MCH TIMELINE - IN-DEPTH ISSUES - RESOURCES

MCH Timeline

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1798: Marine Hospital Service

Background:

The Marine Hospital Service (MHS), which would eventually become the U.S. Public Health Service, was established in 1798 to provide medical care to the increased numbers of ill merchant seamen traveling to U.S. port cities. The MHS also offered states technical assistance on epidemics and matters of quarantine.

Impact:

Over the next century the MHS would become the foundation of public health in the United States. In 1912, the MHS would officially be renamed the U.S. Public Health Service and be given increased responsibility for health investigation and environmental sanitation.

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. 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 disease.

Related Pinpoints

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. "Urbanization, industrialization, and immigration were the impetus behind the nation's first public school movement. In the 1840's the swelling ranks of immigrant poor in America's cities were a visiable and troubling presence. Public education was seen as an effective way to bring these new Americans into the fold."

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 (18221893)

Related Links

http://www.pbs.org/now/society/edhistory.html

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 has, over the last century and a half, continued to set medical guidelines and improve public health care.

Category: Public Health and Medicine


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 Nov. 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


1859: Charles Darwin publishes The Origin of Species

Background

Charles Darwin publishes The Origin of Species, promoting the theory of evolution by natural selection. Darwin's theory emphasizes the importance of variation in populations and the transmission of variation from one generation to the next. He is unable, however, to propose a workable explanation for the transmission of variation.

Impact

Darwin's theories remain central to our understanding of life on Earth and provide a unifying framework for all work in biology and biomedicine.

Category: Public Health and Medicine


1860: First Children's Clinic

Background

The nation's first freestanding children's hospital, established in Philadelphia, began receiving children suffering from acute diseases and accidents on Nov. 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


4/12/1861: The Civil War

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. Before the end of the Civil War 3 million would fight and 600,000 would die, more than any other war involving US soldiers. The roots of the Civil War run deep and are still debated today. 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 was also responsible for the reorganization of the society, the economy and the politics of southern states, and eventually a much stronger centralized government in the US. The social affects of the Civil War would be felt for over a century culminating in the 1960s with the Civil Rights Movement.

Category: Milestones


1866: Gregor Mendel and Laws of Inheritance

Background

Gregor Mendel, a monk working in what is now the Czech Republic, studied acquisition of different traits in pea plants, and based on those experiments published his findings on the inheritance of those traits. His work begins to answer the questions about the nature and transmission of inherited biological variation that Darwin was unable to answer. Few in the scientific community recognize the significance of Mendels results, however, and his publication is essentially ignored for 35 years.

Impact

Mendel's research lays the basis for laws of inheritance and influences research in the twentieth century and beyond. He is called the "father of genetics."

Category: Public Health and Medicine


1867: The U.S. Office of Education established

Background

President Andrew Johnson created the first education department 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 not well 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.

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 it's failure to control a smallpox epidemic and led to the creation of autonomous local boards of health in 1872.

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

The APHA continues to be the oldest and largest organization of public health professionals in the world. It's influence on policies and public health priorities has been continually present over the last 125 years.

Related Links

http://www.apha.org

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 the humane work being done for 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 episode, the Society for the Prevention of Cruelty to Children was founded.

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.

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.

Category: Public Health and Medicine


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 (AFL). By 1899, 28 states had passed some kind of legislation protecting child workers. This was accomplished in spite of opposition by employers who felt they would not be able to stay in business if such a law were passed. 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.

Category: Government and Policy


1888: American Pediatric Society

Background

The relative neglect of the problems of child illness and health spurred the establishment of the American Pediatric Society, the first medical specialty society in the U.S. Dr. Abraham Jacobi was its first president.

Impact

The current goal of the APS is "To bring together men and women for the advancement of the study of children and their diseases, for the prevention of illness and the promotion of health in childhood, for the promotion of pediatric education and research, and to honor those who, by their contributions to pediatrics, have aided in its achievement." The society has become a leading force in the promotion of academic pediatrics.

