the weekly clinic, medical students were able to focus on conditions specific to children.

IMPACT

Dr. Jacobi is regarded as the founder of American pediatrics. By initiating the first children’s clinic in the U.S., he set the precedent for including children’s clinics in hospitals across the nation.

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Category: Public Health and Medicine


4/12/1861: The Civil War

BACKGROUND

The Civil War began with cannon fire ringing out on the morning of April 12, 1861 and ended as the most deadly war in United States history with the surrender of General Lee and his Confederate forces on April 9, 1865. Three million men fought and 600,000 died, more than any other war involving U.S. soldiers. The succession of Southern states from the Union, taxation, and most notably slavery were the immediate catalysts for the first shots of the war. The aftermath of the Civil War, “Reconstruction,” led to the ratification of the Thirteenth Amendment, which abolished slavery in the United States. Reconstruction led to the reorganization of society, the economy and the politics of Southern states.

IMPACT

The roots of the Civil War run deep and are still debated. The social effects of the Civil War have lasted well over a century, and continue today. Following the Civil War, the Reconstruction Era eventually led to a much stronger centralized government in the U.S.

Category: Milestones


1867: The U.S. Office of Education established

BACKGROUND

President Andrew Johnson created the first Department of Education in 1867. The controversial department was demoted to an office within a year because Congress feared that the department would exercise too much control over local schools. Over the next several decades, the Office of Education remained small, operated under different titles, was housed in various government agencies, and was poorly funded. In 1979, the Office of Education became the Department of Education.

IMPACT

Although the Office of Education remained small for many decades, it's creation laid the foundation for future legislation on the role of government in public education.

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Category: Government and Policy


1869: First Board of Health established

BACKGROUND

The first state board of health, established in Massachusetts in 1869, was limited to investigative and consultative responsibilities. The Board's limited scope, small budget, and untrained staff were partly responsible for its failure to control a smallpox epidemic. As a result, autonomous local boards of health were created in 1872.

IMPACT

The board of health in Massachusetts was the first board established to promote the general health of the public. Its creation led the way for the establishment of similar boards of health in most states across the nation.

Category: Government and Policy


1872: American Public Health Association (APHA) established

BACKGROUND

The American Public Health Association was established in 1872 by Stephen Smith in New York. The majority of its membership was composed of physicians who served as officials in local and state health departments. The APHA's main purpose initially was to increase these departments' regulatory authority.

IMPACT

APHA continues to be the oldest and largest organization of public health professionals in the world. Its influence on policies and public health priorities has been continually present since its inception.

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Category: Government and Policy


1874: Society for the Prevention of Cruelty to Children established

BACKGROUND

The first organized attempts to protect abused children arose from humane work that focused on animals. The American Society for the Prevention of Cruelty to Animals was established in 1866 by Henry Bergh. In 1874, a woman came to Mr. Bergh seeking help for a brutally abused foster child, Mary Ellen Wilson. Since there was no agency to protect children, the Society for the Prevention of Cruelty to Animals was the only agency to take responsibility for helping the child. Stemming from this event, the Society for the Prevention of Cruelty to Children was founded in 1874. In 1875, it was incorporated as The New York Society for the Prevention of Cruelty to Children.

IMPACT

With the inception of the Society for the Prevention of Cruelty to Children, the protection of children became a more widely publicized issue and thus a growing concern for state and local governments.

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Category: Government and Policy


1879: AMA Section: Diseases of Children

BACKGROUND

The Section on Diseases of Children of the American Medical Association was formed in 1879.

IMPACT

The formation of this section supported pediatrics as a special branch of medicine.

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1881: Abolition of Child Labor becomes top priority for AFL

BACKGROUND

The use of child labor continued to be of great concern for society and labor groups. In 1881, the abolition of child labor became a top priority for the American Federation of Labor. By 1899, 28 states had passed legislation designed to protect child workers. This was accomplished despite opposition by employers who felt these laws would make it difficult to stay in business. The first state child labor committee was organized in Alabama in 1901. In 1904, the first national child labor committee met in New York. The central purpose of the National Child Labor Committee was to prevent child labor through legislation.

IMPACT

These concerted and focused efforts to protect child workers has ultimately led to the existence of child labor laws in all 50 U.S. states.

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Category: Government and Policy


1888: American Pediatric Society

BACKGROUND

Dr. Abraham Jacobi founded the nation’s first children’s health clinic in New York. During the weekly clinic, medical students were able to focus on conditions specific to children.

IMPACT

Dr. Jacobi is regarded as the founder of American pediatrics. By initiating the first children’s clinic in the U.S., he set the precedent for including children’s clinics in hospitals across the nation.

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1889: Hull House Settlement Established

BACKGROUND

Jane Addams, with friend Ellen Starr, established the Hull House Settlement in 1889 in Chicago, and initiated the Settlement House Movement in the U.S. Services provided at Hull House included kindergarten classes and health, child care and legal aid services.

IMPACT

Jane Addams was the first American woman to receive the Nobel Peace Prize in 1931. She was one of the early advisors for the Children's Bureau.

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1890: Progressive Era

BACKGROUND

The period between 1890 and 1920 involved such intense reform activity that historians have labeled it the "Progressive Era." Over these three decades, Americans organized voluntary and political associations to devise solutions to the problems created by industrialization, urbanization, and immigration.

During this period, a reform movement referred to as the "crusade for children" revolved around efforts to improve child health and labor conditions. On state and local levels, the increased development of health departments provided new forums for expanding and disseminating pediatric and obstetric knowledge. The private sector increased its involvement in programs for people with disabilities. Notably, volunteer organizations such as the Shriners, the National Society for Crippled Children (Easter Seals Society), the Rotary Club, and the Lions Club each initiated new programs for children and adults with disabilities.

IMPACT

The efforts of the government to improve child health and labor conditions and the increased sharing of pediatric knowledge paved the way for reform in the next century. Private organizations laid a strong foundation for the continued involvement of the public in programs for children.

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Category: Milestones


1893: First State Program for Children with Special Health Needs

BACKGROUND

Minnesota was the first state to provide a state program for children with disabilities.

IMPACT

By the end of the 19th century, hospitals for children with orthopedic impairments had been established in many major cities.

Category: Government and Policy


1893: Henry Street Settlement

BACKGROUND

Trained as a nurse, Lillian Wald founded the Henry Street Settlement in New York City in September 1893.

IMPACT

Lillian Wald pioneered public health nursing and helped to found the National Organization for Public Health Nursing. She was also instrumental in helping to establish the federal Children's Bureau, National Child Labor Committee, and National Women's Trade Union League.

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Category: Public Health and Medicine


1893: Henry Street Settlement

BACKGROUND

Trained as a nurse, Lillian Wald founded the Henry Street Settlement in New York City in September 1893.

IMPACT

Lillian Wald pioneered public health nursing and helped to found the National Organization for Public Health Nursing. She was also instrumental in helping to establish the federal Children's Bureau, National Child Labor Committee, and National Women's Trade Union League.

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Category: Government and Policy


1893: Milk Stations

BACKGROUND

Lack of safe milk was among the most significant child health problems during the 1800s. In 1893, Nathan Straus, a New York philanthropist, established a number of milk stations for the poor in an attempt to decrease infant mortality and morbidity caused by “summer diarrhea.” In 1897, Rochester, New York became the first municipality to provide milk stations.

IMPACT

Due to the provision of safe milk at milk stations and the advent of pasteurization in 1910, diarrheal disease was no longer a major cause of infant mortality by the early 1900s.

Category: Government and Policy


1894: School Inspections

BACKGROUND

With the introduction of modern public health methods, schools began to take more responsibility for preventive health care. The Boston Board of Health was the first to introduce medical inspection of children to prevent infectious diseases in schools. Chicago followed by becoming the first city to appoint school physicians. The New York City Health Department became the first health department to introduce compulsory medical inspection in all public schools. Ideas for health education and school medical inspection led to a request from the New York Health Commissioner for the loan of a full-time nurse to provide medical inspection in schools.

IMPACT

These initial efforts set the precedent for standardized school medical inspections. The school setting allowed for efficient screening of diseases and developmental concerns in schoolchildren.

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Category: Government and Policy


1900: The 1900's

The 1900s were initiated with the establishment of progressive organizations focused on many emerging maternal and child health issues. The American Medical Association added an Obstetrics and Diseases of Women section. The First National Child Labor Committee and First Bureau of Child Hygiene helped combat the developing health concerns regarding issues such as child labor and overcrowding-related health concerns. The American Association for Study and Prevention of Infant Mortality was the first organization to have a set agenda on reducing the rate of infant mortality. Use of the Little Mother’s League proved that public health assistance training programs allowed for various volunteers across the nation to help decrease the number of infant deaths.

Category: Milestones


1903: AMA Section: Obstetrics and Diseases of Women

BACKGROUND

The American Medical Association (AMA) established a section called Obstetrics and Diseases of Women.

IMPACT

The formation of this section supported the gynecological and obstetrical needs of women in the medical field prior to any national and professional organizations. Although unbeknownst at the time, this would lay the groundwork for a whole specialty of medicine that would greatly contribute to the improvement of women’s health.

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Category: Public Health and Medicine


1904: First National Child Labor Committee

BACKGROUND

The National Child Labor Committee was organized in 1904 in an attempt to persuade Congress to prevent child labor though legislation. Jane Addams was one of its founding members. The Committee was incorporated by an Act of Congress in 1907. In the same year, Jane Addams reported that there were more than 2 million children under 16 years of age in paid employment in the U.S. She argued that the vast number of children working in the U.S. helped to explain the 580,000 children between 10-14 years old who did not know how to read or write.

IMPACT

The development of the first national child labor committee indicated a presence in Congress of individuals who were concerned about child labor. The establishment of the committee led to the development of the Federal Children's Bureau in 1912 and the Federal Child Labor Law in 1916. This committee laid the foundation for the strong state and federal child labor laws that were developed later on to ensure the health and safety of America's youth entering the working world.

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Category: Government and Policy


1907: First Bureau of Child Hygiene

BACKGROUND

Dr. Josephine Baker was the first Chief of the MCH Bureau of Child Hygiene (later Bureau of Child Health) in the New York City Health Department from 1908-1923. In addition to being a physician, she was also the first woman to receive a doctorate in public health from the New York University School of Medicine.Through her efforts, she organized visits to tenement homes of newborn babies, provided instruction and assistance to mothers on infant care and was instrumental in the prevention of diarrheal diseases.The MCH Bureau of Child Hygiene in the NYC Health Department also provided care to school children, conducted health clinics, supervised midwives, and regulated children's institutions and boarding homes.

IMPACT

The development of the first Bureau of Child Hygiene in New York with the help of Josephine Baker had many impacts including:allowing the licensure of midwivesthe development of a dispenser for administering silver nitrate to newborns' eyes to prevent gonococcal infections and blindnessthe development of a newborn formula which added water, calcium carbonate, and lactose to cow's milkthe controversial development of the Little Mothers Leagues where 8 and 9 year old girls were taught how to take care of children while their mothers worked to try and support the children.The establishment of this first MCH bureau paved the way for other state bureaus as well as the subsequent establishment of the federal Children's Bureau in 1912. In addition, the first bureau of child hygiene marks the beginning of the American vision and goal to have children reach their optimal health and to receive quality healthcare.

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Category: Public Health and Medicine

1908: Little Mothers’ League

BACKGROUND

Dr. Josephine Baker, Director of the Division of Child Hygiene at the New York City Department of Health, organized “Little Mothers’ Leagues” starting in 1908. The “leagues” were established to provide care for infants, with the greater goal of reducing infant mortality. Members were females aged 12 to 16, although girls as young as 10 could join. After attending classes, girls became certified as “volunteer aides of the Department of Health.”

IMPACT

Young girls were very interested in joining Little Mothers’ Leagues, and the leagues spread to other cities. Within seven years, nearly 50,000 girls had attended classes across the country.

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Category: Government and Policy


1909: White House Conference on Dependent Children

BACKGROUND

In 1909, President Theodore Roosevelt convened a group of medical professionals and lay leaders interested in the care of dependent children. This marked the first White House Conference on the Care of Dependent Children. One of the major recommendations from this conference was for the development of a federal Children's Bureau.

IMPACT

In 1909, the first ever White House Conference on the Care of Dependent Children brought national focus to the health and well-being of dependent children and provided the venue for a government leadership role in child welfare reform, including efforts to prevent childhood diseases, reduce infant mortality, and reform child labor practices. This conference led to the development of the Children's Bureau in 1912. Today, the activities of the original Children's Bureau are divided between two agencies in the U.S. Department of Health and Human Services; the child welfare responsibilities are housed in the Administration for Children and Families and the health responsibilities are housed in HRSA’s Maternal and Child Health Bureau.

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Category: Government and Policy


1909: Prevention of Infant Mortality

BACKGROUND

In 1909, the American Association for Study and Prevention of Infant Mortality was organized in New Haven, Connecticut. It was the first nationwide association whose mission was to study and identify ways to prevent infant mortality. Dr. Helen Putnam, who served as the president of the American Academy of Medicine, was instrumental in the Association’s development.

IMPACT

The Association played a major role in creating a new registration procedure for all infant births and deaths in the country.

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Category: Public Health and Medicine


1910: The 1910s

The decade began to lay the foundation for numerous public health efforts, many of which focused on maternal and child health. By the year 1910, pasteurization of milk was being widely implemented on the national level to provide safe milk for infants and children. Establishment of the National Organization of Public Health Nursing, Children’s Bureau, the United States Public Health Service, and the American Child Hygiene Association helped show that both private and federal organizations and agencies were serious about the health and wellness of women and children, particularly the most vulnerable and impoverished populations. The National Birth Registry, set forth by the Children’s Bureau provided the first concrete evidence of the social causes of infant mortality. The Keating-Owen Act rendered illegal for the exchange of goods produced by factories that employed children under the age of fourteen. The first edition of the Children’s Bureau’s infant care pamphlet along with the Baby Week Campaign and the 1919 Children’s Year all worked to increase the public’s knowledge and awareness of burdens on child health. However, setbacks such as the Spanish Influenza pandemic took a toll on all age groups.

Category: Milestones


1910: Sickle Cell Anemia Described

BACKGROUND

Dr. James B. Herrick presented the first published description of sickle cell anemia in 1910. The patient described was a dental student from Grenada studying in Chicago. As more studies were published, it was realized that all patients described shared origins in Africa. Evaluation of chromosome structure indicates that the sickle cell gene was derived by mutations at least four separate times, three times in Africa and a fourth in either Saudi Arabia or central India.

IMPACT

Sickle cell diseases are the most prevalent group of disorders identified by newborn screening, with more than 1500 affected infants born in the United States each year. It is now recognized that genes with mutations for sickle cell disease are common in persons of African, Mediterranean, Middle Eastern, and Indian ancestry, and in persons from the Caribbean and parts of Central and South America.

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Category: Public Health and Medicine


1910: Flexner Report

BACKGROUND

The American Medical Association employed Abraham Flexner to inspect medical schools in the U.S. regarding entrance requirements, quality of facilities, and financial capabilities to train students and support faculty.

IMPACT

Flexner's recommendations, though criticized during his time, became the foundations for the present educational and licensing requirements of physicians.

Category: Public Health and Medicine


1910: Pasteurization

BACKGROUND

By 1910, pasteurization was recognized as the best way to ensure delivery of safe milk to infants and the general U.S. population.

IMPACT

Since the discovery of pasteurization in the mid-1800s, the concepts of sterilization, disinfection, and antiseptics have been widely applied to improve public health.

Category: Public Health and Medicine


1911: Mandatory School Health Inspection

BACKGROUND

By 1911, nine states had mandatory school health inspection laws and nearly 400 cities had adopted a system of medical inspection.

IMPACT

The early school health inspections were used for infectious disease surveillance to identify and quarantine children with threatening conditions. School health programs provided the opportunity for proactive health intervention to educate and screen children and prevent diseases.

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Category: Public Health and Medicine


1912: Public Health Nursing

BACKGROUND

The National Organization of Public Health Nursing (NOPHN) was formed in 1912. Lillian Wald, who had previously coined the term “public health nurse,” served as NOPHN’s first president.

IMPACT

Public health nurses have made tremendous contributions to the field of maternal and child health, providing and assuring care to the most vulnerable and underserved populations. For example, Wald helped to establish the world’s first public school nursing system.

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Category: Government and Policy


1912: U.S. Public Health Service

BACKGROUND

A series of laws in the late 19th century placed the responsibility of providing medical inspections for all arriving immigrants on the Marine Hospital Service (MHS), and ultimate authority of quarantine enforcement with the Surgeon General instead of with the states. In 1912, the MHS was renamed the U.S. Public Health Service (USPHS), which was given greater responsibilities in providing healthcare services to medically underserved populations through health investigations, environmental safety, and health promotion.

IMPACT

As America's uniformed service of public health professionals with core values of leadership, service, integrity, and excellence, the USPHS Commissioned Corps protects, promotes, and advances the health and safety of national and international medically underserved populations through:

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Category: Government and Policy


1912: Children's Bureau

BACKGROUND

The Children's Bureau was established under President Taft in 1912 at the recommendation of the First White House Conference on Dependent Children in 1909. The mission of the Children's Bureau was to investigate and report “upon matters pertaining to the welfare of children and child life among all classes of our people." Although Federal involvement in such issues was controversial at the time, the Bureau was established through active support of President Taft. Julia C. Lathrop became the first chief of the Children’s Bureau and the first woman to be appointed by a president to head a Federal statutory agency.

IMPACT

In addition to the mandate to investigate and report on child health issues, the early leaders of the Children's Bureau sought to resolve problems through legislation and the political process. The National Birth Registry and the Sheppard-Towner Act were important outcomes of the Bureau's activism. As a result of the leadership provided by the Children’s Bureau, 28 states had established child hygiene bureaus by 1920. Sixteen of these state bureaus were established in 1919 alone.

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Category: Government and Policy


1914: World War I

World War I (also known as The Great War) was a military conflict of catastrophic size that took place mainly in Europe. The results of the war shaped the modern world both in ideology and historical events as it led to the development of World War II and other milestones, including scientific advancements and women's voting rights.

Category: Milestones


1914: Pamphlet on Infant Care

BACKGROUND

In 1914, the first edition of the Infant Care pamphlet was published as a result of the Children's Bureau’s studies on infant and maternal morbidity and mortality.

IMPACT

Infant Care provided advice to parents on recording births, the latest research on prenatal and infant care, and support for breastfeeding. It became a “bestseller,” with nearly 1.5 million copies circulated by 1921. Over the next 50 years, a total of 45 million copies of the pamphlet were distributed as an educational resource.

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Category: Government and Policy


1915: National Birth Registry

BACKGROUND

Proposed by the Children’s Bureau, the National Birth Registry was established in 1915 to improve data collection of vital statistics.

IMPACT

In the 1900s, the National Birth Registry and other infant vital records related the first concrete evidence of the social causes of infant mortality, demonstrating how high mortality rates in industrial cities were connected with the unmet health and educational needs of children. As the perpetuating cycle of poverty and ill health was recognized, increased efforts were made to mobilize communities and promote good health.

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Category: Government and Policy


1916: Keating-Owen Act

BACKGROUND

By 1900, one in six 10- to 15-year-olds was employed in industry and agriculture, and children as young as 7 were employed in hazardous work environments. The Keating-Owen Act was meant to regulate child labor by prohibiting interstate commerce of goods produced by companies that employed children within certain restrictions. The U.S. Supreme Court overturned the Act in the 1918 Hammer v. Dagenhart case.

IMPACT

The Act attempted to protect children from wrongful exploitation; however, the Supreme Court ruling in the 1918 case demonstrated that the federal government had no right to intervene in child labor decisions – it was up to the parent whether a child would work instead of attend school. Despite the ruling, the children's rights movement continued to progress. New child labor laws were enacted during the Great Depression in the 1930s.

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Category: Government and Policy


1916: Establishment of Schools of Public Health

BACKGROUND

From 1916 to 1923, schools of public health were established in colleges and universities in order to meet health departments' increased need for more broadly trained personnel.

IMPACT

Today, more than 50 accredited schools of public health are in the United States. Public health professionals protect and promote the health of our nation.

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Category: Government and Policy


1917: Baby Week Campaign (1917) and Children's Year (1918)

BACKGROUND

"Next to the duty of doing everything possible for the soldiers at the front, there could be, it seems to me, no more patriotic duty than that of protecting the children who constitute one-third of our population."
- President Wilson announcing the Baby Week Campaign.

IMPACT

The Baby Week Campaign (1917) and Children's Year (1918) led to an increased awareness among states and local health agencies of the importance of maternal and child health. The public awareness campaigns helped to garner support for the Sheppard-Towner Act.

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Category: Government and Policy


1918: American Child Hygiene Association

BACKGROUND

The American Association for the Study and Prevention of Infant Mortality (AASPIM) changed its name to the American Child Hygiene Association, reflecting a broader scope to child health.

IMPACT

Once AASPIM became the American Child Hygiene Association, more emphasis was placed on raising public consciousness regarding good health practices, particularly in children. The American Child Hygiene Association contributed to the drastic reduction in infant mortality.

Category: Government and Policy


1918: Influenza Pandemic

BACKGROUND

The worldwide influenza epidemic, also known as the Spanish Flu, killed an estimated 20 to 50 million people, more than were killed in World War I. Children and young adults were particularly susceptible to transmission and disease.

IMPACT

The influenza epidemic affected nearly one-quarter of the U.S. population and decreased the life expectancy in the U.S. by over ten years.

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Category: Milestones


1919: White House Conference on Standards of Child Welfare

BACKGROUND

The Second White House Conference addressed "child welfare" in terms of the entire health and social well-being of the child. The conference called for federal responsibility in providing service programs and financial aid for infant and child health and welfare.

IMPACT

The conference framed the first important body of child health and welfare standards to “give every child a fair chance,” including opportunities for education, recreation, and vocational preparation. The minimum standards on the protection of maternity and infancy, established as part of the Conference, were the beginning of a national movement that led to the enactment of the Shepard-Towner Act in 1921.

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Category: Government and Policy


1920: The 1920s

The 1920s catapulted a series of maternal and child health efforts that would occur over the next century. The Children’s Bureau came under the leadership of its second chief Grace Abbott, which marked an important time as the Sheppard-Towner Act passed despite opposition by many medical professionals and professional organizations. The Act launched nurse-training programs, which helped to increase the number of public health nurses in the late 1920s. Initial progress took place towards the prevention of rickets, a problem that affected children throughout the nation.

Category: Milestones


1920: Cities of 100,000+ Provide MCH

BACKGROUND

By 1920, all U.S. cities with a population of 100,000 or more provided services for maternal and child health (MCH). In addition, most state health departments had established an organizational unit for MCH.

IMPACT

As MCH services became established and more common, the American people became more accepting of the idea that child health was a public responsibility.

Category: Public Health and Medicine


1921: APHA Section: Child Hygiene

BACKGROUND

In 1921, the American Public Health Association (APHA) established a section on Child Hygiene (now known as the Maternal & Child Health Section).

IMPACT

The establishment of this section marked a time of increasing awareness of how hygiene affects health. The dissemination and practice of this information became increasingly important in maternal and child health (MCH). Today the MCH Section of APHA remains active in advocating for mothers, children, youth and families.

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Category: Public Health and Medicine


1921: American Birth Control League

BACKGROUND

With growing support for contraceptive information and distribution, the American Birth Control League was established in 1921 by Margaret Sanger.

IMPACT

Margaret Sanger worked to assure that women had information about sex, health, and contraceptives. Her work eventually gave rise to organizations such as the National Organization for Women and Planned Parenthood.

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Category: Government and Policy


1921: Maternity and Infancy Care Act / Sheppard Towner Act

BACKGROUND

The Maternity and Infancy Care Act, better known as the Sheppard-Towner Act, was adopted by Congress in 1921. It was repealed in 1929 amid concerns about socialism.

IMPACT

The passage of this Act resulted in federal grants-in-aid to states for child and adult health programs. Other major results of this Act included the development of full-time units for maternal and child health (MCH) services in state health departments and the first MCH training program. By the time the Act expired in 1929, every state but one had established MCH units. Many states continued to provide training even though there was no longer adequate funding. The Act set the stage for state-federal cooperation that would re-emerge in Title V of the Social Security Act in 1935.

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Category: Government and Policy


1921 to 1934: Grace Abbott Served as Second Chief of Children's Bureau

BACKGROUND

In 1921, Grace Abbott was appointed by President Harding as the second Chief of the Children's Bureau, taking over administration of the Sheppard-Towner Act from Julia Lathrop.

IMPACT

Priorities for Grace Abbott in the Children's Bureau included a seminal study on childhood rickets, neglected children, crippled children, and juvenile delinquency. In her later years, Abbott helped to draft the Social Security Act of 1935. She was known by the media as “the Mother of America’s 43 million children.”

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1921: Nursing Training Programs Supported by Sheppard Towner Act

BACKGROUND

The Sheppard-Towner Act of 1921 provided funds for states to improve children's health and reduce infant mortality rates. States soon discovered that they needed adequately trained professionals to make progress, so some of the funds appropriated under the Act were designated to provide nurses with tuition, a per diem, and one-year sabbatical expenses while they participated in specialized training courses. Thus, the first MCH training program was born. Throughout the 1920s and 1930s, the Children’s Bureau offered short courses for a variety of disciplines, including nurses, social workers, physical therapists, obstetricians, and pediatricians.

IMPACT

The early investments in workforce training through the Sheppard-Towner Act eventually resulted in the MCH Training Program. Today the program invests in graduate level leadership training programs across the U.S. in areas such as public health, neurodevelopmental disabilities, adolescent health, pediatrics, and nutrition.

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Category: Government and Policy


1924: Ricketts Demonstration Grant

BACKGROUND

In 1924, the Children's Bureau funded a researcher from Yale University, Dr. Martha Eliot, to determine if a program could be designed and implemented to protect every child living in a poor community from rickets.

IMPACT

Dr. Eliot's successful three-year demonstration program in New Haven, Connecticut showed that rickets could be prevented in a community. Her model illustrated the community health center approach to meeting child health needs.

RELATED PINPOINT

Category: Government and Policy


1927: Increased number of Public Health Nurses

BACKGROUND

By 1927, there were 11,500 public health nurses, representing a tremendous increase from the 900 nurses practicing in 1907.

IMPACT

Public health nurses have played and continue to play a critical role in delivering services to underserved populations and providing education about child health and development.

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Category: Public Health and Medicine


1928: Child Health Day

BACKGROUND

In 1928, the first National Child Health Day was declared by President Calvin Coolidge.

IMPACT

The declaration of the first National Child Health Day brought attention to communities, agencies and organizations, calling on them to unite and disperse information concerning children and their health needs. National Child Health Day continues to address a wide variety of concerns and issues each year.

Category: Government and Policy


10/29/1929: Stock Market Crash

BACKGROUND

Commonly referred to as "Black Tuesday," on October 29, 1929 the U.S. stock market crashed, sending America into the devastating economic tailspin known as the Great Depression.

IMPACT

The U.S. stock market crash precipitated the Great Depression, during which unemployment rates soared, families lost their homes, birth rates declined, and America slumped into a time of lost hope and economic turmoil.

Category: Milestones

The 1930s

The 1930s is synonymous with the Great Depression as the public’s health was in a fragile state. The passage of the Title V amendment of the Social Security Act during this decade would help many women and children in the 1930s as well as lay the groundwork for many public health assistance programs for the next century. Public health interventions through food regulation and enforcement began to take shape as milk was fortified to prevent rickets and vitamin K was recommended for newborns. The federal Food Stamp Program was created to help meet nutritional needs of many families during the Great Depression. Technological advances to the hospital grade incubators, and formation of the March of Dimes helped further reduce infant mortality rates.

Category: Milestones


1930: White House Conference on Child Protection

BACKGROUND

In 1930, President Herbert Hoover convened the White House Conference on Child Health and Protection. The Conference was called "to study the present status of the health and well-being of the children of the United States and its possessions, to report what is being done, to recommend what ought to be done, and how to do it." Its major focus was child development.

IMPACT

The White House Conference on Child Health and Protection generated reports that described the health care and protection needed for America's children and highlighted the deficits in the current care for children. The committee reports laid the groundwork for the inclusion of federal-state programs for aid to dependent children, crippled children, and maternal and child health and welfare services in the Social Security Act of 1935 and the Fair Labor Standard Act of 1938.

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Category: Government and Policy


1930: Milk Fortification for the Prevention of Rickets

BACKGROUND

By the 1930s, it had been known for a number of years that rickets was caused by a deficiency of vitamin D. While cod liver oil (a good source of vitamin D) was used to prevent rickets in the 1920s, it was not until the early 1930s that milk became fortified with vitamin D. Initial research was conducted by Martha Eliot and supported by the Children's Bureau.

IMPACT

In the 1930s, the public health prevention initiative of supplementing milk with vitamin D led to the eventual eradication of rickets in the United States.

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Category: Public Health and Medicine


8/14/1935: Title V of the Social Security Act

BACKGROUND

As a result of the Great Depression, cutbacks in federal health programs, and the declining health of mothers and babies, the Social Security Act was signed into law in August 1935 by President Franklin Delano Roosevelt. Secretary of Labor Frances Perkins enrolled Katharine Lenroot, then Children's Bureau Chief, to work with her to ensure that children were considered by the Committee on Economic Security, which drafted the legislation.

Title IV of the legislation also provided funding for federal-state partnerships to help the blind, the elderly, and children, the latter of which became the first incarnation of the Aid to Dependent Children welfare program. Funding was initially provided strictly for needy, dependent children, and it was not until the 1950s that funding was also given to caretakers. This was reflected in a name change to Aid to Families of Dependent Children (AFDC).

IMPACT

Title V provided programs for maternity, infant, and child care, as well as a full range of medical services for children. Funds were allocated to states to pay for Maternal and Child Health and Crippled Children services, including physicians, dentists, public health nurses, medical social workers, and nutritionists. Unlike other sections of the Social Security legislation, Title V was not an entitlement program. It consisted of four parts: 1) Maternal and Child Health Services, 2) Services for Crippled Children, 3) Child Welfare Services, and 4) Vocational Rehabilitation. Title V is the longest-standing public health legislation in American history, and it continues to work to improve the health of women and children.

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Category: Government and Policy


1935: Introduction of Vitamin K

BACKGROUND

Vitamin K was discovered in 1935 by Henrick Dam and Adelbert Doisy.

IMPACT

The discovery of vitamin K led to the prevention of hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding. Hemorrhagic disease is a potentially life-threatening bleeding condition in infants where severe bleeding or hemorrhage can result after birth. Due to the discovery that vitamin K can prevent hemorrhagic disease, it was recommended that every newborn baby be given an injection of vitamin K after delivery.

Category: Public Health and Medicine


1938: Fair Labor Standards Act

BACKGROUND

The Fair Labor Standards Act of 1938 was the first federal legislation to set employment standards for minimum age and hours of work for children.

IMPACT

While previous child labor laws, such as the Keating-Owen Act of 1916, had been met with failure, the Fair Labor Standards Act was the first permanent child labor law enacted by Congress.

RELATED LINK

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Category: Public Health and Medicine


1938: General Use of Sulfonamides

BACKGROUND

Sulfonamides, the first drugs found to be effective against bacterial infections, were discovered by Gerhand Domagk in 1932. Domagk found that one sulfonamide, Prontosil, was effective against streptococcus in mice, and treated his daughter with the drug when she became ill with a streptococcus infection. The treatment saved her arm from being amputated. Domagk won the Nobel Prize for his accomplishments in 1939, but was forced to decline it by the Nazi regime until after the war in 1947.

IMPACT

Sulfonamides came into general use by 1938. A variety of derivatives were soon synthesized - sulfapyridine in 1938, sulfathiazole in 1939, and sulfadiazine in 1949. Domagk's work with sulfonamides was revolutionary in curing bacterial infections and led to the development of a class of drugs which aided in slowing the European tuberculosis epidemic.

Category: Public Health and Medicine


1938: Improved Infant Incubator

BACKGROUND

Charles C. Chapple (1903-1979) designed the first closed incubator for infants in which the temperature and humidity were so well regulated, that the infant could remain unclothed.

IMPACT

Improved designs of infant incubators, including Chapple’s closed incubator, and improvements in premature nurseries contributed to the reduction in infant mortality rates.

RELATED LINK

Category: Public Health and Medicine


1938: Initiation of the March of Dimes

BACKGROUND

President Franklin Delano Roosevelt established the National Foundation for Infantile Paralysis (now known as the March of Dimes Birth Defects Foundation) in 1938 as a result of polio’s impact on America’s youth and his personal experiences with the disease.

IMPACT

Through research on vaccines and a polio patient aid program, the March of Dimes’ efforts led to the rapid decline of polio. Today, the March of Dimes works to improve the lives of children through the prevention of birth defects, premature birth, and infant mortality.

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RELATED PINPOINT

Category: Government and Policy


9/1/1939 to 9/2/1945: World War II

BACKGROUND

The Second World War, also known as World War II, resulted in more than 500,000 casualties among U.S. soldiers alone.

IMPACT

During World War II, demographic changes such as an increase in population, demands on the health care delivery system and changes in medical education resulted in a shortage of physicians and health care professionals who provided primary care services.

Category: Milestones


5/16/1939: Food Stamp Program

BACKGROUND

The first food stamp program was created in 1939 during President Franklin Delano Roosevelt’s term, primarily in response to the Depression. It had the dual purpose of productively using food surpluses and providing food to people in need. The program permitted people on public assistance to buy orange stamps that could be used to purchase any food. For each $1 of orange stamps that people purchased, they additionally qualified to receive 50 cents in blue stamps, which were used to purchase food determined to be in surplus. The program lasted until 1943.

IMPACT

From 1939 to 1943, the first food stamp program reached nearly 20 million people in the U.S. at a cost of $262 million. This first program paved the way for a series of future food stamp programs working to end hunger.

RELATED PINPOINT

Category: Government and Policy


The 1940s

Amidst World War II, the government continued to address gaps in the health of the nation’s women and children in the 1940s. Efforts such as the Emergency Maternity and Infant Care Program and the White House Conference on Children in a Democracy indicated that maternal and child health were on the federal government’s list of priorities. Discussion regarding childhood nutrition was deemed necessary for the National School Lunch Act. Advances in medicine helped drive down the maternal and infant mortality rates as antibiotics became widely available to the public.

Category: Milestones


1940: White House Conference on Children in a Democracy

BACKGROUND

The White House Conference on Children in a Democracy addressed problems concerning malnutrition and the elimination of discrimination on the basis of race or creed.

IMPACT

One result of the conference was a proposal for a national program on maternity care. This conference was also one of the many events that gave rise to the child advocacy laws of the 1970s.

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Category: Government and Policy


1943: Emergency Maternity and Infant Care Program

BACKGROUND

The Emergency Maternity and Infant Care Program (EMIC), passed by Congress in 1943, provided funds for maternity and infant care for the wives and infants of servicemen in the four lowest pay grades. These families were provided with medical, nursing, and hospital services for the prenatal period, delivery, and six weeks postpartum at no charge. Complete care was provided for infants less than one year old.

IMPACT

The EMIC was the largest public medical care program undertaken in the United States up to that time. Congress and the Executive branch strongly supported this program because of its affiliation with the war effort.

Category: Government and Policy


1946: Children's Bureau placed in Federal Security Agency

BACKGROUND

By 1945, the Department of Labor (DOL) was in a seriously weakened state. Of the four bureaus that constituted DOL when it was created in 1913, only the Children's Bureau and the Bureau of Labor Statistics remained. In 1946, Congress transferred the Children's Bureau to the Federal Security Agency, leaving only the child labor functions in DOL.

IMPACT

By the late 1940s and early 1950s, the Department of Labor's reorganization allowed for improved efficiency and more control over the major labor functions of the federal government.

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Category: Government and Policy


1946: The National School Lunch Act

BACKGROUND

The National School Lunch Act, signed by President Harry S. Truman, was passed to "safeguard the health and well-being of the Nation’s children and to encourage the domestic consumption of nutritious agricultural commodities and other food.”

IMPACT

The National School Lunch Act established multi-year authority for the financing of school food programs. It now permanently authorizes the National School Lunch Program (NSLP) and the Child and Adult Care Food Program (CACFP). Through these programs, the National School Lunch Act provides federal subsidies for every school lunch served, particularly for meals served to low-income children. Moreover, federal payment and a set value of commodity assistance is required for meals and snacks served to children, older adults, and people with disabilities in care facilities. The National School Lunch Act also supports other activities, including meal supplements for children in afterschool care programs, nutrition programs for homeless children, and meal service for Department of Defense overseas dependents' schools.

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Category: Government and Policy


1946: Hill-Burton Act

BACKGROUND

The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was passed in 1946 in response to President Truman's proposal to provide federal grants and loans to improve the infrastructure of the nation's hospitals. Funds were designated to states to achieve 4.5 beds per 1,000 people.

IMPACT

Federal funding was provided to hospitals where state municipalities were willing to match funds for building renovations.

Facilities receiving Hill-Burton funding had to comply with several requirements. Hospitals were not allowed to discriminate based on race, color, national origin, or creed. Facilities were required to provide a "reasonable" amount of uncompensated care each year for 20 years to local residents who needed medical attention but could not afford to pay. Participation in Medicare and Medicaid were also later added to the list of requirements for funding.

In 1975, the Act was amended and became Title XVI of the Public Health Service Act.

Category: Government and Policy


1946: UNICEF established

BACKGROUND

Following World War II, the United Nations established the United Nations International Children's Emergency Fund (UNICEF). Katharine Lenroot, Children's Bureau chief, was the United States Representative on the executive board. Dr. Martha May Eliot, associate director of the Children's Bureau, visited European countries to determine what kind of help was most needed.

IMPACT

Since its inception in 1912, the Children's Bureau had been active in international work related to children. Thus, the Children’s Bureau was invited to help lay the foundation for social programs under the United Nations and World Health Organization and postwar activities under the International Labor Organization.

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Category: Government and Policy


1946: Center for Disease Control established

BACKGROUND

The Communicable Disease Center, which grew out of the Malaria Control in War Areas program, was founded on July 1, 1946 in Atlanta, Georgia. In 1970, the Communicable Disease Center was renamed the Center for Disease Control, which is today known as the Centers for Disease Control and Prevention (CDC).

IMPACT

The CDC is globally recognized as a leading force in public health expertise. It has become a national resource in controlling communicable diseases and serving state and local health departments through grants and technical assistance. The CDC has been dedicated to protecting health and saving lives through the prevention and control of disease, injury, and disability in America and throughout the world.

RELATED LINK

Category: Government and Policy


1947: MCH Departments Established in Schools of Public Health

BACKGROUND

In 1947, the first federally funded long-term MCH training programs at universities were established. Four universities -- Harvard University, the University of California at Berkeley, the University of North Carolina at Chapel Hill, and Johns Hopkins University -- received grants from the Children's Bureau to establish MCH departments within their schools of public health. The primary goal was to train administrators with a public health and child/family focus for the new programs being developed in states under Title V.