Category: Public Health and Medicine


1889: Hull House Settlement Established

Background

Jane Addams, with friend Ellen Starr, establishes the Hull House Settlement in Chicago, and initiates the Settlement House Movement in the U.S. Services included kindergarden classes, 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.

Related Links Hull House Exhibit at the National Women's History Museum : https://www.nwhm.org/online-exhibits/progressiveera/hullhouse.html

Category: Public Health and Medicine


1890: Progressive Era

The decades between 1890 and 1920 constituted a period of such intense reform activity that historians have labeled the "Progressive Era." Over these 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" engaged in 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 the handicapped. 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 disabled children and adults.

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. During this period private organizations laid a strong foundation for the continued involvement of the public in programs for children.

Also see Women in the Progressive Era at nps.gov

Category: Milestones


1893: First State CSHCN Program

Background

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

Impact

By the end of the 19th century, hospitals for orthopedically handicapped children 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.

Related Links

Category: Public Health and Medicine


1893: First 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 safe milk being provided by milk stations, and the advent of pasteurization in 1910, by the early 1900s diarrheal disease was no longer a major cause of infant mortality.

Related Links
Video Clips

NurseLillianWald.ram

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 was 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.

Category: Government and Policy


1900: The 1900's

Progressive Period: Reforms for children and child health care

Category: Milestones


1900: Three scientists re-discover Mendel's publication

Background:

E. Tschermak, H. de Vries, and C. Correns, working independently on breeding experiments similar to those conducted by Mendel, rediscover his paper and recognize its significance.

Impact:

With the help of prominent scientists, Mendel's work begins to reach a broader audience, stimulating additional work on the science of heredity.

Category: Public Health and Medicine


1903: Establishment of a New AMA Section

Background:

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

Impact:

With the help of prominent scientists, Mendel's work begins to reach a broader audience, stimulating additional work on the science of heredity.

Related Links:

American Medical Association: http://www.ama-assn.org/ama

Category: Public Health and Medicine


1904: First National Child Labor Committee

Background:

The first national child labor committee was organized in 1904 in an attempt to persuade Congress to prevent child labor though legislation. This committee was incorporated by an Act of Congress in 1907. The first state child labor committee was organized in Alabama in 1901.Jane Addams was one of the founding members of the national child labor committee and in 1907, she reported that there were over 2 million children under 16 years of age in paid employment in the U.S. She also argued that the vast amount of children working in the U.S. helped 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 future strong state and federal child labor laws that were developed to ensure the health and safety of America's youth entering the working world.

Related Links:

http://www.kapow.org/nclc.htm http://www.historyplace.com/unitedstates/childlabor/index.html

Category: Government and Policy


1907: Local Communities and School Health

Background:

The Education Act of 1907 required educational authorities to appoint school doctors and nurses, as well as the principal county school medical officer (usually the county public health officer) as responsible for running health services in the schools.

Impact:

The Education Act of 1907 established a link between the fields of health and education that continues today.

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.

Related Links:

Category: Public Health and Medicine


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 of this enclave 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 isses. This Conference also led to the development of the Children's Bureau in 1912. Today, the activities of the original Children's Bureau are divided between 2 agencies within the U.S. Department of Health and Human Services, the child welfare aspects are in the Administration for Children and Youth and the health aspects are within the Maternal and Child Health Bureau.

Related Links:

http://www.libertynet.org/edcivic/whoukids.html http://www.acf.hhs.gov/programs/cb/ http://www.mchlibrary.info/history/chbu/19074.pdf http://www.cwla.org/advocacy/whitehouseconfhistory.pdf

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 development of this Association as she planned a conference which directly resulted in the development of the American Association for the Study and Prevention of Infant Mortality.

Impact:

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

Category: Public Health and Medicine


1909: Prenatal Care

Background:

Organized prenatal care in the United States began in Boston in 1909. The Instructive District Nursing Association was responsible for developing an intensive prenatal care program for women with special health care needs. Due to the success of this program, outpatient clinics were created for prenatal care on a wide-scale basis. The Little Mothers' League was also established, in which older daughters were trained to help take care of younger children.