IMPACT

Several other long-term MCH training programs were established soon after the MCH departments in schools of public health, including Public Health Social Work (1948) and Adolescent Medicine (1950s). Today the program invests in graduate-level education programs across the U.S. to educate and train the nation’s future leaders in maternal and child health.

RELATED LINK

Division of MCH Workforce Development

RELATED PINPOINTS

Category: Government and Policy


1949: Formation of United Cerebral Palsy

BACKGROUND

The National Foundation for Cerebral Palsy was founded after Leonard and Isabelle Goldenson and Jack and Ethel Hasuman put an advertisement in the New York Herald Tribune in 1945. They recruited parents of children with cerebral palsy in the greater New York City area who were interested and active in improving services for their children. In 1949, the name was changed to United Cerebral Palsy. Affiliate groups formed quickly across the U.S.

IMPACT

United Cerebral Palsy is one of the largest health nonprofit organizations in America and has become a major advocate for the rights of individuals with disabilities. Leonard and Isabelle Goldenson also helped to establish the National Institute of Neurological Diseases and Stroke, part of the National Institutes of Health.

RELATED LINK

Category: Government and Policy


1949: Dr. Virginia Apgar's achievements

BACKGROUND

In 1949, Dr. Virginia Apgar became the first woman to be named full professor at Columbia University College of Physicians and Surgeons. In 1952, Dr. Apgar developed the first standardized method to assess the status of a newborn, known as the Apgar Score.

IMPACT

The Apgar method examined an infant's heart rate, respiratory effort, muscle tone, reflex response, and color on a scale of 0-2 points. The total number of points determined the baby's score. The Apgar score, initially presented in 1952 at a scientific meeting, has become a standard used throughout the world.

RELATED LINK

Category: Public Health and Medicine


1949: Sickle Cell Disease and Altered Hemoglobin

BACKGROUND

In 1949, Linus Pauling, Harvey A. Itano, Seymour J. Singer, and Ibert C. Wells published “Sickle Cell Anemia, A Molecular Disease.” They discovered that sickle cell disease was associated with an atypical form of hemoglobin, now termed hemoglobin S.

IMPACT

Sickle cell disease was the first disease to be linked with the alteration of a specific protein (hemoglobin). As a result, the term “molecular disease” was coined. This discovery marked a milestone in the history of molecular biology.

RELATED PINPOINTS

Category: Public Health and Medicine


The 1950s

Despite the medical and technological advancements of the 1940s, the 1950s presented years of stagnation for child health. Infant mortality ceased to decline and maternal mortality rates remained high for certain subgroups. An increasing number of new mothers chose to bottle-feed their infants rather than breastfeed as more women held full-time occupations outside of the household. Additionally, large numbers of children in low-income families received no medical or dental care. However, introduction of the polio vaccine and increased funding for MCH programs allowed some continued progress to occur, including increased services and support for children with intellectual and developmental disabilities and their families.

Category: Milestones


1950: National Association for Retarded Children

BACKGROUND

As a result of the Mid-Century White House Conference, the National Association for Retarded Children (now called The Arc of the United States, or The Arc) was formed.

IMPACT

At the time of its formation, there was little support or assistance available for people with intellectual disabilities or their families. While the Arc began as a grassroots movement, it has grown and adapted over time. Today it continues to promote support and improved services for people with intellectual and developmental disabilities and their families, and has over 140,000 members.

RELATED LINK

Category: Public Health and Medicine


1950: Mid-Century White House Conference

BACKGROUND

The Mid-Century White House Conference on Children and Youth focused on the total well-being of children, including the needs of children with intellectual disabilities. In addition, the conference addressed racially segregated public schools and commissioned Kenneth Clark to write "Prejudice and Your Child." In 1954, this document became part of the U.S. Supreme Court's opinion in Brown v. Board of Education.

IMPACT

The Mid-Century White House Conference on Children and Youth laid the foundation for many of the social movements that would take place over the next two decades concerning children, their education and their mental, physical and emotional needs.

RELATED LINKS

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Category: Government and Policy


1951: Martha May Eliot Becomes Bureau Chief

BACKGROUND

Martha May Eliot worked for the Children’s Bureau for over 25 years. She first served as the director of the Bureau’s Division of Child and Maternal Health and later served as assistant chief. In 1951, Dr. Eliot was named the head of the Children’s Bureau and served as chief until 1956. Eliot was a pediatrician and was instrumental in many postwar programs for maternal and child health populations.

IMPACT

Martha May Eliot was a pioneer in maternal and child health and received numerous honors for her work in the field. During her tenure with the Children’s Bureau, Dr. Eliot drafted much of the Social Security Act’s language regarding maternal and child health and administered the Emergency Maternity and Infant Care program, which provided maternity care for more than one million servicemen's wives. Dr. Eliot was the first woman to be elected the president of the American Public Health Association (APHA) and was an instrumental member of the maternal and child health section of APHA. She was the only woman to sign the founding document for the World Health Organization.

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Category: Government and Policy


1951: American College of Obstetricians and Gynecologists (ACOG)

BACKGROUND

In 1951, the American College of Obstetricians and Gynecologists was founded in Chicago, Illinois. In 2010, the American Congress of Obstetricians and Gynecologists (ACOG) became operational as a separate companion organization.

IMPACT

Now based in Washington D.C., ACOG continues to be one of the nation's leading groups of professionals dedicated to health care for women.

RELATED LINK

Category: Public Health and Medicine


1953: Department of Health, Education and Welfare

BACKGROUND

Under the leadership of President Dwight Eisenhower, all functions of the Federal Security Agency were transferred to the newly established Department of Health, Education and Welfare (HEW) in 1953. The first Secretary of HEW was Texas native Oveta Culp Hobby, who served as Commander of the Women's Army Corps in World War II and was editor and publisher of the Houston Post. There were six major components of the new Department: the Public Health Service; the Office of Education; the Food and Drug Administration; the Social Security Administration; the Office of Vocational Rehabilitation; and Saint Elizabeths Hospital.

IMPACT

The creation of a new Cabinet-level department assured that the areas of health, education and social security were represented in the President’s Cabinet and improved federal administration of the government’s human services programs.

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Category: Government and Policy


5/17/1954: Brown v. Board of Education

On May 17, 1954 the Supreme Court announced its decision that "Segregation of white and Negro children in the public schools of a State solely on the basis of race, pursuant to state laws permitting or requiring such segregation, denies to Negro children the equal protection of the laws guaranteed by the Fourteenth Amendment -- even though the physical facilities and other "tangible" factors of white and Negro schools may be equal."

The Supreme Court's decision also had a significant impact on the future course of special education. This decision challenged the long held opinion that a separate but equal education system was legally and socially acceptable. This same ruling was used in Utah in 1969 to support the decision requiring fair and equal education for mentally retarded students.

Category: Milestones


1954: Polio Vaccine Developed

BACKGROUND

Three immunologically distinct polio viruses were established as causative agents of poliomyelitis during the 1940s. In 1954, Dr. Jonas Salk developed an inactivated vaccine. Shortly thereafter, Dr. Albert Sabin perfected a live attenuated vaccine, which became the standard in the 1960s.

IMPACT

Polio has been virtually eradicated through vaccination programs and improvements in hygiene.

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RELATED PINPOINT

Category: Public Health and Medicine


1957: Maternal and Child Health Services for Children with Intellectual and Developmental Disabilities

BACKGROUND

Increased appropriations for Maternal and Child Health programs were authorized by Congress in 1957. One million dollars were earmarked for demonstration clinical programs to serve children with intellectual and developmental disabilities. Due to a prompt and well-organized response, new diagnostic, consultative, and educational clinics were rapidly established nationwide.

IMPACT

The demonstration clinical programs raised awareness and provided support, services and education to communities, families and people affected by intellectual and developmental disabilities. Previously, there had been little state or federal support.

RELATED LINK

Category: Government and Policy


1958: Full Time Working Mothers

BACKGROUND

By 1958, women were entering the workforce in greater numbers than ever before. It was estimated that 4,037,000 children under age 12 lived in households where the mother worked full-time. A Children's Bureau survey found that 400,000 of these children had no adult supervision during the day.

IMPACT

After World War II, the workforce opened up to women prior to the establishment of provisions for children. Women began building careers, out of necessity or want, driving rapid social change in the US.

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Category: Public Health and Medicine


1958: Special Projects for Children with Intellectual and Developmental Disabilities

BACKGROUND

By 1958, special programs for children with intellectual and developmental disabilities (formerly called mental retardation) existed in 44 states.

IMPACT

By the end of the 1950s, the number of services and supports for adults and children with intellectual and developmental disabilities and their families was increasing. These programs and services have continued to grow, gain funding and recognition, and provide support.

RELATED PINPOINTS

Category: Government and Policy


The 1960s

The 1960s were a time of unprecedented program and policy development in the MCH field. President Kennedy initiated programs for people with intellectual and developmental disabilities. The Civil Rights Act prohibited discrimination on the grounds of race, color or national origin. President Lyndon B. Johnson declared a War on Poverty and established programs that had a wide range of impacts on the MCH population. Head Start, Neighborhood Health Centers, Maternity and Infant Care Projects, Medicaid, the National Institute of Child Health and Human Development (NICHD), and MCH Research program all had their roots in the 1960s.


1960: The Genetic Code

BACKGROUND

Scientists knew that the genetic information encoded into DNA is translated into proteins with the help of an intermediary molecule -- messenger RNA (mRNA), but they did not know how the information was encoded or decoded. They also suspected that each element of the code -- a codon -- would have to consist of three mRNA bases to allow enough combinations to code for the 20 known amino acids that make up proteins. In 1960, Francis Crick, Sydney Brenner and others demonstrated clearly that the genetic code is structured as a set three mRNA bases -- a triplet code. Additional work during the 1960s, pioneered by Marshall Nirenberg and Heinrich Mattaei, identified the triplet combinations that specified each amino acid and other coded messages that help to control the translation of mRNA into protein.

IMPACT

Identification of the genetic code increased our understanding of the relationship between DNA and protein structure. It provided insights into the effects of changes in DNA sequences on phenotype, into the mechanism of protein synthesis, into the relationship between mutations and disease, and into the manipulation of the genetic material to produce specific phenotypes. The discovery that the DNA code is universal in the living world also affirms the relatedness of all life on Earth by descent with modification from common ancestors.

Category: Public Health and Medicine


3/27/1960: Golden Anniversary White House Conference on Children and Youth

BACKGROUND

The 1960 Golden Anniversary White House Conference on Children and Youth was convened by President Eisenhower. The conference was named in celebration of the 50th anniversary of the first White House Conference on Children and Youth, which was convened by President Roosevelt in 1909. The conference was held during a time when child poverty rates were at an all-time high, with over 20% of families with children under 18 years of age living in poverty.

IMPACT

The Golden Anniversary White House Conference on Children and Youth addressed myriad contextual issues related to deprivation, poverty, civil rights abuses, and racial discrimination. These included: i) drug abuse, ii) inadequate opportunities for employment, iii) concern for the environment, iv) increased incidence of sexually transmitted diseases, and v) an increasing number of children born out of wedlock. Although health issues were not specifically addressed during this conference, an urgent concern was expressed for the improvement of health services for mothers and children.

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Category: Public Health and Medicine


1960: Birth Control Pills Approved for Use

BACKGROUND

In 1960, Enovid - the first birth control pill, was approved for use in the U.S. by the Food and Drug Administration.

IMPACT

The approval and later widespread use of the birth control pill in the U.S. was revolutionary. For the first time, women had control over their childbearing through a pill. Within two years, 1.2 million women in the U.S. were using the pill. Millions of American women still use the birth control pill today as a method of contraception.

RELATED PINPOINT

Category: Public Health and Medicine


1961: From the 'Guthrie Test' to Newborn Screening

BACKGROUND

Dr. Robert Guthrie, using funding from the March of Dimes and the Children's Bureau, developed a relatively simple and inexpensive blood test to screen newborns for phenylketonuria (PKU). The test became known as the "Guthrie Test.” Its methodology, including the later use of dried blood spots on pieces of filter paper, became widely used to screen newborns for many conditions.

IMPACT

Eventually the PKU test became the nation's first universal newborn screening (NBS) test. NBS for PKU allows for the early treatment of the condition and the prevention of its harmful effects, including brain damage and intellectual disability. NBS now occurs in virtually every developed country in the world.

HRSA’s Maternal and Child Health Bureau (formerly the Children’s Bureau) has been actively involved in the evolution of NBS from its very beginnings; the Bureau played a pivotal role in developing the PKU-NBS blood test and has assisted states in developing statewide NBS programs.

RELATED LINK

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Category: Public Health and Medicine


1961: Panel on Mental Retardation

BACKGROUND

A 25 person Panel on Mental Retardation was appointed by President Kennedy on October 11, 1961. Composed of scientists, educators, and other interested individuals, the panel's function was to examine the causes of mental retardation. Eunice Kennedy Shriver was instrumental in the establishment of this panel and the development of research and programs for people with developmental disabilities (formerly termed mentally retardation), and founder of the Special Olympics in 1968.

IMPACT

A report of their findings was submitted in October, 1962. The report contained 112 recommendations that concerned research, preventive health measures, clinical and social services, facilities for care, and public education programs. Some say that this report is one of the most well researched, comprehensive, and multifaceted documents that exists in the disability field. The report prompted new legislation, including Public Law 88-164, which funded research centers in university and community facilities for people with developmental disabilities (formerly mental retardation), and amendments to the Social Security Act (Public Law 88-156) to increase maternal and child health services and to conduct state studies on the status of services for people with mental retardation.

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Category: Government and Policy


1962: Battered Child Syndrome

BACKGROUND

In 1962, Henry Kempe described the term "Battered Child Syndrome" in an article describing a child who had been severely physically abused. His publication marked the beginning of the recognition of child abuse in the United States.

IMPACT

This first description of child abuse by Kempe sparked a nationwide commitment to child protection. In the same year, the Children's Bureau influenced changes to the Social Security Act requiring states to make welfare services available to all children, including abused children. By 1967, all states had child abuse reporting laws.

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Category: Public Health and Medicine


1962: National Institute of Child Health and Human Development (NICHD) Established

BACKGROUND

In 1962, the National Institute of Child Health and Human Development (NICHD) was established by Congress for the purpose of conducting and supporting research and training related to maternal and child health and human development. Specifically, NICHD was to study the special health needs of mothers and children that dealt with the processes of human growth and development. NICHD is part of the federal government's major medical research organization, the National Institutes of Health (NIH).

IMPACT

The mission of NICHD is "to ensure that every person is born healthy and wanted, that women suffer no harmful effects from reproductive processes, and that all children have the chance to achieve their full potential for healthy and productive lives.” NICHD conducts and supports research and sponsors training programs for doctors, researchers, and scientists.

RELATED LINK

Category: Government and Policy


1962: Migrant Health Act

BACKGROUND

In 1962, President John F. Kennedy signed the Migrant Health Act. The Act provided the foundation for the Migrant Health Program, which offered prenatal and infant care services to migrants, seasonal farm workers and their families. Services included health and dental care, transportation, pharmaceuticals, occupational health and safety, and a variety of pediatric services.

IMPACT

Today the Migrant Health Program is administered by HRSA's Bureau of Primary Health Care. In 2016, these health clinics served more than 860,000 migrant and seasonal farmworkers, and the majority (90%) were of Hispanic origin. The goal of the Migrant Health Program is to guarantee quality, culturally competent and comprehensive health care for migrant and seasonal farmworkers.

RELATED LINK


1963: Measles Vaccine Licensed

BACKGROUND

The measles vaccine was licensed on March 21, 1963. Prior to 1963, 3 to 4 million Americans would contract the measles every year, and an estimated 450 people would die from it.

IMPACT

Because of the extensive use of this vaccine, the number of reported measles cases in the U.S. decreased from about 482,000 in 1962 to 22,000 in 1968. Measles cases found in the U.S. today are either brought in from outside of the U.S. or are due to pockets of unvaccinated people within the U.S.

RELATED LINK

Category: Public Health and Medicine


1963: Public Law 88-156

BACKGROUND

Public Law 88-156 authorized a new Title V program for projects essential to the research and evaluation of issues concerning the care and treatment of individuals with intellectual disabilities (formerly called mental retardation). Recommendations from the Panel on Mental Retardation, appointed by President Kennedy, provided the foundation for this public law.

Public Law 88-156 also led to the creation of Maternity and Infant Care (MIC) projects. These MIC projects were funded by the Children’s Bureau and took a multidisciplinary approach to increasing access to prenatal care in the hopes of preventing infant mortality.

IMPACT

Before prenatal care was routinely provided, some of the MIC projects sent teams of professionals into communities to bring poor women in for their first prenatal care visits. These MIC projects developed programs for prenatal care, family planning, and infant care, which later become models of care for the U.S.

The projects dedicated to the health of people with intellectual disabilities aimed to manage and prevent intellectual disabilities. The appropriation of funds made these aims a priority area for the nation.

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Category: Government and Policy


10/31/1963: Community Mental Health Act

BACKGROUND

The Community Mental Health Act, otherwise known as the Mental Retardation and Community Mental Health Centers Construction Act of 1963, was signed by President John F. Kennedy. The act shifted resources away from large institutions that historically hospitalized people with mental illnesses to establish comprehensive community health centers nationwide.

IMPACT

The Community Mental Health Act led to the creation of comprehensive community mental health centers across the country that helped children, youth, and adults with mental illnesses move back to their communities. In turn, this led to drastic drops in rates of institutionalizations and increased community-based care – by 1980, institutionalization declined by 75% nationwide. Moreover, the passage of this act demonstrated the cost-effectiveness of treatment in community settings compared to institutionalization. The Community Mental Health Act has been instrumental in creating systems of coordinated behavioral healthcare for community-based organizations across the country.

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Category: Government and Policy


1964: The Civil Rights Act

BACKGROUND

The Civil Rights Act of 1964, signed into law by President Lyndon Johnson on July 2, 1964, is a landmark civil rights and labor law in the US that outlawed discrimination based on race, color, religion, sex or national origin in public places, provided for the integration of schools and other public facilities, and made employment discrimination illegal.

Heated and controversial debates preceded the passage of the Civil Rights Act of 1964.

IMPACT

The law provided protection from discrimination based on race, color, or national origin in programs and activities that receive federal financial assistance, including health and human services programs. These protections ensured equal access to critical health and social service programs that improve the health and well-being of Americans, regardless of race, color or national origin and paved the way for future efforts to address health disparities.

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Category: Milestones


1964: Head Start Developed

BACKGROUND

In 1964, the federal government asked a panel of child development experts to develop a program to help disadvantaged preschool children. The report from this panel became the blueprint for Head Start. In 1965, project Head Start began as a summer program launched under the auspices of the Office of Economic Opportunity. This summer program aimed to break the cycle of poverty through aid to preschool children from low-income families. The subsequent Head Start programs were primarily set in low-income settings with significant attention devoted to learning, social development, and health care for economically disadvantaged preschool children.

IMPACT

Head Start was enthusiastically received by education child development specialists, community leaders, and parents across the nation.

Today, Head Start provides child development programs to pregnant women, families, and children from birth to age five with the overarching goal of increasing school readiness for children from low-income families. Head Start serves children and families in all 50 States, the District of Columbia, Puerto Rico, and the U.S. territories.

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1964: Economic Opportunity Act

BACKGROUND

President Lyndon B. Johnson declared the War on Poverty in his 1964 State of the Union address. As part of the War on Poverty, the Economic Opportunity Act of 1964 provided job training, adult education, and loans to small businesses. The Act established the Office of Economic Opportunity, Head Start, and several other programs.

IMPACT

The Economic Opportunity Act developed more than 1,000 community action agencies that worked at the local level. The types of agencies varied from non-profits, to big-city agencies, to community groups. In addition, these agencies provided family-centered health care to many communities.

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1965: Neighborhood Health Centers Developed

BACKGROUND

In 1965, the Office of Economic Opportunity established and supported eight neighborhood health centers to provide comprehensive health services to people classified as low-income. The intent of these centers was to provide family-focused community health care. In 1971, the program was transferred to the Public Health Service and was renamed the Community Health Centers Program. Over time, the number of community and neighborhood health centers has grown significantly.

IMPACT

Today, the term CHC refers to both a specific set of organizations funded under Section 330 of the Public Health Service Act, and to a set of related programs, including: Migrant Health Centers, Health Care for the Homeless, Public Housing, Primary Care Program, Federally Qualified Health Centers and Look-Alikes. Each of these programs combines primary, preventive, and enabling services and activities to address limited access to health care, whether related to insurance coverage, inadequacies in the availability of health care providers in a given area, language and/or cultural barriers, or lack of social support services.

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1965: Children & Youth Projects

BACKGROUND

Public Law 89-97 amended Title V of the Social Security Act by providing comprehensive health care for children and youth. A primary directive of the Children and Youth (C & Y) Projects was to make health services accessible, available and appropriate to the identified low-income neighborhoods.

IMPACT

There was a growing realization that comprehensive care was needed for children and youth, particularly in low-income areas. The intent was to provide comprehensive health care to children and youth, including health supervision, screening, medical care, nutrition, and social services.

Category: Government and Policy


1965: Medicare & Medicaid Established

BACKGROUND

Medicare (Title XVIII) was established to provide health insurance coverage to people over age 65. Medicaid (Title XIX) was established to provide health insurance coverage to people classified as low-income. President Lyndon B. Johnson signed both programs into law on July 30, 1965 as amendments to the Social Security Act.

IMPACT

The establishment of Medicare and Medicaid led to the provision of health care for the majority of Americans over 65 years of age. It has expanded health services to children who are low-income, their caretakers, and people with disabilities. In addition, these programs have led to subsequent government policies that have increased health services to the public.

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1965: MCH Sickle Cell Anemia Initiative

BACKGROUND

in 1965, the Children's Bureau developed and disseminated two educational booklets on sickle cell disease - one for health care professionals and one for the lay public.

IMPACT

This was the first federal initiative to call attention to sickle cell anemia, an important but largely neglected genetic disorder. It helped to increase awareness and acknowledgement of sickle cell disease among government officials, health care professionals, and the lay public. In a presidential message to Congress in 1971, President Nixon targeted sickle cell disease as a neglected disease. In 1972, he signed the Sickle Cell Anemia Control Act.

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1966: Highway & Motor Vehicle Safety Acts

BACKGROUND

President Lyndon B. Johnson signed the Highway Safety Act and the National Traffic and Motor Vehicle Safety Acts in 1966. These Acts authorized the federal government to set and regulate standards for motor vehicles and highways.

IMPACT

As a result of these Acts, vehicles were built with new safety features, including head rests, energy-absorbing steering wheels, shatter-resistant windshields, and safety belts. In addition, roads were improved through better line stripes and reflectors, increased use of lighting, guardrails, and improved signage and poles. By 1970, motor vehicle-related death rates were decreasing.

Category: Government and Policy


1966: Child Nutrition Act

BACKGROUND

On October 11, 1966, President Lyndon B. Johnson signed the Child Nutrition Act to ensure that children had adequate food to better develop and learn. It was created in part due to the success of the National School Lunch Act, signed by President Truman in 1946.

IMPACT

As an amendment to the Child Nutrition Act, the Special Supplemental Food Program for Women, Infants and Children (WIC) was created in 1972. WIC provides nutritious food and nutrition education to eligible pregnant and nursing women and to children under five years of age.

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Category: Government and Policy


1967: Special Infant, Family Planning & Dental Projects

BACKGROUND

The Title V authorization of 1967 created three new clinical project grants: (1) neonatal intensive care, (2) family planning, and (3) dental care.

IMPACT

These project grants reaffirmed the public's interest in maternal and child health and worked to improve health and welfare services for mothers and children in the United States.

Category: Government and Policy


1967: Reorganization & Shift in Children's Bureau

BACKGROUND

In 1967, a reorganization of the Department of Health, Education and Welfare (HEW) was instituted by administrative order. Two years later, the Children's Bureau was disbanded.

IMPACT

Because of the reorganization, the health and welfare components of the Children's Bureau were separated. The service funding was transferred from the Bureau of Family Services to the Social and Rehabilitation Service. Duties that remained with the Children's Bureau after the HEW reorganization were transferred to the newly created Office of Child Development. When this occurred, the health programs of the Children's Bureau were transferred to the U.S. Public Health Service, in an agency now known as the Maternal and Child Health Bureau, part of the Health Resources and Services Administration.

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1967: Medicaid & EPSDT

BACKGROUND

The Medicaid statute (Title XIX) was amended in 1967 under President Lyndon B. Johnson to create the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program for needy children, although regulations for EPSDT were not published until 1972. Much of the language of EPSDT came from the Crippled Children's legislation of 1935. The purpose of EPSDT was to identify and diagnose health problems of low-income children through the provision of periodic physical and developmental examinations. The program also provided funds for the treatment of illnesses and other health conditions.

IMPACT

As a required program in every state, EPSDT aims to improve the health of low-income children by financing appropriate and necessary pediatric services for infants, children, and youth under age 21 who are enrolled in Medicaid.

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1968: Expansion of Lunch & Nutrition Act

BACKGROUND

In 1968, Congress passed legislation to expand the National School Lunch Act. This expansion funded food for school-age children during the summer and extended the School Breakfast Program. Additionally, a year-round program was initiated to provide food to children from low-income families, in day-care centers, and in Head Start programs.

IMPACT

This legislation increased the availability of food for children in need year-round. Today, these programs continue to support children receiving an adequate diet both during and outside of school hours.

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1969: White House Conference on Food, Nutrition, and Health

BACKGROUND

In 1969, President Nixon convened the White House Conference on Food, Nutrition, and Health in an effort to reduce malnutrition and hunger among the nation’s poor.

IMPACT

The White House Conference on Food, Nutrition, and Health shed light on the importance of nutrition in maintaining a healthy nation. Many landmark policies were developed from this conference, including further development of the food stamp program, the school lunch program, and food labeling.

Category: Government and Policy


1969: Rubella Vaccine Licensed

BACKGROUND

Rubella is a virus usually spread through mucus droplets expelled by coughing or sneezing into the environment. From 1963-1964, 12 million people developed rubella in the U.S. As a result of pregnant women contracting rubella, 20,000 babies were born with serious disabilities and there were 11,000 fetal deaths. The rubella vaccine was licensed in June 1969.

IMPACT

After the rubella vaccine was licensed, the number of cases fell dramatically. In 2004, rubella was eliminated from the United States. Today very few cases occur each year, usually while unvaccinated people are traveling outside of the U.S.

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The 1970s

The 1970s further expanded on the developments in maternal and child health set forth in the decade prior. The establishment of the Special Supplemental Food Program for Women, Infants, and Children (WIC) improved the health of the MCH population who were considered at nutritional risk. Implementation of sickle cell disease testing paired with the Genetic Disease Act, HHS Genetic Coordinating Committee and Hemophilia Treatment Centers Act, established later in the decade, helped aid in efforts towards combating health disparities for children with early onset genetic diseases. The landmark decision of Roe v. Wade marked one of the most controversial cases of its time.

Category: Milestones


1970: White House Conference on Children and Youth

BACKGROUND

The 1970 White House Conference on Children and Youth focused on proposals for a national health care program for mothers and children. Specific attention was given to the negative impacts on health and development in minorities and children with disabilities.

IMPACT

The final report of the conference identified gaps in services and suggested ways to correct deficiencies.

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Category: Government and Policy


1970: Developmental Disabilities Services and Facilities Construction Amendments

BACKGROUND

The Developmental Disabilities Services and Facilities Construction Amendments created Developmental Disabilities (DD) Councils in each state. Members of DD Councils included people with disabilities and representatives of state and social service agencies, such as Title V and the Department of Education.

IMPACT

The Developmental Disabilities legislation initiated a multifaceted mandate to organize services for people with developmental disabilities. By 1978, developmental disabilities were functionally defined and DD Councils had developed comprehensive state plans identifying the needs of the disability community.

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1970: Family Planning Act

BACKGROUND

The Family Planning Act of 1970, authorized under Title X of the Public Health Service Act, was the first U.S. statute to provide authority and funds for family planning. It also provided support for comprehensive programs of voluntary family planning services.

IMPACT

Family planning services support positive birth outcomes and a healthy start for infants.

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1972: Head Start to Serve Handicapped Children

BACKGROUND

As an amendment to the Economic Opportunity Act, Congress mandated in 1972 that at least 10 percent of all children enrolled in Head Start must be handicapped children. An amendment to the National School Lunch Act reemphasized that all schools with Head Start programs were to provide free food, or reduced-priced lunches, to all needy children.

IMPACT

These Congressional mandates demonstrated the growing government attention towards providing resources for children with special needs.

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Category: Government and Policy


1972: Special Supplemental Food Program for Women, Infants, and Children (WIC)

BACKGROUND

The Special Supplemental Food Program for Women, Infants, and Children (WIC) was created in 1972 as an amendment to the Child Nutrition Act of 1966. Under federally established guidelines and funds, the program supported state distribution of food (or coupons) to low-income pregnant women, nursing mothers, infants, and children under five considered at nutritional risk.

IMPACT

WIC has become a fundamental component of government support for mothers and children. It provides nutritious food, nutrition education, and health care referrals. Through its efforts, WIC consistently has been associated with health improvements and reduced rates of low birth weight, infant mortality, and anemia.

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1972: Sickle Cell Anemia Control Act (P.L. 92-294)

BACKGROUND

In 1972, Congress authorized the National Sickle Cell Anemia Control Act. Its purpose was to establish a nationwide program for research, screening, diagnosis, treatment, and counseling for sickle cell disease. Although responsibility for implementing the Act was delegated to the National Institutes of Health (NIH), the NIH transferred previously authorized funds to the Maternal and Child Health Program (now Maternal and Child Health Bureau) of the Health Services Administration (now Health Resources and Services Administration) to develop community-based sickle cell education, screening, testing, and counseling programs.

IMPACT

As a result of the legislation, 23 comprehensive sickle cell centers were developed in 1978, which were reduced to 10 federally funded study centers by 1986, and screening and education clinics were established in 40 states and the District of Columbia by 1981.

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1/22/1973: Roe vs. Wade Supreme Court Case

BACKGROUND

After much deliberation, the United States Supreme Court decision in 1973 established that laws prohibiting abortion violated one's constitutional right to privacy, thus legalizing abortion.

IMPACT

Roe vs. Wade was arguably one of the most controversial cases during its time. The ongoing discussion and national divide among "pro-choice" and "pro-life" supporters has inspired grassroots activism. The Supreme Court decision of Roe vs. Wade has become a milestone case in reshaping national politics in confronting the role of personal beliefs in constitutionally interpreting the law.

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1973: Screening for Sickle Cell Disease

BACKGROUND

In 1973, Garrick et al. reported an electrophoresis technique for screening of sickle cell disease and other hemoglobinopathies using blood spots on filter paper as specimens. Taken as a group, sickle cell diseases are the most prevalent group of disorders identified by newborn screening. About 1 in 13 African American babies is born with the sickle cell trait. About 1 in every 365 black children is born with sickle cell disease.

IMPACT

This electrophoresis technique opened the way for testing for hemoglobinopathies in newborn screening programs. Despite the success of these programs, newborn screening for sickle cell disease was not universally accepted as a public health strategy for improving health outcomes and some reports stressed the potential for harm. Haste and lack of education of the community, the general public, law and policy makers, and public health and heath care providers led initially to poor screening practices.

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1973: Health Maintenance Organization Act

BACKGROUND

In the early 1970s, Health Maintenance Organizations (HMOs) were developed, providing comprehensive medical services in exchange for a monthly payment from the plan participant. Federally, the Health Maintenance Organization Act passed in 1973. The law applied minimum, uniform standards in all 50 states for a health insurance organization to qualify as an HMO. Under these standards, an HMO had to provide a comprehensive set of medical services for a prepaid fee or with minimal co-payments and could not deny coverage to people with preexisting illnesses. The Act also required that participants in the plan be represented in making decisions about how the plan was to be administered.

IMPACT

The Health Maintenance Act of 1973 was an attempt to contain the escalating costs of healthcare. It encouraged the development of HMOs and shifted the framework of policy from regulation to competition. Moreover, cost controls of HMOs created incentives for the promotion of early diagnosis, treatment, and interventions.

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1973: Children's Defense Fund

BACKGROUND

The Children's Defense Fund, founded by Marian Wright Edelman, is a non-profit, private organization that advocates "for all children who cannot vote, lobby, or speak for themselves."

IMPACT

Since its founding in 1973, the Children's Defense Fund has:

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Category: Government and Policy


1974: Food Stamp Nationwide Program

BACKGROUND

In 1974, the Food Stamp Program (FSP) started operating nationwide to improve the nutrition of individuals and families classified as low-income, which generally included households with incomes below 135% of the poverty line. Qualified recipients received federal assistance (food stamps) on a term-by-term basis to purchase foods at FSP participating stores.

IMPACT

Since its inception, the Food Stamp Program has encountered some abuse and adverse outcomes within the recipient population, including stigma and fraud. However, with revisions to the Food Stamp Act in 1977, fraud decreased and participation increased. The FSP name was changed to the Supplemental Nutrition Assistance Program (SNAP) in 2008 to help reduce stigma.

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Category: Government and Policy


1974: Child Abuse Prevention and Treatment Act (P.L. 93-247)

BACKGROUND

Henry Kempe's publication of "The Battered Child Syndrome" in 1962 attracted national attention on the protection of abused children. By 1967, all states had child abuse reporting laws. In 1974, the Child Abuse Prevention and Treatment Act was passed with the support of numerous children's advocacy groups and the American Medical Association, which created a structure for responding to the problem of child maltreatment.

IMPACT

With the passage of the Child Abuse Prevention and Treatment Act (P.L. 93-247) in 1974, the federal government adopted a more direct role in child abuse policy. However, even though this legislation established a uniform standard for identifying and managing child abuse cases, individual states continued to apply their own definitions for maltreatment and procedures of investigation.

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Category: Government and Policy


1975: Education of All Handicapped Children Act (P.L.94-142)

BACKGROUND

By 1975, it was discovered that more than half of children with disabilities in the United States were not receiving adequate educational services. This Congressional finding triggered the enactment of the Education for All Handicapped Children Act, which required that all handicapped children and youth (three years of age and beyond) be provided with free, appropriate education in the least restrictive environment. The Act was renamed the Individuals with Disabilities Education Act (IDEA) in 1990.

IMPACT

The passage of Public Law 94-142, also known as the Education of All Handicapped Children Act, was a major development in addressing the needs of children and youth with disabilities. New collaborations were formed among teachers and healthcare professionals to better serve the interests of children with disabilities.

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1975: Hemophilia Treatment Centers Act (P.L. 94-63)

BACKGROUND

The Hemophilia Treatment Centers Act of 1975 authorized federal funding to establish a network of comprehensive hemophilia treatment centers (Section 606 of P.L.94-63, amended Title XI of the Public Health Service Act) for the care and treatment of individuals with hemophilia. Hemophilia is a collection of genetic disorders that impair the body's ability to control bleeding. Common hemophilias are types A, B, and C. Von Willibrand disease is another genetic bleeding disorder included in these treatment centers. In 1976, approximately $3 million was appropriated to fund more than 20 centers.

IMPACT

Health care professionals, patients and their families, and government agencies, including the Maternal and Child Health Program, have worked together to create a nationwide, regionalized health care delivery system that has improved access to clinical care, prevention, and research for people with hemophilia in the U.S. More than 140 comprehensive hemophilia diagnostic and treatment centers have served about 80% of the nation's hemophilia patients and their families. These centers have resulted in improved survival and reduced disability among affected individuals.

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Category: Government and Policy


1975: Comprehensive Hemophilia Diagnostic and Treatment Center Program Established

BACKGROUND

In 1975, Congress amended Part D to Public Law 94-63, 1131, under SEC. 606 Title XI of the Public Health Service Act to establish Comprehensive Hemophilia Diagnostic and Treatment Centers (HTC) to provide: 1) access to outpatient comprehensive diagnosis and treatment services, including vocational and social counseling; and 2) programs for training professional personnel in hemophilia research, diagnosis, and treatment.

IMPACT

Public Law 94-63 stimulated the development of regionally organized HTCs. Using a multidisciplinary team approach, HTCs provide comprehensive diagnosis, treatment, education, outreach, outcomes surveillance, research, and low-cost pharmacy services to people with hemophilia and related inherited bleeding disorders throughout the U.S. and its territories.

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1976: The Supplemental Security Income Disabled Children's Program

BACKGROUND

In 1976, the Supplemental Security Income Disabled Children's Program (SSI/DCP) provided cash payments to low-income children with disabilities (under the age of seven) to help defray family costs in caring for children with special health care needs. Through the program, a child was referred to the state's Title V agency and was ensured Medicaid services and benefits under the state's Crippled Children's Services (CCS) program.

IMPACT

Federal laws, such as Title V, IDEA, and SSI, demonstrated the shift in mentality from identifying disabilities as diseases/conditions to focusing on meeting the special needs of children with disabilities.

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1976: Improved Pregnancy Outcome Projects

BACKGROUND

The Improved Pregnancy Outcome (IPO) Projects, initiated by the Office of Maternal and Child Health, was an outgrowth of widespread efforts to improve child health. The goal of the projects was to reduce infant mortality through new statewide systems of care for mothers and infants. One of the specific objectives was to use existing services more effectively through improved planning and implementation.

IMPACT

The IPO Projects raised awareness of the importance of maternal health and interventions before and during the developmental course of pregnancy. The drastic reduction of infant mortality in the twentieth century is attributed to the cumulative effects of these types of interventions.

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Category: Government and Policy


1976: Genetic Diseases Act (P.L. 94-278)

BACKGROUND

P.L. 94-278, the National Sickle Cell Anemia, Cooley's Anemia, Tay-Sachs, and Genetic Diseases Act, consolidated separate 1972 acts for sickle cell anemia (P.L. 92-294) and Cooley's anemia (P.L. 92-414), and added six other genetic conditions. P.L. 94-278 aimed "to establish a national program to provide for basic and applied research, research training, testing, counseling, and information and education programs with respect to genetic diseases, including sickle cell anemia, Cooley's anemia, Tay-Sachs disease, cystic fibrosis, dysautonomia, hemophilia, retinitis pigmentosa, Huntington's chorea, and muscular dystrophy." In 1978, Congress amended the Act to include "genetic conditions leading to mental retardation and genetically caused mental disorders" (P.L. 85-262). Congress appropriated more than $35 million over the course of three fiscal years (1979-1981) to implement the National Genetic Disease Act (P.L. 95-626).

IMPACT

This was the first genetic services legislation to receive appropriations. The Maternal and Child Health (MCH) Program was responsible not only for dispersing the funds, but also for developing funding priorities and guidelines for grant applications, and for providing technical assistance and consultation to states and others in order to help move the provision of genetic services beyond academic medical centers. The assignment of implementation responsibility of this law to MCH suggested an understanding between the U.S. Department of Health and Human Services and Congress of the importance of federal-state partnerships in building this new service program. These Acts reflected a recognition of the importance of screening, early diagnosis, management, and counseling of patients and families with genetic disorders. They also helped increase access to genetic health care services, including the development, publication, and dissemination of educational information and materials aimed at health care professionals, teachers and students, and the public in general.