Impact:

Although there is a general agreement that prenatal care is beneficial and important, there is little evidence to document the effectiveness of prenatal care. However, some studies show a relationship between comprehensive prenatal care and the decrease in infant mortality in the U.S.

Category: Government and Policy


1910: The 1910s

Influenza, World War I & Building organizations: US PHS, Children's Bureau, Public Health Nursing and the National Birth Registry

Category: Milestones


1910: Sickle Cell Anemia Described

Background:

Herrick describes sickle cell anemia in a case report. Sickle cell disease is an autosomal recessive group of genetic disorders characterized by the presence of sickle hemoglobin (HbS) in red blood cells. Heterozygotic individuals are carriers; the carrier status is generally a benign, asymptomatic state. Homozygous and some compound heterozygotic individuals have clinical symptoms. Four genotypes — sickle cell anemia (HbSS), sickle-hemoglobin C disease (HbSC), and two types of sickle β-thalassemia (Sβ +-thalassemia and Sβ o-thalassemia) -- account for most sickle cell disease in the United States. Genes with mutations for sickle cell disease are common in persons of African, Mediterranean, Middle Eastern, and Indian ancestry and persons from the Caribbean and parts of Central and South America.

Impact:

Taken as a group, sickle cell diseases are the most prevalent group of disorders identified by newborn screening, with over 1500 affected infants born in the United States each year. The origin of the mutation that led to the sickle cell gene was initially thought to be in the Arabian Peninsula, spreading to Asia and Africa. Evaluation of chromosome structure indicates that there have been at least four independent mutational events, three in Africa and a fourth in either Saudi Arabia or central India. These independent events occurred between 3,000 and 6,000 generations ago, approximately 70,000-150,000 years.

Related Pinpoints:

1949: Sickle Cell Disease and Altered Hemoglobin, 1965: MCH Sickle Cell Anemia Initiative, 1972: Sickle Cell Anemia Control Act

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 United States population.

Impact:

Since the discovery of pasteurization in the mid-1800s, the concept of sterilization, disinfection, and antisepsis 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 used the schools as a place of infectious disease surveillance to identify and quarantine children with threatening conditions. School health programs provided the opportunity for proactive health intervention to educate, screen, and prevent diseases.

Category: Public Health and Medicine


1912: Public Health Nursing

Background:

The National Organization of Public Health Nursing was formed in 1912. The NOPHN nominated the ""Public Health Nurse,"" Lillian Wald, to meet with President Wilson in 1916 to voice the opinion that neutral nations should stay out of World War I.

Impact:

Nurse Wald also helped to establish the world's first public school nursing system. 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.

Related Links:

Jewish Women's Archive: http://www.jwa.org/exhibits/wov/wald/lwbio.html

Category: Government and Policy


1912: U.S. Public Health Service

Background:

The Marine Hospital Service was renamed the U.S. Public Health Service and was given greater responsibilites in the areas of health investigations and environmental sanitation. The U.S. Public Health Service Commissioned Corps was and continues to be committed to providing healthcare services to medically underserved populations.

Impact:

U.S.Public Health Service Commissioned Corps Officers have held a broad range of responsibilities 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 groups, supplying medical assistance in the aftermath of disasters.

Related Links:

U.S. Public Health Service. The Commissioned Corps: http://www.usphs.gov/

Category: Government and Policy


4/9/1912: Children's Bureau

Background:

The Children's Bureau was established under President Taft in 1912 as the result of a recommendation from the First White House Conference on 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 people...""Although Federal involvement in such issues was controversial at the time, the Bureau was created through active support of President Taft and other key individuals including Julia C. Lathrop, whom became the chief of the new bureau (for 9 years) and the first woman to be selected 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 also 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.The Children's Bureau continued to hold a leadership role in various areas of maternal and child health including education. By 1920, child hygiene bureaus had been established in 28 states, 16 of them in 1919 alone, as a result of the Children's Bureau leadership.