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1977: Public Health Service Genetics Coordinating Committee

BACKGROUND

The Public Health Service (PHS) Genetics Coordinating Committee provided advice to the Assistant Secretary for Health and the directors of several PHS agencies concerning the coordination of various aspects of PHS programs and activities related to genetic diseases, including that the programs and activities were consistent with legislative mandates, e.g., P.L. 94-278.

IMPACT

The Committee served as the first focal point for the coordination of and a forum for the discussion of PHS activities related to basic and applied research, research training, testing, counseling, treatment, and information and education programs with respect to genetic diseases. The Committee's charter ended in 1979.

Category: Government and Policy


1978: MCH Genetic Services Program

BACKGROUND

To implement P.L. 94-278 (the National Sickle Cell Anemia, Cooley's Anemia, Tay-Sachs, and Genetic Diseases Act) and P.L. 95-626 (the National Genetic Disease Act), the Genetic Services Branch (GSB) was created as part of the Maternal and Child Health Program (now Maternal and Child Health Bureau) under the Health Services Administration (now Health Resources and Services Administration).

IMPACT

Since 1978, GSB has provided vision and national leadership in translating advances in genetics into services that are accessible and appropriate to the diverse U.S. population. GSB has been instrumental in planning and implementing culturally sensitive and competent genetic services nationwide - clinical, public health, research, educational, peer and parent support, and others, including tens of millions of dollars devoted to community-based clinics, testing, newborn screening, and multilingual and culturally appropriate educational materials and patient care guidelines.

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Category: Government and Policy


1978: Eradicating Smallpox

BACKGROUND

In 1966, there were approximately 10-15 million cases of smallpox in more than 50 countries and approximately 2 million deaths per year from the disease. However, through World Health Organization immunization programs and international efforts, the last case of smallpox in the United States occurred in 1949. By 1977, the last endemic case of smallpox was recorded in Somalia. No new cases have been reported since 1978. After two years of search and surveillance, in May 1980, the World Health Assembly officially declared smallpox as the first disease in human history to have been eradicated.

IMPACT

The eradication of smallpox is considered one of the greatest achievements of international public health, demonstrating the human ability to triumph over infectious diseases. Its eradication continues to inspire other disease eradication efforts, including measles, poliomyelitis, and guinea worm disease.

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1979: Health Objectives for 1990

BACKGROUND

U.S. Surgeon General Julius Richmond led an effort to develop quantitative public health objectives for the nation. These efforts resulted in Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. Healthy People set health objectives for the nation, which included objectives for maternal and infant health. Examples included efforts to reduce rates of infant and maternal deaths, neonatal and fetal mortality, low birth weight, and teenage pregnancies.

IMPACT

The 1979 Surgeon General's report began the system of establishing targeted health objectives for the coming decade. Today, Healthy People objectives continue to provide a framework for public health professionals and policymakers to address prevention, health disparities, and a wide variety of other public health issues.

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The 1980s

The 1980s Public health efforts during the Reagan years were defined by Medicaid expansion, block grants and budget reforms. The maternal and child populations became more closely associated as the Healthy Mothers, Healthy Babies Coalition and the United States House Select Committee on Children, Youth and Families were formed. Economically disadvantaged families benefited from the Medicaid expansion efforts of the Deficit Reduction Act of 1984 (DEFRA), the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), and the Omnibus Budget Reconciliation Act (OBRA) of 1986. In HRSA’s Maternal and Child Health Bureau, the Emergency Medical Services for Children (EMSC) Program was initiated to improve services for children in need of treatment for trauma or critical care.

Category: Milestones


1980: Select Panel for the Promotion of Child Health

BACKGROUND

Through the enactment of P.L. 95-626, the Select Panel for the Promotion of Child Health was established. Composed of 17 members from public and private sectors, the Panel issued a report, Better Health for Our Children: A National Strategy, in December 1980.

IMPACT

The Panel brought national attention to five concerns in Better Health for Our Children: A National Strategy. These included inadequate availability and use of health promotion and disease prevention services, health disparities, insufficient recognition of the role of family in health care, health care systems that were not equipped to cope with family health issues, and poor collaboration between public health programs.

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1981: U.S. Department of Health and Human Services

BACKGROUND

One of the first moves of the Reagan Administration was to reorganize the Department of Health, Education and Welfare. The Department's responsibilities were divided among the newly named Department of Health and Human Services and the Department of Education.

IMPACT

The Department of Health and Human Services is the United States Government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. By separating the health and education agencies at the federal level, coordination to sustain a seamless system of care for children, particularly children with special health care needs, became more challenging.

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Category: Government and Policy


1981: Omnibus Budget Reconciliation Act of 1981

BACKGROUND

Title V of the Social Security Act was amended drastically in 1981 through the Omnibus Budget Reconciliation Act of 1981 (OBRA) (P.L. 97-35).

IMPACT

Although the Act did not change the program's focus on services to high-risk mothers and children, it modified the method of supplying the money to states through block grants, as well as the role of the federal government. The change resulted in the consolidation of seven categorical programs into a single block grant.

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1981: Acquired Immune Deficiency Syndrome (AIDS)

BACKGROUND

In 1981, a publication in Morbidity and Mortality Weekly Report (MMWR) regarding a killer strain of pneumonia targeting homosexual men was released. This signaled the onset of one of the greatest public health challenges of the twentieth century. Pediatric issues included children born and living with human immunodeficiency virus (HIV), which is the precursor to acquired immune deficiency syndrome (AIDS), and those left behind by parents who died from AIDS.

IMPACT

By 2010, 636,000 people had died from AIDS in the U.S. alone. From 1981 through 2006, in children 13 and younger, there were 9,504 reported cases of AIDS in the U.S. During the same time period, adult and adolescent cases totaled 1,004,111. Since the mid-1990s, significant advancements have been made in treating people living with HIV/AIDS through use of antiretroviral medications.

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1981: Healthy Mothers, Healthy Babies Coalition

BACKGROUND

The National Healthy Mothers, Healthy Babies Coalition (HMHB) began in 1981, prompted by the U.S. Surgeon General's conference on infant mortality. The American College of Obstetricians and Gynecologists, March of Dimes, American Academy of Pediatrics, American Nurses Association, National Congress of Parents and Teachers, and U.S. Public Health Service helped establish this coalition to improve the quality and reach of public and professional education related to prenatal and infant care.

IMPACT

HMHB focused attention on raising public awareness of the basic components of prenatal care--early care, good nutrition, avoidance of drugs, and promotion of breastfeeding. The Coalition targeted low-income and underserved communities where women often do not receive early prenatal care and infant mortality rates are high. HMHB produced educational materials and resources to help providers and consumers. In 2010, HMHB launched Text4Baby campaign, a public-private partnership designed to promote maternal and child health through text messaging.

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Category: Government and Policy


1981: MCH Thalassemia Initiative

BACKGROUND

The Genetic Services Branch (GSB) in the Maternal and Child Health (MCH) Program (now Maternal and Child Health Bureau) of the Health Services Administration (now Health Resources and Services Administration) developed and disseminated a publication that called attention to thalassemias in population groups, specifically individuals from Asia and the Middle East. Until the 1970s, thalassemia, which was also known as Mediterranean Anemia, was largely viewed as a genetic disorder that only affected individuals of Mediterranean origin. In the U.S., an influx of Southeast Asian refugees beginning in the mid-1970s forced a re-examination of this belief, as the health care system began to encounter thalassemia in this new, non-Mediterranean immigrant population.

IMPACT

Beginning in 1984, the MCH Program utilized Special Projects of Regional and National Significance (SPRANS) grants to demonstrate the need for cross-cultural genetics education and counseling, community outreach, and education and screening programs aimed at diverse populations at-risk for thalassemias, particularly Southeast Asians. The MCH education initiative and SPRANS demonstration grants played a key role in focusing attention on thalassemias among Asian Americans, and the need for timely, appropriate, and culturally sensitive genetic testing, education, counseling, outreach, and other services for immigrant populations of diverse origin. Many of the educational efforts and service activities for thalassemias, initiated under the MCH SPRANS grants, are now supported by states and other institutions.

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Category: Public Health and Medicine


1983: Select Committee on Children, Youth, and Families

BACKGROUND

The Select Committee on Children, Youth, and Families was formed in the U.S. House of Representatives to provide an ongoing assessment of the conditions of American children and families and to make policy recommendations to Congress and the public.

IMPACT

From 1983 to 1993, the committee assessed conditions and policies related to a range of issues, including changes in family composition in the US, infant mortality, and mental and behavioral health in children and adolescents. The committee’s assessment helped shape the federal government’s response to meet the needs of America’s children, youth, and families.

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Category: Government and Policy


1983: First Disease Gene Mapped

BACKGROUND

The gene for a human genetic disease is mapped to a specific human chromosome. In 1983, the HD gene, whose mutation causes Huntington’s disease, was mapped to the short arm of chromosome 4. HD was the first disease gene to be mapped using DNA polymorphisms, variants in the DNA sequence.

IMPACT

The first genetic test for a disease (Huntington's) was developed based on this finding and laid the groundwork for developing techniques for mapping the genome.

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Category: Public Health and Medicine


1983: MCH Regional Genetics Networks

BACKGROUND

Using Special Projects of Regional and National Significance (SPRANS) funds dispersed by the Maternal and Child Health Program (now HRSA’s Maternal and Child Health Bureau), ten regional genetics networks and a national coordinating organization, the Council of Regional Networks for Genetic Services (CORN), were created to build infrastructure to support genetic services.

IMPACT

The Networks, working together with CORN, were successful in coordinating and improving genetic services systems throughout the U.S. from 1983 until 2000.

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Category: Government and Policy


1984: Emergency Medical Services for Children

BACKGROUND

The Preventive Health Amendments of 1984 provided the initial congressional authorization for the Emergency Medical Services for Children (EMSC) Program, which was charged with supporting demonstration projects for the expansion and improvement of emergency medical services for children who need treatment for trauma or critical care.

IMPACT

Since 1984, all 50 states, the District of Columbia, five U.S. territories, and three freely-associated states have received funding from the EMSC Program to improve the readiness of communities to manage the unique needs of children in a medical emergency. The program has resulted in increased pediatric training for prehospital and hospital providers, increased prevalence of critical pediatric equipment in ambulances, and increases in the number of hospitals that establish well-defined pediatric treatment protocols and procedures.

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Category: Government and Policy


1984: Baby Doe Law

BACKGROUND

Increasing concern that newborns with disabilities were being denied life-sustaining treatment led to the development of the Baby Doe Law or Baby Doe Amendment to the Child Abuse Law.

IMPACT

The Law or Amendment, issued by the Department of Health and Human Services in January 1984, was developed to ensure that the withholding of treatment to these infants would no longer occur, regardless of the wishes of the parents. In 1986, the Law or Amendment was struck down by the US Supreme Court.

Category: Government and Policy


1984: Deficit Reduction Act of 1984 (DEFRA)

BACKGROUND

The Deficit Reduction Act of 1984 (DEFRA) mandated state Medicaid coverage for children under the age of 5, including children in two-parent families, who were eligible for the Aid to Families with Dependent Children (AFDC) program, and pregnant women who qualified for either the AFDC or AFDC-Unemployed Parent programs once their children were born.

IMPACT

In addition to mandating state Medicaid coverage for all eligible children under 5 and pregnant women who qualified, the Act also made infants born to mothers covered by Medicaid automatically eligible for one year of coverage.

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Category: Government and Policy


1984: Child Safety Seats

BACKGROUND

By 1985, all U.S. states had laws requiring children to use a child restraint device when riding in vehicles.

IMPACT

Since laws requiring the use of safety seats have been passed, deaths from motor vehicle injuries have continued to decline despite an increase in motor vehicle use.

Category: Government and Policy


1985: Institute of Medicine (IOM) Report on Preventing Low Birth Weight

BACKGROUND

The Institute of Medicine (IOM) (now the National Academy of Medicine, or NAM) convened an interdisciplinary committee in 1983 to study the causes and prevention of premature birth and intrauterine growth retardation, the twin contributors to low birth weight.

IMPACT

The committee concluded that preventing low birth weight in the United States would significantly reduce infant mortality rates and improve child health.

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Category: Government and Policy

1986: Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

BACKGROUND

In 1986, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) was signed into law by President Ronald Reagan. COBRA extended Medicaid coverage to all pregnant women with family incomes below Aid to Families of Dependent Children (AFDC) eligibility levels. It also provided pregnant women with 60 days of postpartum care.

IMPACT

COBRA extended coverage beyond first-time pregnant women and two-parent families to include all pregnant women eligible under AFDC requirements.

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Category: Government and Policy


1986: Crippled Children's Services Renamed Children with Special Health Care Needs

BACKGROUND

In 1986, Surgeon General C. Everett Koop coined the phrase 'Children with Special Health Care Needs' to replace Crippled Children's Services.

IMPACT

MCHB's Division of Services for Children with Special Health Needs works to make an impact on the nearly 20 percent of U.S. children under age 18 who have a special health care need. It seeks to give assistance to the one in five U.S. families who have a child with a special health care need, and to coordinate services from multiple systems to assist children and youth with special health care needs.

Category: Government and Policy


1986: Omnibus Budget Reconciliation Act (OBRA) of 1986

BACKGROUND

The Omnibus Budget Reconciliation Act (OBRA) of 1986 provided states the option of extending Medicaid to pregnant women and children under age five (on a year-by-year phased-in basis) whose family incomes exceeded Aid to Families of Dependent Children (AFDC) eligibility levels but were less than the federal poverty level.

IMPACT

OBRA of 1986 allowed states to expand coverage beyond AFDC eligibility requirements. This was in contrast to previous legislation, including the Deficient Reduction Act of 1984 (DEFRA) and the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), which provided eligibility for services according to AFDC levels.

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Category: Government and Policy


1986: Amendments to the Education for all Handicapped Children Act (EHA

BACKGROUND

In 1986, the re-authorization of P.L. 94-142, Education of All Handicapped Children Act (EHA), mandated early intervention and preschool programs under P.L. 99-457.

IMPACT

This new federal mandate was established to assist states in the development and implementation of a comprehensive program for early intervention. It also provided incentives for states to serve all three- to five-year-olds with disabilities.

Category: Government and Policy


1986: Sickle Cell Disease Consensus Statement

BACKGROUND

Gaston et al. published an article entitled “Prophylaxis with oral penicillin in children with sickle cell anemia: A randomized trial.” This study caused a revolution in the treatment of children with sickle cell disease. The conclusions of this study were that children should be screened in the neonatal period for sickle cell hemoglobinopathy, and those with sickle cell anemia should receive prophylactic therapy with oral penicillin by four months of age to decrease the morbidity and mortality associated with pneumococcal septicemia. In April 1987, two important meetings were held: an NIH and HRSA co-sponsored Consensus Development Conference on Newborn Screening for Sickle Cell Disease and Other Hemoglobinopathies, and an Ad Hoc Council of Regional Networks for Genetic Services (CORN) Committee Conference on Newborn Screening for Hemoglobinopathies. At the time, the Genetics Services Branch of the Maternal and Child Health (MCH) Program was already funding newborn screening sickle cell disease projects, which demonstrated that state and regional cooperation could lead to rapid implementation of high quality public health programs aimed at early diagnosis and appropriate follow-up management services.

IMPACT

The publication in the New England Journal of Medicine (NEJM) by Gaston et al. and two conferences noted above played a significant role in the effort to improve regional and statewide newborn screening for sickle cell disease and other hemoglobinopathies. In part due to the publication of the paper and the consensus statement, Congress earmarked money in the Omnibus Budget Reconciliation Act of 1986 (OBRA 86; P.L. 99-509) to the MCH Program in 1987, 1988, and 1989 to fund newborn screening for sickle cell disease and other hemoglobinopathies. Although the legislative language included other hemoglobin disorders, the Genetic Services Branch dedicated virtually all of the earmarked amount to newborn screening for sickle cell disease. This enabled states to add a new public health initiative to their existing newborn screening programs. States improved clinical and public health guidelines and implemented new and/or improved newborn screening programs, including follow-up treatment and counseling for sickle cell disease and other hemoglobin disorders.

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Category: Government and Policy


1987: Surgeon General's Report on Children with Special Health Care Needs

BACKGROUND

In 1987, Surgeon General C. Everett Koop released the Surgeon General's Report on Children with Special Health Care Needs.

IMPACT

The report made specific recommendations to define the scope of the problem, develop standards, develop systems of care, improve methods of financing, support research, and support training for health professionals.

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Category: Government and Policy


1988: Institute of Medicine (IOM) Publishes “The Future of Public Health”

BACKGROUND

Published in 1988 by the Institute of Medicine (IOM) (now the National Academy of Medicine, or NAM), "The Future of Public Health" described a public health system in disarray and outlined three core functions needed in public health: assessment, assurance, and policy development.

IMPACT

This seminal report contained ideas and proposals for making a strong health care system that would continue to be effective and accessible. The book brought attention to the current state of the health care system and called for a change.

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Category: Government and Policy


1988: MCH Ethnocultural Initiatives Launched

BACKGROUND

To improve access to genetic and other maternal and child health services and improve health status outcomes, the Genetic Services Branch (GSB) in the Maternal and Child Health (MCH) Program funded a series of projects beginning in the late 1980s to overcome ethno-cultural barriers and increase access to and utilization of genetic services for populations confronted by cultural and language barriers.

IMPACT

GSB provided national leadership in identifying ethno-cultural and language barriers as critical issues in accessing genetic services at a time when underserved racial and ethnic minorities were expanding rapidly in the U.S. The MCH guidelines for genetic Special Projects of Regional and National Significance (SPRANS) grant applications provided the basic framework for culturally appropriate genetic services that required a two-pronged approach: 1) cultural competency training of service providers, and 2) culturally and linguistically appropriate genetic education and outreach to the minority communities targeted. In May 1989, the March of Dimes Birth Defects Foundation, the Mid-Atlantic Regional Human Genetics Network, and GSB co-sponsored a meeting, Genetic Services for Underserved Populations, in association with the National Center for Education in Maternal and Child Health. This meeting identified many important issues, including the large number of barriers to appropriate and timely health care and social services that confront people with genetic disorders. The proceedings were a resource for future program and project planning at the national, state, and local levels. One additional outcome was the "National Dialogue on Genetics" conference held in 1998. The conference was meant to establish a dialogue among ethnically diverse communities and genetic policy makers in the United States and to empower these communities for the future planning and implementation of genetic services nationwide.

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Category: Government and Policy


1989: Omnibus Budget Reconciliation Act (OBRA) of 1989

BACKGROUND

With the Omnibus Reconciliation Act (OBRA) of 1989, Congress linked greater flexibility of the MCH Block Grant with greater accountability. The theme of assisting states in the design and implementation of MCH programs to meet local needs, while at the same time asking states to account for the use of federal/state funds, was embodied in the OBRA 1989 legislation.

IMPACT

The Act reintroduced accountability, made needs assessments and annual reporting a requirement, and had an explicit focus on family-centered, community-based, coordinated care.

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Category: Government and Policy


1989: United Nations Convention on the Rights of the Child

BACKGROUND

The United Nations Convention on the Rights of the Child set out the civil, political, economic, social, health, and cultural rights of children.

IMPACT

The ratification of "Rights of Children" by the United Nations reaffirmed that children's rights require special protection and called for continuous improvement of the situation of children all over the world, as well as for their development and education in conditions of peace and security.

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Category: Government and Policy


1989: The Public Health Service Expert Panel Releases Report on the Content of Prenatal Care

BACKGROUND

In 1989, the Public Health Service Expert Panel on the Content of Prenatal Care released a report making new recommendations for the content and delivery of prenatal care.

IMPACT

The Public Health Service report included new standards for the number of medical visits necessary throughout pregnancy. The report put a special focus on providing appropriate prenatal care for high-risk pregnancies and outlined the medical, psychological, and social factors that could contribute to poor birth outcomes. The recommendations in the report were used to enhance the health of mothers, infants, and families, and the report shaped the future of prenatal care.

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Category: Government and Policy


The 1990s

The 1990s noted a period of unprecedented change for women, including the approval of emergency contraceptive Plan B, enactment of the Violence Against Women Act and establishment of the NIH Office of Research on Women’s Health. Both the H.W. Bush and Clinton administrations prioritized welfare and education reform, which directly impacted many children. The formation of the Children’s Health Insurance Program (CHIP) provided health insurance for children who did not meet the requirements for Medicaid, bridging the gap for many uninsured and impoverished American children. Newborn outcomes improved as enriched cereal grain products became fortified with folic acid and the Back to Sleep campaign launched to promote prevention of sudden infant death syndrome (SIDS). HRSA’s Maternal and Child Health Bureau began the Healthy Start Initiative to reduce infant mortality.

Category: Milestones


1990: Bright Futures Initiated

BACKGROUND

Initiated in 1990 and guided by HRSA’s Maternal and Child Health Bureau, four interdisciplinary panels of experts in infant, child, and adolescent health developed Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, a comprehensive set of child health supervision suggested guidelines.

IMPACT

The project works towards optimal child health and prevention and has four goals: foster partnerships between families, health professionals, and communities; promote desired social, developmental, and health outcomes of infants, children, and adolescents; increase family knowledge, skills, and participation in health-promoting and prevention activities; and enhance health professionals' knowledge, skills, and practice of developmentally appropriate health care in the context of family and community. Bright Futures has developed and disseminated materials for health professionals, families, and communities, and has trained these same groups to collaborate and work together towards optimal child health.

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Category: Government and Policy


1990: Individuals with Disabilities Education Act (IDEA)

BACKGROUND

In 1990, the Education for All Handicapped Children Act of 1975, which required that children from ages 6 to 21 with disabilities received a Free and Appropriate Public Education (FAPE) based on individual needs, was amended and renamed the Individuals with Disabilities Education Act (IDEA). Previously, in 1986, a preschool mandate and the Infants and Toddlers Program component were added to include systems planning and services for infants and toddlers with developmental delay and those at-risk for a disability. Provisions enacted in 1986 included the establishment of Interagency Coordinating Councils (ICCs) at the federal, state, and local levels for the purpose of advising and assisting with the implementation of the IDEA Part C program. In 2004, IDEA was amended to align more closely with the No Child Left Behind Act, which included special education students in school performance measurement. Congress reauthorized the IDEA in 2004, and amended the IDEA through Public Law 114-95, the Every Student Succeeds Act, in December 2015.

IMPACT

Services for infants, toddlers, children and youth with disabilities are provided through IDEA. IDEA services for children ages 3-21 include Individualized Education Plans (IEPs) that specify what is "appropriate education" for each participant, and "related services," defined as those necessary to enable an eligible child to benefit from the educational process.

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Category: Government and Policy


1990: Americans with Disabilities Act (ADA) Passed

BACKGROUND

On July 26, 1990, President George H.W. Bush signed into law the Americans with Disabilities Act of 1990 (ADA) -- the world's first comprehensive civil rights law for people with disabilities. The Act prohibits discrimination against people with disabilities in employment (Title I), in public services (Title II), in public accommodations (Title III) and in telecommunications (Title IV). The U.S. Equal Employment Opportunity Commission (EEOC) is responsible for enforcing Title I's prohibition against discrimination of people with disabilities in employment.

IMPACT

The ADA signifies an “equal opportunity” law for people with disabilities, including protecting qualified individuals with disabilities from discrimination, and requiring access to activities for students and parents.

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Category: Government and Policy


1990: MCH Genetic Lay Advocacy Groups Funded

BACKGROUND

HRSA's Maternal and Child Health Bureau (MCHB) used demonstration grants to fund a variety of support group activities aimed at people with genetic disorders. The organizations supported included the Alliance of Genetic Support Groups, Sickle Cell Disease Association of America, and the March of Dimes Birth Defects Foundation.

IMPACT

Lay support groups continue to play an important role in improving the lives of people with genetic disorders. They provide a valuable consumer prospective that is knowledgeable, articulate, and savvy.

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Category: Government and Policy


1990: NIH Office of Research on Women's Health

BACKGROUND

HRSA's Maternal and Child Health Bureau (MCHB) used demonstration grants to fund a variety of support group activities aimed at people with genetic disorders. The organizations supported included the Alliance of Genetic Support Groups, Sickle Cell Disease Association of America, and the March of Dimes Birth Defects Foundation.

IMPACT

Lay support groups continue to play an important role in improving the lives of people with genetic disorders. They provide a valuable consumer prospective that is knowledgeable, articulate, and savvy.

RELATED LINKS

Category: Government and Policy


1991: National Breast and Cervical Cancer Early Detection Program

BACKGROUND

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established in 1991 to expand access to breast and cervical cancer screening and diagnostic services. A major goal of the program was to address racial and socioeconomic disparities in cancer screening, treatment, and survival.

IMPACT

The NBCCEDP funds screening and diagnostic services for low-income, uninsured, and underinsured women throughout the United States and its territories. These services include breast exams, mammograms, pap tests, pelvic exams, diagnostic testing, and treatment referrals. In 2000, Congress passed an act that allows women participating in the NBCCEDP to receive cancer treatment through the Medicaid program.

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Category: Government and Policy


1991: Healthy Start Initiated

BACKGROUND

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 percent over the five-year period and to improve the health and well-being of women, infants, children and their families.

IMPACT

Since its inception, Healthy Start has provided services to hundreds of thousands of people in what now amounts to 100 federally funded projects. Healthy Start is a community-based program that serves at-risk women and works to reduce infant mortality through the provision of services, such as preconceptional care, postpartum care and infant care. In 2016, the program’s 100 grantees served more than 70,000 women and children in 37 states and the District of Columbia.

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Category: Government and Policy


1991: Teen Pregnancy Rate Rises

BACKGROUND

After decades of rapidly declining rates, teen pregnancy rates rose significantly in the late 1980s and hit a high point in 1991. A variety of factors likely contributed to the rising rate, including inadequate access to family planning services, low rates of contraceptive use, an economic downturn, and improved reporting of teen pregnancies.

IMPACT

Teen pregnancies affect the health of mothers and infants, and have significant financial costs for individuals and society. When compared to mothers in other age groups, teens are less likely to receive early and regular prenatal care and are more likely to experience pregnancy complications. Also, babies born to teens are at higher risk for prematurity and the associated poor health outcomes. Following the rise in teen pregnancy rates, policymakers and the public began paying increased attention to teen sexual health, and new teen pregnancy prevention initiatives were developed.

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Category: Government and Policy


1992: Family Voices Established

BACKGROUND

In 1992, amidst national discussions of health care reform, a group of parents of children with special health care needs established Family Voices. This group has evolved into a national grassroots organization whose mission is to achieve family-centered care for all children and youth with special health care needs and/or disabilities.

IMPACT

Family Voices provides families with information and tools to make informed decisions, provides support for improved public and private policies, builds partnerships among professionals and families, and serves as a resource on health care. Family Voices is also home to the MCHB-funded National Center for Family/Professional Partnerships, which provides technical assistance to family run Family-to-Family Health Information Centers across the country, among other activities.

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Category: Government and Policy


1993: Omnibus Budget Reconciliation Act of 1993

BACKGROUND

Enactment of the Omnibus Budget Reconciliation Act of 1993 allowed for a major expansion of the earned income tax credit (EITC), a refundable tax credit that supplements the earnings of many low- and moderate-income workers.

IMPACT

President Clinton doubled the EITC when he was in office, giving more than 15 million working families a tax cut. In 1998 alone, the EITC lifted more than 4 million people and more than 2 million children out of poverty. In 2004, more than 21 million families received $39 billion in refunds from the EITC.

Category: Government and Policy


1993: Reinventing Government

BACKGROUND

The 1990s brought many changes to traditional governmental administrative systems. Momentum for change was captured in a book published in 1992, Reinventing Government: How the Entrepreneurial Spirit is Transforming the Public Sector, by Osborne and Gaebler. The authors argued that public institutions and systems could benefit from competition, customer choice, and other non-bureaucratic mechanisms to heighten efficiency and effectiveness and achieve higher levels of "customer" satisfaction.

IMPACT

Reinventing government was a time of widespread downsizing and rightsizing in the corporate sector that filtered into the public sector with moves to privatize. Widespread reorganization occured in environmental health and other environmental programs, human services in large umbrella agencies, and children's agencies.

Category: Government and Policy


1993: Emergency Medical Services for Children (EMSC) Report Released

BACKGROUND

The Institute of Medicine (now called the National Academy of Medicine) released the most comprehensive report on children’s emergency medical care in 1993.

IMPACT

The Emergency Medical Services for Children (EMSC) report detailed the nature, extent, and outcomes of pediatric illness and traumatic emergencies, and revealed continued deficiencies in pediatric emergency care for many areas of the country.

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Category: Public Health and Medicine

1993: Government Performance and Results Act (GPRA)

BACKGROUND

The Government Performance and Results Act (GPRA) of 1993, Public Law 103-62, held agencies accountable for the first time for program performance by requiring strategic planning, performance measurement, and reporting. GPRA was created to improve the efficiency and effectiveness of federal programs, to develop program performance indicators and goals, and to improve policy making through better informed decision-making. For the first time, the federal government linked budget outcomes to indicators of performance. Many states developed similar requirements.

IMPACT

Agencies developed strategic plans, performance plans, and performance reports on an annual basis. In addition, agencies linked their budgets to strategic plans and achievement of stated performance indicators. As a result, agencies have become more results-oriented and efficient regarding the programs and services they provide.

Category: Government and Policy


1994: MCH Genetics for Primary Care Providers

BACKGROUND

Most primary care physicians in the early 1990s were not adequately trained in clinical genetics. In addition, post-graduate clinical genetics continuing education programs aimed at primary care physicians were few and far between. The Genetics Services Branch (GSB) in HRSA’s Maternal and Child Health Bureau posited that: 1) primary care physicians frequently did not know about and/or did not fully appreciate the important role that genetics plays as a causal factor in premature death and disability throughout the continuum of life, and 2) a lack of training in clinical genetics was one reason why a significant proportion of patients and families were not receiving timely and appropriate genetic services and/or referrals for genetic services. In 1994, the GSB funded grants to create new or improved genetics continuing education programs for primary care physicians and other providers. The expectation was, and continues to be, that increased training for primary care physicians will improve patient access to appropriate and timely genetic services. The grants targeted providers working in a variety of settings, with an emphasis on Title V programs, federally qualified health centers, managed care organizations, and programs that served minority, uninsured, and Medicaid populations.

IMPACT

More than a dozen provider genetic education Special Projects of Regional and National Significance (SPRANS) demonstration grants were funded. Needs assessments were performed and a variety of curricula were developed and made accessible using different educational venues. Many of these projects were highly successful in achieving their goals and continued on after federal funding ended. The GeneTests/GeneClinics® (now GeneReviews®) project has become one of the most widely used clinical genetics web sites in the world.

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Category: Government and Policy


1994: Violence Against Women Act

BACKGROUND

The Violence Against Women Act (VAWA) was passed in 1994 to address the issues of domestic violence and sexual assault.

IMPACT

VAWA coordinated the criminal justice system, the social services system, and private organizations to respond to violence against women. The Act provided financial support for domestic violence shelters, rape crisis centers, and other organizations working to end violence against women. It also introduced interstate enforcement of protective orders and federal prosecution of interstate domestic violence and sexual assault crimes. VAWA resulted in the passage of national, state, and local laws that provide women with increased protection from domestic abuse and sexual violence. Subsequent reauthorizations of VAWA created a legal assistance program for victims and expanded the definition of violence against women to include dating violence and stalking.

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Category: Government and Policy


1994: Back to Sleep Campaign

BACKGROUND

Back to Sleep, a national campaign to prevent sudden infant death syndrome (SIDS), was launched in 1994. The campaign targeted parents and caretakers, urging them to place infants on their backs to sleep. This message was based on new medical evidence that back-sleeping infants had significantly lower rates of SIDS.

IMPACT

In the years following the Back to Sleep campaign, the percentage of infants who were placed on their backs to sleep increased dramatically, and the SIDS rate declined by 50 percent.

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Category: Government and Policy


1994: 10 Essential Public Health Services

BACKGROUND

Public health, like many fields, has had numerous reorganizations over the last two decades. In 1988, the Institute of Medicine (IOM) (now the National Academy of Medicine, or NAM) clearly defined public health's mission, purpose, and three core functions: assessment, policy development, and assurance. In 1994, the three core functions evolved into the 10 Essential Public Health Services, which were written by a committee co-led by the Centers for Disease Control and Prevention's (CDC) Public Health Practice Program Office and the Office of Disease Prevention and Health Promotion. In 1995, several MCH stakeholders contributed to write ten MCH essential services, and the Association of Maternal and Child Health Programs (AMCHP) issued one of the earliest policy papers on health reform and the role of public health. In addition to these happenings, a state tax was issued to tax managed care organizations to fund public health infrastructure, and foundations began to fund initiatives to shore up public health.

IMPACT

This marked a time of revitalization for public health. Events such as the development of the 10 Essential Public Health Services presented public health with a clearer mission and purpose, which has further unified public health.

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Category: Government and Policy

1995: Healthy Child Care America

BACKGROUND

Between 1975 and 1995, increasing numbers of women entered and remained in the workforce. Consequently, more families needed to rely on childcare for their infants and children. In 1975, 39 percent of mothers with children under 6 years of age worked outside the home; now more than two-thirds of mothers do so. Healthy Child Care America (HCCA), a campaign implemented in 1995-2005, introduced the idea that families, childcare providers, and health professionals in partnership can promote the healthy development of young children in child care and increase access to preventive health services, safe physical environments, and a medical home for all children.

IMPACT

In collaboration with the American Academy of Pediatrics (AAP), the HCCA Program promoted childcare education and training, and increased access to preventive health services, safe physical environments, and medical facilities for all children.

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Category: Government and Policy


1996: Health Insurance Portability and Accountability Act of 1996

BACKGROUND

After the proposed Health Care Reform Act of 1993 failed to pass the Senate, more incremental approaches were taken, including the Health Insurance Portability and Accountability (HIPAA) Coverage Act at the federal level and numerous health care reform efforts at the state level.

IMPACT

HIPAA attempted to make health insurance more portable to people who changed or lost their jobs, and also strived to provide patient confidentiality. Under HIPAA, if an insured person were to lose their job and try to acquire new health insurance through a new job or private plan, they would not be subject to the preexisting conditions clause. However, HIPAA regulations also posed new challenges, such as insurance companies raising prices.

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Category: Government and Policy


1996: Welfare Reform

BACKGROUND

Temporary Assistance for Needy Families (TANF), the Welfare Reform Legislation enacted in 1996, was created through the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 in order to reduce welfare dependency. TANF replaced the Aid to Families with Dependent Children (AFDC) program.

IMPACT

TANF provides states and territories with funds ($16.5 billion per year) to operate programs that serve families in need. TANF funds help families care for their children, limiting the dependency of parents through encouraging work, marriage, and two-parent families, preventing unintended pregnancies, and reducing teen pregnancy. In order to receive cash assistance, TANF requires that people work and limits how long people can receive welfare. Since its development, millions of Americans have entered the workforce and, as a result, dependence on welfare has decreased.

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Category: Government and Policy


1996: Education Reform

BACKGROUND

The 1990s era of reinventing government gave rise to major reforms in public education that represented a shift in focus from educational inputs to educational outcomes. For example, instead of focusing on how much was spent on student instructional materials, the focus shifted to the scores that students received on statewide assessments.

IMPACT

Reform efforts included new standards, assessments, accountability, finance reforms, training of teachers, and school choice options. These reforms coincided with a large increase in home schooling and greater demand for parent choice.

RELATED PINPOINT

Category: Government and Policy


1996: MCH Genetic Service Guidelines for the Public's Health

BACKGROUND

On February 16-17, 1996, the Council of Regional Networks for Genetic Services (CORN) organized the conference Developing Guidelines for the Public's Health to define and develop guidelines for genetic services and education at the national, regional, and state levels. The guidelines provided state and territorial public health agencies, other publicly and privately supported health care agencies and organizations, and consumers and communities with a framework for developing and implementing plans for genetic health care systems.

IMPACT

The guidelines addressed specific state needs, including comprehensive genetic services aimed at early diagnosis, treatment, prevention, research, and education. They also focused on infrastructure-building, including organization, administration, funding, and the public health core functions (assessment, policy development, and assurance). Over the years, the guidelines have been revised, modified, and re-published using similar titles by state genetics programs.

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Category: Government and Policy


1996: Abstinence-Only Sexual Education

BACKGROUND

Following a rise in teen pregnancy rates in the early 1990s, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 included $50 million in federal funding for states to implement abstinence-only sexual education programs. In 2000, Community-Based Abstinence Education was established, a federal funding source that offered grants to community groups and nonprofits that provided abstinence-only education programs. President George W. Bush supported this initiative, and over the course of his administration, more than $1 billion in federal funds were invested in abstinence-only education.

IMPACT

In the first years of the abstinence-only initiative, all states except California participated, but as evidence emerged that abstinence-only programs were less effective for teens than comprehensive sexual education programs, states began to turn down federal funding. After a decade, policymakers began to shift support to comprehensive, age-appropriate sexual education and teen pregnancy prevention programs.

Category: Government and Policy


1997: State Children's Health Insurance Program

BACKGROUND

The State Children's Health Insurance Program (SCHIP) (now known as the Children's Health Insurance Program, or CHIP) Title XXI was added to Social Security Act on October 1, 1997.

IMPACT

The addition of SCHIP provided nearly $40 billion dollars over a ten-year period to provide health coverage to children in families with incomes too high to qualify for Medicaid. SCHIP is financed by both federal and state governments, but is administered by the states. Each state designed its own program, and defined their eligibility groups, benefit package, coverage amount, and program procedures. The advent of SCHIP greatly reduced the number of uninsured children in the U.S.

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Category: Government and Policy


1997: Conference on Genetic Services and Managed Care

BACKGROUND

The Council of Regional Networks for Genetic Services (CORN) and the Genetic Services Branch of HRSA's Maternal and Child Health Bureau convened a conference in 1997. The conference presented a broad overview of clinical genetic services and managed care, including affordability, availability, accessibility, quality (standards versus guidelines for care), awareness, funding sources, cost effectiveness and benefit, and patient and provider satisfaction.

IMPACT

This conference began a much needed dialogue between the genetics community and the managed care and health insurance communities. A “think tank” of stakeholders, known as the Partners, was formed to represent diverse interests in the delivery and management of genetic services. Through forums convened several times annually over three years (1997-2000), the Partners addressed specific issues related to these topic areas and worked diligently to form a common perspective.