Related Links:

http://www.acf.hhs.gov/programs/cb/index.htm

Related Pinpoints:

1915: National Birth Registry 1921-1929: Maternity and Infancy Care Act; Sheppard Towner Act

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

Impact:

Infant Care offered advice to parents on recording births, the latest research regarding prenatal and infant care, support of breastfeeding, and medical supervision of children.During the next 50 years, a total of 45 million copies of the pamphlet were distributed as an educational resource.

Category: Government and Policy


1915: National Birth Registry

Background:

The National Birth Registry, proposed by the Children's Bureau, was established in 1915 in response to past efforts to improve data collection of vital statistics.

Impact:

Vital record keeping provided the first real evidence of the social causes of infant mortality.In the 1900s, infant vital records demonstrated the high rates of mortality in industrial cities due to unmet health and educational needs of children. Such awareness stimulated change: as social workers recognized the perpetuating cycle of poverty and ill health, poverty was fought through efforts to mobilize the community and promote good health.

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. Although the Keating-Owen Act prohibited interstate commerce of goods produced by children, the U.S. Supreme Court overturned the Act in a 1918 case because of the need for children from poor families to work.

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: whether a child was to go to school instead of work was the parent's decision. Despite the ruling, the children's rights movement continued to progress and child labor laws were enacted during the Great Depression in the 1930s.

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

Related Pinpoints:

1921-1929: Maternity and Infancy Care Act; Sheppard Towner Act

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:

Through the efforts of the AASPIM, infant mortality was drastically reduced.As AASPIM became the American Child Hygiene Association, more emphasis was placed on raising public consciousness regarding good health practices, particularly in children.

Category: Government and Policy


1918: Establishment of Schools of Public Health

Background:

From 1918 to 1923, schools of public health were established in colleges and universities in order to meet the health departments' increased need for more broadly trained personnel.

Related Links:

http://www.asph.org

Category: Public Health and Medicine


1918: Influenza Pandemic

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

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/child health and welfare.

Impact:

The recommendations from the conference gave rise to the Mother's Aid Movement and the American Association for the Study and Prevention of Infant Mortality, groups which drew attention to the improvement of child welfare.

Related Pinpoints:

1918: American Child Hygiene Association

Category: Government and Policy


1920: The 1920s

Social Reforms: Prelude to the Stock Market Crash

Category: Milestones


1920: Cities of 100,000+ Provide MCH

Background:

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

Impact:

As MCH services became established and more common, there was a gradual shift in the mind set of the American public. The idea that child health was a public responsibility became more generally accepted by the American people, although some doubts and opposition still existed.

Category: Public Health and Medicine


1921: APHA Section: Child Hygiene

Background:

The APHA established a section on Child Hygiene in 1921.

Impact:

At this time, there was an increased awareness in the role of proper hygiene in good health. The dissemination and practice of this information became increasingly important in maternal and child health. Today the MCH Section of APHA remains active in advocating for mothers, children, youth and families.

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. However, Congress did not pass a bill which would have removed prohibitions against contraceptives and allowed information about them to be widely available.

Impact:

Margaret Sanger worked diligently to assure that women would be provided information about sex, health and contraceptives. Her work would eventually spawn organizations such as the National Organization for Women and Planned Parenthood.

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 and remained in effect until 1929.

Impact:

The passage of this Act resulted in federal grants-in-aid to states for child and adult health programs. Another major result of this Act was the development of full-time units of maternal and child health services in state health departments and the first MCH training program. Although repealed in 1929, the Act set the pattern for State-Federal cooperation that would re-emerge in Title V of the Social Security Act in 1935.

Category: Government and Policy


1921: Children's Bureau

Background:

Grace Abbott replaces Julia Lathrop as Chief of Children's Bureau, taking over administration of the Sheppard-Towner Act.