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Category: Public Health and Medicine


1998: Folic Acid Fortification

BACKGROUND

Folic acid supplements have long been recommended for pregnant women or women planning to become pregnant as a way to reduce the risk of neural tube defects (NTD). In 1998, due in part to the advocacy work of the March of Dimes, the U.S. Food and Drug Administration required that all enriched cereal grain products be fortified with folic acid to further decrease NTD rates.

IMPACT

Folic acid fortification proved effective, as neural tube defects decreased by one-third and a marked decline in cases of spina bifida was observed in the years following fortification of the food supply.

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Category: Government and Policy


1998: Tobacco Settlements

BACKGROUND

Since 1964, the U.S. Surgeons General have reported the harmful effects of smoking. Although tobacco is one of the most preventable causes of death, deaths from smoking continue. In November 1998, the Master Settlement Agreement (MSA) was reached between the tobacco industry and 46 states.

IMPACT

The MSA involved prohibiting youth targeting in marketing and advertising, a change in tobacco corporate culture, as well as the provision of billions of dollars annually to states in perpetuity. States are not required to allocate MSA funds to tobacco prevention and cessation programs, and some states have used settlement dollars for MCH-related projects.

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Category: Government and Policy


1999: Plan B Approved

BACKGROUND

In 1999, the U.S. Food and Drug Administration approved Plan B, a progestin-only emergency contraceptive designed to prevent pregnancy when taken within 72 hours of sexual intercourse.

IMPACT

Plan B made emergency contraception more readily available to women who needed it. Initially, it was only available by prescription. In 2006, Plan B was approved for over-the-counter sale to people 18 and older; and later, the drug became available to 17-year-olds over-the-counter. By 2008, nearly three million doses of Plan B were sold annually.

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Category: Government and Policy


1999: Newborn Screening Task Force Report

BACKGROUND

In May 1998, the Genetic Services Branch of HRSA’s Maternal and Child Health Bureau requested that the American Academy of Pediatrics convene a Newborn Screening (NBS) Task Force to evaluate newborn screening programs in the U.S., and to develop multi-disciplinary recommendations for sustaining the accomplishments achieved by these programs. The recommendations address the impact of advances in genetics, changes in technology, variations in state services and financing, as well as the wide array of ethical, legal and social challenges and opportunities in identifying, retrieving and referring affected newborns into an appropriate system of treatment/care. The Task Force report, Serving the Family From Birth to the Medical Home: A Report From the Newborn Screening Task Force, was published in 2000. In the report, the Task Force outlined a national agenda for strengthening state NBS systems. The Task Force believed that public health agencies (federal and state), in partnership with health professionals and consumers, should work together to establish a national agenda for NBS systems.

IMPACT

The Task Force evaluation and its recommendations established the framework for activities regarding the NBS system in the U.S. over the next 10 years. It also served as the basis for legislation establishing the Advisory Committee on Heritable Disorders.

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Category: Government and Policy


The 2000s

In the early 2000s, public health professionals began to take on a different view of public health application for MCH practice. The CDC “Learn the Signs. Act Early” campaign for early detection of developmental disabilities helped increase awareness of developmental milestones. New recommendations and guidelines were put forward to improve preconception care in response to the CDC’s National Summit on Preconception Care. The Newborn Screening Saves Lives Act provided over $50 million in funding for newborn screening programs. Through amendments to the Special Supplemental Food Program for Women, Infants, and Children (WIC), states were provided greater flexibility of culturally and nutritionally appropriate food options. During this decade, HRSA’s Title V Maternal and Child Health Services Block Grant was highly rated in effectiveness, providing evidence of the federal commitment to promoting maternal and child health. Other HRSA programs became formally authorized through the Children’s Health Act of 2000 (Healthy Start, the Heritable Disorders Program, and the Universal Newborn Hearing Screening Program) and the American Jobs Creation Act of 2004 (Sickle Cell Disease Treatment Demonstration Program).

Category: Milestones


2000: MCH Heritable Disorders Program Authorized

BACKGROUND

Title XI of the Children's Health Care Act of 2000, "Screening for Heritable Disorders," established the Heritable Disorders Program to strengthen states' newborn screening programs, improve states' ability to develop, evaluate and acquire innovative testing technologies, and establish programs to provide screening, counseling, testing and special services for newborns and children at risk for heritable disorders. Title XI enacted three sections of the Public Health Service (PHS) Act: sections 1109, 1110, and 1111. Section 1109 authorized the Secretary to "enhance, improve, or expand the ability of States and local public health agencies to provide screening, counseling or health care services to newborns and children having or at risk for heritable disorders." The Act also established the Advisory Committee on Heritable Disorders in Newborns and Children. The Committee's purpose was to provide to the Secretary advice and recommendations concerning the grants and projects authorized, and technical information to develop policies and priorities so state and local health agencies could better provide screening, counseling and health care services for newborns and children having or at risk for heritable disorders. In addition, the Committee provided advice and guidance regarding the most appropriate application of universal newborn screening tests, technologies, policies, guidelines and programs for effectively reducing morbidity and mortality in newborns and children having or at risk for heritable disorders.

IMPACT

In Fiscal Year 2004 appropriations language, Congress directed MCHB to use Special Projects of Regional and National Significance (SPRANS) funds to implement the heritable disorders program authorized under Section 1109 of Title XI of the Public Health Service Act, 42 U.S.C. 300b-10 (Appendix 4). The Regional Genetics and Newborn Screening Collaboratives were formed to address appropriations language.

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Category: Government and Policy


2000: MCH Genetic Literacy Initiatives

BACKGROUND

In 2000, the Genetic Services Branch (GSB) of HRSA’s Maternal and Child Health Bureau began funding Community-Based Educational Projects. The GSB used Community-Based Participatory Research (CBPR) theory to enhance the ability of communities to incorporate genetic information, resources, and services into the lives of consumers and their families to aid them in making informed decisions regarding their genetic health.

IMPACT

The Consumer Initiatives for Genetics Resources and Services projects resulted in an increase in the number of community-based organizations with the knowledge and skill to carry out CBPR and develop culturally and linguistically appropriate educational materials and programs on genetics. Examples of the programs included the Genetics Education Needs Evaluation (GENE) project, the Family History Project, Does it Run in the Family? toolkit, and the newborn screening resource This Test Could Save Your Baby's Life.

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Category: Government and Policy


2000: New regulations to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

BACKGROUND

Enacted on August 21, 1996, the Health Insurance Portability and Accountability Act (HIPAA) (Public Law 104-191) required that the Secretary of HHS publicize standards for the electronic exchange, privacy, and security of health information. Additional regulations were added in 2000, including the Privacy Rule, Security Rule, Transaction Rule, and Identifier Standards to protect individual health information.

IMPACT

HIPAA expanded patients’ authority over personal health information. The regulations emphasized privacy and protection of personally identifiable information (PII) while not compromising the quality of health care.

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Category: Government and Policy


2000: Oral Health in America

BACKGROUND

On May 25, 2000, Surgeon General David Satcher released Oral Health in America: A Report of the Surgeon General. It was the 51st Surgeon General's report issued since 1964, when Luther Terry issued his landmark report on tobacco and health. These reports have helped frame the science on vital health issues in a way that has helped to educate, motivate, and mobilize the public.

IMPACT

In addition to a lack of awareness of the importance of oral health among the public, the report found a significant disparity between racial and socioeconomic groups regarding oral health and related health issues. The Surgeon General called for action to promote access to oral health care for all Americans, especially disadvantaged and minority children, who were found to be at greatest risk for severe medical complications resulting from limited access to oral care and treatment.

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Category: Government and Policy


2001: National Survey of Children with Special Health Care Needs

BACKGROUND

In 2001, HRSA’s Maternal and Child Health Bureau launched the National Survey of Children with Special Health Care Needs (NS-CSHCN). The primary goals of the survey were to assess the prevalence and impact of special health care needs among children in the US and individual states, to evaluate change over time, and provide data for the recently developed Title V national performance measures. The survey explored the extent to which children with special health care needs (CSHCN) had medical homes, adequate health insurance, access to needed services, and adequate care coordination. Other topics included functional difficulties, transition services, shared decision-making, and satisfaction with care. Interviews were conducted with parents or guardians who knew about the child's health. The survey was fielded three times, 2001, 2005-06, and 2009-10 providing both national and state-level estimates.

In 2016, the NS-CSCHN was combined with the National Survey of Children’s Health. The redesigned survey is fielded annually and covers most of the content previously covered in the NS-CSHCN.

IMPACT

At launch, the NS-CSHCN was the only source of data on CSHCN in the country. CSHCN were identified using a 5-item screening questionnaire which utilized a ground-breaking, non-categorical approach to identifying children with such needs by focusing on the impact (on both the child and their family) of a child’s health condition or conditions, rather than the presence of a specific diagnosis. The survey provided policy makers, program managers, researchers, advocates and families with critical information upon which effective programs could be developed to meet the unique needs of this population at both the national and state levels. The Title V Maternal and Child Health Services Block Grant program used these data to track state performance on six core systems outcomes, which assessed various aspects of the quality and accessibility of services received by this population.

The Title V Block grant continues to use the redesigned NSCH to track performance and outcome measures for this population, including medical home receipt and receipt of transition planning services.

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Category: Government and Policy


2001: MCH Genetics Workforce Study

BACKGROUND

The Genetic Services Branch (GSB) of HRSA’s Maternal and Child Health Bureau launched a four-year project to enhance the understanding of clinical genetics services, factors affecting demand for genetic services, and the roles of health professionals providing these services. The study was established to describe models of delivering genetic services and roles of health professionals in delivering those services, and to identify measures for the demand of those services.

IMPACT

The study determined that most genetic services relate to counseling, testing, and test interpretation, and that the number of genetic specialists is quite small. This study provided the first detailed information on the composition and training of the medical geneticists, their diverse professional activities and roles, and their professional satisfaction and perspectives on current genetics health care. It identified the factors that drive the organization and delivery of clinical genetics services and described the practice patterns of geneticists providing patient care and clinical laboratory services, the types of services provided by geneticists, information on staffing, and a number of other issues regarding clinical and laboratory services. The study has served as an important tool in policy decisions about genetic workforce needs.

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Category: Government and Policy


2001: MCH Translational Genetic Research

BACKGROUND

HRSA’s Maternal and Child Health Bureau (MCHB) funds a series of translational research projects such as the evaluation of the use of new technologies in newborn screening programs, the development of screening tests for Fragile X syndrome, and hyperbilirubinemia. Advances in DNA and other technologies in the last decade have facilitated new discoveries in the genetic basis of many diseases. While the mapping of the human genome has been a monumental scientific achievement, it leaves us with significant gaps in our knowledge about the health, ethical, legal, and social implications of genetics. Health educators, health care providers, and public health professionals who work daily at the interface between health systems and communities face unprecedented challenges and opportunities as they try to assist communities to use genetic knowledge in ways that will be helpful to them. Policymakers face similar challenges as they try to effectively communicate to and educate their constituencies regarding the importance of genetic information, resources, and services.

IMPACT

The goals of the policy projects enhanced the state of the science of access to genetic medicine and technologies and informed federal decision-making on translational genetic activities relevant to health care delivery, coverage, and regulation. In 2007, these projects translated into more concrete approaches toward policy development within the National Coordinating Center for the Regional Genetic and Newborn Screening Service Collaboratives. Although these completed projects were effective, a significant federally-funded newborn screening research agenda has yet to be implemented. Recommendations for a research agenda were put forth by the American College of Medical Genetics (ACMG) newborn screening expert group. In 2007, MCHB put forth an initiative to address the current knowledge gap in the acquisition of the parental knowledge process and propose models of practice that promote positive family adaptation and interaction within the newborn screening system.

Category: Government and Policy


2002: MCH Sickle Cell Newborn Screening Initiative

BACKGROUND

Section 501(a)(2) of the Social Security Act, U.S.C. 701(a)(2) authorized Congress to appropriate $2 million to fund a Sickle Cell Disease Program of 15 community-based Sickle Cell Disease and Newborn Screening grants and one cooperative agreement to enhance the follow-up component of state sickle cell disease newborn screening programs for infants who screen positive for sickle cell disease or as carriers. Building on the success of the one-year program, $4 million was appropriated in fiscal year (FY) 2003 to fund 17 community-based programs and one cooperative agreement for two years and; in 2005, $4 million was appropriated to fund 17 community-based programs and one cooperative agreement through FY 2008.

IMPACT

The Sickle Cell Disease Newborn Screening Program: (1) developed a tool kit to help providers educate families about sickle cell disease and carrier status, (2) developed a minimum data set template, (3) identified promising practices, and (4) established networks that are models for replication.

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Category: Government and Policy


2002: No Child Left Behind Act

BACKGROUND

The No Child Left Behind Act (NCLB) reauthorized the Elementary and Secondary Education Act and included provisions for disadvantaged students. It supported standards-based education reform based on the premise that setting high standards and establishing measurable goals could improve individual outcomes in education. The Act required states to develop assessments in basic skills. To receive federal school funding, states had to give these assessments to all students at select grade levels. The NCLB Act was signed on January 8, 2002, providing nearly $1 billion a year to strengthen public schools.

IMPACT

NCLB represented a significant step forward for our nation’s children as it shined a light on where students were making progress and where they needed additional support. NCLB put in place measures that exposed achievement gaps among traditionally underserved students and their peers and spurred an important national dialogue on education improvement. Over time, NCLB’s prescriptive requirements became increasingly unworkable for schools and educators. Recognizing this fact, NCLB was reauthorized as the Elementary and Secondary Education Act (ESSA), then re-named the Every Student Succeeds Act (ESSA) on December 10, 2015.

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Category: Government and Policy


2002: MCH and Family History

BACKGROUND

HRSA’s Maternal and Child Health Bureau proposed the Consumer-based Family History Tool and Education Process, which resulted in the Healthy Choices through Family History Project. This initiative used a non-medical model approach to increase family member access to genetic health-related information and gave family members a way to organize and preserve family history and health related records. Genetic literacy includes knowing about benefits, risks, and limitations of genetic screening and testing, as well as the implications of medical genetic information in a health care setting, including knowledge of relevant financial, ethical, legal, and socio-cultural issues.

IMPACT

Participants in the project agreed that family history was a useful tool for identifying people at increased risk of disease and for developing targeted health promotion interventions for people at higher-than-average risk for diseases. HRSA chose a non-medical approach that relies on the everyday communications process between individuals and families. In 2006, the family history project was expanded to include five additional communities.

Category: Public Health and Medicine


2002: Life Course Approach

BACKGROUND

The life course approach to conceptualizing health care needs and services evolved from research documenting the important role early life events play in shaping a person’s health trajectory. The interplay of risk and protective factors, such as socioeconomic status, toxic environmental exposures, health behaviors, stress, and nutrition, influence health throughout one's lifetime.

IMPACT

This emerging science on gene-environment interactions touches on several aspects of public health, including health disparities, fetal origins of adult disease, and outcomes related to prenatal and preconception health and health care. The life course approach has become a prominent framework for conceptualizing health.

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Category: Government and Policy


2003: National Survey of Children’s Health

BACKGROUND

HRSA’s Maternal and Child Health Bureau (MCHB) launched the National Survey of Children’s Health (NSCH). The primary goal of the survey was to examine the physical and emotional health of children ages 0-17 years of age. Special emphasis was placed on healthcare, family, and community factors that may relate to well-being of children, including medical homes, family interactions, parental health, school and after-school experiences, and safe neighborhoods. In 2016, the NSCH was combined with the National Survey of Children with Special Health Care Needs. The redesigned survey is fielded annually and covers most of the content previously covered in the NSCH.

IMPACT

The NSCH was (and remains) the only source of both state- and national-level data on multiple key indicators of child health and well-being. As such, it is used to inform policy and programmatic efforts at both the state and national levels, including multiple generations of Healthy People and, now, performance measurement and benchmarking for multiple HRSA MCHB investments, including 18 National Performance and Outcome Measures for the Title V Maternal and Child Health Services Block Grant Program and the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program.

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Category: Government and Policy


2004: MCH Sickle Cell Disease Treatment Program

BACKGROUND

HRSA awarded $1.9 million through Section 712(c) of the American Jobs Creation Act of 2004 (Public Law 108-357 as amended) to develop and establish mechanisms to enhance the prevention and treatment of sickle cell disease. Four Collaborative Networks are funded to support regional associations of community-based primary care providers, sickle cell disease support organizations, and sickle cell disease experts to provide comprehensive, culturally accessible, and family-centered care for people with the disease, and one national center to coordinate network collaborative activities. The coordinating center, in partnership with the grantees, is charged with: 1) the identification of a model protocol for implementing the recommendations of Congress regarding changes that should be made in health care and health education to people with sickle cell disease, as well as in methods of screening for people having the disease or the trait; 2) the procedures for implementing this protocol at the four grantee sites; and 3) the set of methods for evaluating the degree of success that each grantee has attained.

IMPACT

In fiscal years 2014-2016, the Sickle Cell Disease Treatment Demonstration Program (SCDTDP) supported four grantees that developed regional networks to improve the delivery of care for patients with sickle cell disease and improve data collection to inform the delivery of care. SCDTDP’s four regions include an estimated 56,733 individuals with sickle cell disease, or roughly half of the 100,000 individuals with sickle cell disease in the United States.

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Category: Government and Policy


2004: MCH Heritable Disorders Program Implemented

BACKGROUND

Legislation authorized the establishment of The Heritable Disorders Program to enhance, improve, and expand the ability of state and local public health agencies to provide screening, counseling or health care services to newborns and children having or at risk for heritable disorders. In 2004, HRSA funded seven Regional Genetics and Newborn Screening Services Collaboratives, inclusive of all states in each region, and one National Coordinating Center to implement the Heritable Disorders Program. The purpose of the Regional Genetics and Newborn Screening Collaboratives is to enhance and support the genetics and newborn screening capacity of states across the nation by undertaking a regional approach to determine needs and address the uneven distribution of genetic resources and expertise across the region.

IMPACT

This program has built a coordinated and integrated infrastructure and a foundation of state, regional, and national partnerships (both public and private) that are generating activities to support the Heritable Disorders Program.

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Category: Government and Policy

2004: Learn the Signs. Act Early.

BACKGROUND

In October of 2004, the Centers for Disease Control and Prevention (CDC) launched the “Learn the Signs. Act Early.” campaign to promote the early identification of children with developmental disabilities and improve families’ abilities to obtain needed services and support. The three components of the program include a health education campaign, an “Act Early” initiative, and research and evaluation. The health education campaign provides families and health professionals with materials and tools to track developmental milestones as well as information on the importance of acting early to address concerns. The “Act Early” initiative works to increase collaboration between state early childhood programs to improve screening and referral. Research and evaluation projects focus on analyzing how to improve the identification of developmental disabilities.

IMPACT

Research on the effects of the campaign show that the campaign has increased awareness regarding developmental milestones and referral resources among parents and health care professionals.

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Category: Government and Policy


2005: Gulf Coast Hurricanes

BACKGROUND

In 2005, the United States experienced an unprecedented emergency, which resulted from one of its worst hurricane seasons ever. Three hurricanes brought suffering to people of the Gulf Coast, devastating an area larger than North and South Carolina combined. Hurricanes Katrina, Rita, and Wilma damaged communities, trapped 40,000 people, and displaced millions from their homes. By some measures, the 2005 hurricanes created basic human needs that were 10 to 20 times greater than any domestic disaster in the past 125 years.

IMPACT

Hurricane Katrina demonstrated that patients can be unexpectedly removed from the doctor-patient relationship, displaced geographically, and disoriented in terms of usual care. Federal and state health systems revised and established strategic responses to a damaged healthcare infrastructure, community-based screening and surveillance systems, community health systems, and primary care practices. Health professionals recognized not only the physical impact, but the psychological impact, including the need for mental health services for those affected by the hurricanes.