Impact:

Priorities for Grace Abbott in the Children's Bureau included a seminal study on childhood rickets, neglected children, crippled children, and juvenile delinquency. Shortly before she left the Children's Bureau, Grace Abbott delivered the commencement address at the New Jersey College of Women in which she stated, ""Without apology, then, I ask you to use courageously your intelligence, your strength, and your good will toward the removal of economic barriers which have retarded the full development of children in the past. The important thing is that we should be 'on our way' toward adequately meeting their needs. Perhaps you may ask, 'Does the road lead uphill all the way?' and I must answer, 'Yes, to the very end.' But if I offer you a long hard struggle, I can also promise you great rewards. Justice for all children is the high ideal in a democracy . . . We have hardly, as yet, made more than a beginning in the realization of that great objective.

Category: Government and Policy


1922: Nursing Training Programs Supported by Sheppard Towner Act

Background:

The Sheppard-Towner Act of 1922 provided funds that states could use to improve children's health and reduce the rate of infant mortality. States soon discovered that they could do little in these areas without people who had the necessary training, so some of the funds appropriated under the act were used to provide nurses with tuition, a per diem, and 1-year sabbatical expenses while they participated in specialized training courses. Thus, the first MCH training program was born. Throughout the 1920s and 1930s the Bureau offered short courses for a variety of disciplines, including nurses, social workers, and physical therapists, obstetricians and pediatricians. In 1943 public health nutrition programs were established.

Impact:

These early investments in workforce training through the Sheppard Towner Act eventually expanded to become the MCH Training Program. Today the program invests in graduate level leadership training programs across the U.S. in areas including Nursing, Nutrition, Public Health Social Work, and interdisciplinary training programs in Public Health, Neurodevelopmental Disabilities, Adolescent Health, and Pediatric Pulmonary Centers.

Category: Government and Policy


1924: Ricketts Demonstration Grant

Background:

The Children's Bureau funds a young researcher, Dr. Martha Eliot from Yale University, to conduct a demonstration project to determine if a program could be designed and carried out which would protect every child in a poor community from rickets.

Impact:

Dr. Eliot's successful three-year demonstration in New Haven showed that rickets could be prevented in a community and was a model of a community health center approach to meeting child health needs.

Related Links:

http://www.mchb.hrsa.gov/training/

Related Pinpoints:

1947: MCH Departments Established in Schools of Public Health

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

Related Links:

http://www.nlm.nih.gov/hmd/pdf/celebration.pdf

Category: Public Health and Medicine


1928: Child Health Day

Background:

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

Impact:

Through the national declaration of a day designated to address child health needs and through media attention, the National Child Health Day called for communities, agencies and organizations to unite and disperse information concerning children and their health needs. The National Child Health Day continues to address a wide variety of concerns and issues each year.

Category: Government and Policy


1929: Maternity and Infancy Care Act; Sheppard Towner Act Repealed

Background:

The Sheppard-Towner Act was repealed in 1929 amid concerns about socialism.

Impact:

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.

Category: Government and Policy


1929: Stock Market Crash

Commonly referred to as ""Black Tuesday,"" on October 29, 1929 the US stock market crashed sending America into the devastating economic tailspin known as the Great Depression. Throughout the Great Depression unemployment rates soared, families lost their homes and went without food or proper nutrition, birth rates declined and America slumped into a time of lost hope and economic turmoil.

Category: Milestones


1930: The 1930s

The Great Depression and the 1935 Social Security Act (Title V)

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. This 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 was being done, to recommend what ought to be done and how to do it."" Its major focus was on child development.

Impact:

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

Related Links:

http://jdr.iadrjournals.org/cgi/reprint/11/2/237 http://www.sciencenews.org/articles/20001202/timeline.asp http://www.cwla.org/advocacy/whitehouseconfhistory.pdf

Category: Government and Policy


1930: Prevention of Rickets Milk Fortification

Background:

By the 1930s, it had been known for a number of years that rickets was caused by a deficiency of vitamin D. In fact, by this time, cod liver oil (a good source of vitamin D) was used to prevent rickets, however it was not until a little later in the 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.