Category: Milestones


2005: Uniform Newborn Screening Panel

BACKGROUND

The Newborn Screening (NBS) Task Force's Report of 1999 identified a need to develop national guidelines to ensure equitable access to NBS nationwide. For this reason, HRSA’s Maternal and Child Health Bureau contracted with the American College of Medical Genetics (ACMG) to analyze the scientific literature and gather expert opinion on information concerning the scope of newborn screening programs and anticipated future directions, including the delineation of the best evidence for screening specified conditions. An ACMG-convened expert panel recommended the following:

IMPACT

The project was presented to the Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and Children for review and recommendations, and was endorsed by this Committee in 2005. Over the course of two years, there was a rapid uptake by state newborn screening programs in the recommendations put forth by the ACMG panel.

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Category: Government and Policy


2005: Rise in Preterm Birth and Low Birth Weight

BACKGROUND

In 2005, researchers noted significant increases in the rates of preterm birth and low birth weight in the U.S. More than 12 percent of infants were born preterm, a 20 percent increase since 1990, and more than 8 percent of infants were low birth weight, a 20 percent increase since the mid-1980s.

IMPACT

Preterm birth and low birth weight are correlated with poor health outcomes and cost the U.S. health care system billions of dollars each year. High rates of preterm birth and low birth weight also contribute to the U.S. infant mortality rate, which is one of the highest among developed nations. Factors that likely contributed to the rise in preterm birth and low birth weight included delayed childbearing and high rates of multiple births associated with the use of assisted reproductive technologies.

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Category: Government and Policy

2005: Preconception Care

BACKGROUND

The National Summit on Preconception Care was convened by the Centers for Disease Control and Prevention (CDC) in June 2005. At the summit, the CDC and 35 partner organizations discussed the current state of preconception care and convened a panel tasked with developing national recommendations that would improve the health of women before conception and thereby improve pregnancy outcomes.

IMPACT

The panel made recommendations for improvements in clinical care, public health, and community action. It refined the definition of preconception care and developed a strategic plan to improve preconception health. The panel's complete recommendations can be found in the Morbidity and Mortality Weekly Report.

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Category: Government and Policy


2006: New Developments in Vaccines

BACKGROUND

New vaccines were developed to improve the health of women and children. Two live, oral, attenuated vaccines against rotavirus infection were licensed by the U.S. Food and Drug Administration (FDA) in 2006 and were subsequently introduced in routine immunization programs. FDA also approved the first vaccine for cervical cancer for women between the ages of 9 and 26.

IMPACT

The rotavirus vaccines were intended to prevent most physician visits for rotavirus gastroenteritis and at least two-thirds of hospitalizations and deaths related to rotavirus. Moreover, the vaccine for preventing cervical cancer aimed at preventing the nearly 10,000 new cases of cervical cancer and 3,700 deaths that occur in the U.S. each year.

Category: Government and Policy


2006: Future of Emergency Care Series Released

BACKGROUND

In 2006, the Institute of Medicine (now called the National Academy of Medicine) released the Future of Emergency Care, a series of reports that included “Emergency Medical Services at the Crossroads,” “Hospital-Based Emergency Care: At the Breaking Point,” and “Emergency Care for Children: Growing Pains.”

IMPACT

The reports comprehensively described the “fragmented” system of emergency care with emphasis in the pediatric report on the “uneven” nature of emergency care for children.

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2006: Increase in Autism Awareness and Funding

BACKGROUND

In 2006, the U.S. Congress passed the Combating Autism Act (P.L. 104-416) to address public concern with the increasing prevalence of autism, interest in determining the causes, and the need for early identification, effective treatment and support services. The Act appropriated a total of $168 million, including $42 million for the Health Resources and Services Administration (HRSA), to focus on autism and related developmental disability education, early detection, and intervention. The Act also authorized funding for autism spectrum disorder (ASD) surveillance and research through the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) and created the Interagency Autism Coordinating Committee (IACC) to coordinate all federal autism research efforts and improve interagency collaboration.

Section 399BB of the Act authorized HRSA to conduct activities to:
• Increase awareness of ASD and other developmental disabilities (DD);
• Reduce barriers to screening and diagnosis;
• Support research on evidence-based interventions for ASD and other DD;
• Promote the development of evidence-based guidelines and tools for interventions;
• Train professionals to use valid and reliable screening and diagnostic tools and provide evidence-based interventions for ASD and other DD.

The Act also authorized HRSA to expand existing interdisciplinary training and leadership programs (authorized in Title V of the Social Security Act).

The Combating Autism Act authorized appropriations for these activities from FY2007 through FY2011. The Act was reauthorized in 2011 as the Combating Autism Reauthorization Act and again in 2014 as the Autism Collaboration, Accountability, Research, Education and Support Act (Autism CARES Act).

IMPACT

Increased advocacy efforts and additional funding contributed to enhanced autism awareness and federal efforts to address issues affecting people with ASD and their families.

HRSA’s Maternal and Child Health Bureau (MCHB) implemented a coordinated portfolio of research, training and state systems grant programs that work to improve the health and well-being of children with ASD and other DD by promoting and improving access to early screening, diagnosis and interventions, increasing the number of professionals able to diagnose and provide evidence-based interventions, advancing the evidence base on the effectiveness of interventions, and increasing awareness of ASD and other DD.

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Category: Government and Policy


2007: WIC Food Package Revised

BACKGROUND

New federal requirements were introduced in 2007 for the Special Supplemental Food Program for Women, Infants, and Children (WIC) to align program practices with infant feeding guidelines and updated dietary guidelines. The new requirements were designed to improve the nutritional intake of all WIC recipients and address high rates of overweight and obesity among children receiving WIC benefits.

IMPACT

The new federal WIC requirements promote and support long-term breastfeeding and alter the WIC food package to include a variety of nutritious foods. Fruits and vegetables, whole grains, and soy-based foods were added to the WIC food package, and WIC state agencies were given more flexibility to offer an assortment of culturally appropriate foods.

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Category: Government and Policy


2008: Newborn Screening Saving Lives Act

BACKGROUND

The Newborn Screening Saves Lives Act of 2007 was signed into law by President George W. Bush on April 24, 2008. The Act authorized more than $58 million in funding for newborn screening grants.

IMPACT

The new funding supported newborn screening education and outreach, coordination of follow-up care after screening, and evaluation of the effectiveness of newborn screening programs.

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Category: Government and Policy


2008: MCH Block Grant Rated Effective

BACKGROUND

The Program Assessment Rating Tool (PART) was designed to assess the performance of public programs and help guide program improvements and budget decisions. In 2008, the Title V Maternal and Child Health Services Block Grant was among the 19 percent of federal programs that received the highest PART rating of "effective."

IMPACT

The PART assessment found that the MCH Block Grant has been effective at reducing infant mortality, expanding access to early prenatal care, collaborating with other organizations, and implementing successful programs to improve the health of women, children, and families.

Category: Government and Policy


2009: Children's Health Insurance Program Reauthorization Act

BACKGROUND

In 2007, Congress passed two separate bills in an attempt to reauthorize the State Children's Health Insurance Program and expand the program to cover more uninsured children. Both bills were vetoed by President George W. Bush, and at the end of 2007, a one-year program extension was passed. In January 2009, the 111th Congress passed new legislation, the Children's Health Insurance Program Reauthorization Act (CHIPRA), and President Obama signed it into law on February 4, 2009.

IMPACT

CHIPRA increased funding for the Children's Health Insurance Program and changed the way that program funding is allocated to states. CHIPRA provided additional funding for CHIP outreach to increase enrollment of eligible children and gave states the option to cover pregnant women and children who are lawfully residing in the U.S.

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Category: Government and Policy


2009: American Recovery and Reinvestment Act

BACKGROUND

The American Recovery and Reinvestment Act of 2009 was designed to address the failing U.S. economy by authorizing $787 billion in spending on several projects and programs.

IMPACT

The American Recovery and Reinvestment Act designated about $142 billion for children, including funding for school modernization, Head Start, foster care and adoption assistance, the Child Tax Credit, and the Supplemental Nutrition Assistance Program. The Act also invested in the lives of children and families by creating new jobs and enhancing safety net services like community health centers and unemployment benefits.

Category: Government and Policy


The 2010s

In 2010, Maternal, Infant and Early Childhood Home Visiting, under the Patient Protection and Affordable Care Act, brought health and developmental services into the homes of at-risk children throughout communities across the nation, with many visits occurring in rural or tribal areas. To combat developmental, behavioral and social delays among children and infants, the Centers for Disease Control and Prevention, in conjunction with the U.S. Department of Health and Human Services, launched the “Birth to Five: Watch Me Thrive!” campaign. HRSA’s Title V Maternal and Child Health Services Block Grant Program was amended for feasibility for states and their programs in 2015. Then, in early 2016, cases of Zika and related birth defects were occurring in the United States. This prompted immediate attention from many MCH professionals. The National Academy of Medicine released the Women’s Preventive Services Initiative, prompted by the Affordable Care Act, to accommodate areas lacking in women’s health, particularly in the realm of her life course.


2010: Patient Protection and Affordable Care Act

BACKGROUND

The Patient Protection and Affordable Care Act (PPACA) (PL 111-148) was enacted in March 2010. The goals of the PPACA were to make health insurance available to more people at an affordable price, expand Medicaid coverage, and support innovative methods designed to lower health care costs. Section 3509 specifically focused on improving women’s health.

IMPACT

The PPACA increased coverage to low-income populations, including women and children. It limited the cost sharing requirements for women’s preventive services, including mammograms, screenings for cervical cancer, and prenatal care. Plans offering dependent child coverage were required to extend coverage until a child reached the age of 26.

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Category: Government and Policy


2010: MIECHV Program Established

BACKGROUND

The Patient Protection and Affordable Care Act of 2010 authorized the creation of the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV Program) under Title V of the Social Security Act to support voluntary, evidence-based home visiting services for at-risk pregnant women and parents with young children up to kindergarten entry. States, territories, and tribal entities receive funding through the MIECHV Program, which is under HRSA's Maternal and Child Health Bureau. They have the flexibility to tailor the program to serve the specific needs of their communities.

IMPACT

The MIECHV Program provided an unprecedented opportunity for collaboration and partnership at the federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs. Since 2010, HRSA has awarded grants to 56 states, territories, and nonprofit organizations; 29 tribal entities have received funding through the Tribal Home Visiting program, administered by the Administration for Children and Families.

Following the five years of funding initially provided in 2010, the MIECHV Program was extended through the Protecting Access to Medicare Act of 2014 (FY 2015) and the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (FY 2016 and FY 2017).

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Category: Government and Policy

2010: Tackling Childhood Obesity

BACKGROUND

In 2010, President Barack Obama signed a presidential memorandum establishing the first ever task force on childhood obesity to develop an interagency action plan to solve the problem of obesity among our Nation's children within a generation. A supplement to First Lady Michelle Obama's Let's Move! Campaign, the White House Task Force on Childhood Obesity facilitated the creation of a "national action plan to maximize federal resources and set concrete benchmarks toward the first lady’s national goal."

IMPACT

The Task Force on Childhood Obesity prioritized five pillars in addressing childhood obesity: creating a healthy start for children, empowering parents and caregivers, providing healthy food in schools, improving access to healthy and affordable foods, and increasing physical activity. Goals, benchmarks, and measureable outcomes were linked to each priority to help track progress at local, state, and federal levels. At the same time, through collaboration with federal agencies, businesses, and non-profits, Let's Move! instituted programs to support kids and families in leading healthier lives, and to support communities in meeting goals set by the Task Force on Childhood Obesity. Associated initiatives included the Healthy, Hunger-Free Kids Act, the launching of MyPlate and Drink Up campaigns to promote well-balanced meals, and spinoff campaigns like Let's Move! Active Schools that further promoted physical activity and nutrition among youth and families.

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Category: Government and Policy


2010: Bullying Prevention

BACKGROUND

The Federal Partners in Bullying Prevention convened in 2010, at the same time the U.S. government launched the annual Federal Partners in Bullying Prevention Summit. Comprised of representatives from the U.S. Departments of Agriculture, Defense, Education, Health and Human Services, the Interior, and Justice, as well as the Federal Trade Commission and the White House Initiative on Asian Americans and Pacific Islanders, the Federal Partners coordinate policy, research, and communications on a range of bullying topics. The FPBP provides consistent and well-informed resources to the field in order to significantly reduce the prevalence of youth peer-to-peer bullying.

IMPACT

Since establishment, the Federal Partners have worked on a number of bullying prevention initiatives and campaigns. Stopbulling.gov, the official website of the Federal Partners and U.S. bullying prevention, plays a key role in disseminating these resources to school leaders, community members, parents, and youth across the country. Whether families are coping with a bullying incident, or looking for ways to prevent bullying in their own communities, Stopbullying.gov offers toolkits, trainings, and research to support anti-bullying efforts. In 2018, the Federal Partners hosted the first Cyberbullying Prevention Summit, where First Lady Melania Trump spoke about her Be Best campaign to prevent bullying through social, emotional, and physical health. With new trends in cyberbullying and internet safety, the Federal Partners in Bullying prevention continue to identify best-practices and research priorities to guide institutions and communities toward creating safer and healthier environments for kids.

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Category: Government and Policy


2014: Autism CARES Act

BACKGROUND

In August 2014, the Autism Collaboration, Accountability, Research, Education and Support (CARES) Act of 2014 was signed into law. This bipartisan effort reauthorized earlier autism-related legislation and continued research initiatives and service provisions for people with autism spectrum disorder (ASD) and other developmental disabilities (DD). The law also furthered federal autism training and surveillance efforts.

IMPACT

The law reauthorized for five years existing federal autism programs through 2019 to continue addressing the needs of children and adolescents with ASD and other DD, including the needs of transition age youth and young adults. The Act also ensured consistent representation by people with ASD and their families within organizations, including the Interagency Autism Coordinating Committee (IACC). The Act required the Secretary of Health and Human Services to assign a lead in charge of organizing and monitoring all federal research and related programs to improve coordination and prevent duplication.

The Act authorized HRSA’s Maternal and Child Health Bureau (MCHB) to continue supporting a coordinated portfolio of research, training and state systems grant programs that work to improve the health and well-being of children with ASD and other DD with an increased emphasis on expanding the reach of programs and addressing disparities in early identification, effective interventions and access to care for underserved populations including rural communities.

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Category: Government and Policy


2014: Birth to Five: Watch Me Thrive!

BACKGROUND

Birth to 5: Watch Me Thrive! was developed as a coordinated federal initiative promoting developmental and behavioral screening for children. The initiative was designed to encourage families to monitor children’s milestones, promote universal screening, detect delays as soon as possible, and enhance the supports available to children. Birth to 5: Watch Me Thrive! includes several resources, such as a screening passport for parents, guides on the use of screening tools, and guidance on locating local support and assistance for families.

IMPACT

Birth to 5: Watch Me Thrive! provides valuable resources to as many as 1 in 4 children who are at moderate or high risk for developmental, behavioral, or social delay. The program continues to play an important role in increasing the diagnosis and treatment of children with developmental delays. Its resources for families, education providers, communities, and other stakeholders allow for the use of much needed tools in a variety of settings.

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Category:Government and Policy


2015: Title V Maternal and Child Health Services Block Grant to States Program Transformation

BACKGROUND

In 2015, the Title V Maternal and Child Health (MCH) Services Block Grant Program was transformed with the triple aims of lessening burden on State applicants, maintaining State flexibility in addressing unique MCH priority needs and improving program accountability at both Federal and State levels. Key revisions included a streamlined Application/Annual Report, the implementation of a three-tiered performance measure framework, an emphasis on the use of evidence-based strategy measures and the inclusion of a logic model for development of the State’s Five-year Action Plan. Full implementation of these changes was achieved with the submission of the fiscal year (FY) 2018 MCH Block Grant Applications/FY 2016 Annual Reports. The Block Grant Transformation continues the strong legacy of Title V.

IMPACT

The revisions to the 2015 Title V MCH Block Grant Application/Annual Report Guidance were intended to enhance the ability of States to document the impact and value of this investment towards improving MCH outcomes within the State as well as to tell a national story about the impact of Title V funding across the country. Revising the program’s National Performance Measures (NPMs) allowed the Federal MCH program to assume lead responsibility in ensuring that each measure had a national data source, which allowed for more timely, reliable, and valid data reporting. In addition to being more actionable and providing greater accountability, the new performance measure framework was implemented to track areas where State MCH programs could best demonstrate the impact of their Title V investments.

In 2016, State Title V programs reported serving almost 54 million mothers and children in the U.S., including two-thirds of all pregnant women, and one half of all infants and children.

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Category: Government and Policy

2016: The Zika Virus Epidemic

BACKGROUND

Since 1952, outbreaks of Zika virus have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. In January 2016, CDC began responding to Zika outbreaks in the Americas amid increased reports of birth defects. In August of that same year, U.S. Health and Human Services Secretary Sylvia M. Burwell declared a public health emergency for Puerto Rico, as the spread of Zika virus posed a significant threat to pregnant women and children born to women with Zika. HRSA’s Maternal and Child Health Bureau made addressing the Zika epidemic a top priority as research found that infection during pregnancy can cause serious birth defects, especially affecting the neurological and nervous systems.

IMPACT

From 2015-2018, the CDC reported more than 7,000 pregnant women with laboratory evidence of possible Zika virus infection in the United States and its territories and jurisdictions. HRSA awarded $18 million to the Departments of Health of Puerto Rico, American Samoa and the U.S. Virgin Islands for the Zika Maternal and Child Health Services Program to ensure access to services and comprehensive medical homes for affected women, children and families. HRSA continues to work closely with the CDC, Centers for Medicare and Medicaid Services, and other U.S. government partners as part of the federal response to the Zika threat.

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Category:Government and Policy


2016: Women’s Preventive Services Initiative

BACKGROUND

The HRSA-supported Women's Preventive Services Guidelines, developed by the Institute of Medicine (IOM) (now the National Academy of Medicine, or NAM), helped to ensure that women receive a comprehensive set of preventive services without cost sharing. The guidelines were created under the Patient Protection and Affordable Care Act to account for the unique needs of women throughout the life course, and went into effect on August 1, 2012. In response to consumers and clinical practitioners requesting additional guidance to better define specific benefits and services, HRSA's Maternal and Child Health Bureau provided funding to the American College of Obstetricians and Gynecologists (ACOG) to support the development and dissemination of updated Women's Preventive Services Guidelines in 2016.

IMPACT

This work has developed a comprehensive set of guidelines for well woman care that addresses current concerns with screening, strengthens the clinical workforce knowledge-base on women’s health, and increases education and awareness on the importance of women’s health care for both providers and consumers.

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Category:Government and Policy


2018: MIECHV Extended for Five Years

BACKGROUND

The Bipartisan Budget Control Act included a five-year extension of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program with level funding of $400,000,000 each year through Fiscal Year (FY) 2022. The legislation also contained programmatic changes, including an option to fund evidence-based home visiting on a pay for outcome basis, a follow-up statewide needs assessment, and continued demonstration of improvements in at least four of six benchmark areas.

IMPACT

The five-year extension continues the federal investment in evidence-based home visiting programs to improve health and development outcomes for at-risk children. MIECHV state and territory grantees provided over 4.2 million visits from FY 2012 through FY 2017. Tribal grantees provided over 72,000 home visits from FY 2012 to FY 2017. Since FY 2012, the reported number of children and parents served increased nearly five-fold to approximately 156,000, and the number of home visits provided increased more than five-fold to nearly 943,000 million home visits in FY 2017.

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Category:Government and Policy


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