Category: Public Health and Medicine


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 Roosevelt. Secretary of Labor Frances Perkins enrolled Katharine Lenroot, then Children's Bureau Chief, to work with her to assure 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 also 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. Title V was not an entitlement program like other sections of the Social Security legislation. It consisted of 4 parts:1) Maternal and Child Health Services,2) Services for Crippled Children,3) Child-Welfare Services, and4) Vocational Rehabilitation.Title V is the longest-standing public health legislation in American history and continues to work to improve the health of women and children.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 also reflected in a name change to Aid to Families of Dependent Children (AFDC).

Related Links:

Social Security Online

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 in newborns. Hemorrhagic disease is a potentially life-threatening bleeding problem for 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 was given an injection of vitamin K after delivery to prevent this disease.

Category: Public Health and Medicine


1938: General Use of Sulfonamides

Background:

Sulfonamides were discovered by Gerhand Domagk in 1932. They were the first effective drugs against bacterial infections. Interestingly, Domagk found that one sulfonamide, Prontosil, was effective against streptococcus in mice and when his daughter became ill with a streptococcus infection, he treated her with the drug and it 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. Besides being revolutionary at the time in terms of curing bacterial infections, Domagk's work with sulfonamides 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 like Chapples' and improvements in premature nurseries were credited for reduction in infant mortality rates. This particular incubator was shown as novelty by Dr. William Silverman at Chicago World's Fair 1933-1934.

Related Links:

Neonatology On the Web - An Incubator for Infants

Category: Public Health and Medicine


1938: Initiation of the March of Dimes

Background:

President Roosevelt established the National Foundation for Infantile Paralysis (now known as the March of Dimes Birth Defects Foundation) in 1938 as a result of the toll polio was taking on America's youth.

Impact:

Through research, the March of Dimes defeated polio. Today, the March of Dimes works to improve the lives of children through the prevention of birth defects, prematurity, and infant mortality. In addition, the March of Dimes has a chapter within each state in the U.S.

Related Links:

March of Dimes

Category: Government and Policy


1939: World War II

The Second World War (WWII) was a worldwide conflict that resulted in more than 500,000 casualties among U.S. soldiers alone. The scientific advancements during WWII had convinced Americans that science could mobilize and produce a successful war on anything. During World War II, demographic changes (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


1939: Food Stamp Program

Background:

The first food stamp program was created in 1939 to provide food to those who were unemployed and to use food available due to food surpluses. The program lasted nearly 4 years until 1943. This first program was created during President Franklin Roosevelt's term, primarily in response to the Depression. The program permitted people on relief to buy orange stamps that equaled their typical food spending and then for each $1 of orange stamps purchased they would receive 50 cents in blue stamps. Orange stamps could be used to purchase any food and blue stamps were restricted to food that was determined to be in surplus.

Impact:

From 1939-1943, 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 that still exists today.

Related Links:

Food Stamp Program

Category: Government and Policy


The 1940s

The United States experienced significant advances in medicine and public health during these years and technical developments in the health field grew at a rapid pace.

Antibiotics, known as the ""miracle drugs,"" provided enormous benefits to adults and children. Penicillin, streptomycin, and tetracycline discovered during this period reduced child morbidity and mortality caused by pneumonia, meningitis, dysentery, and other bacterial infections.

Sir Alexander Fleming, Ernest B. Chain, and Sir Howard Florey were awarded the Nobel Prize in Medicine in 1945 ""for the discovery of penicillin and it's curative effects in various infectious diseases""

Decades of a gradual increasing trust in science, added to the advancements of WWII, had convinced Americans that science could mobilize and produce a successful war on anything. Penicillin, DDT, and the atomic bomb all testified to the power and implications of science.

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 eventually resulted in the child advocacy laws of the 1970s.

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 lower pay grades.Medical, nursing, and hospital services for the prenatal period as well as delivery and six weeks of postpartum care were provided for these families 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 it was closely identified with the war effort.

Related Links:

https://mchdata.hrsa.gov/tvisreports/LearnMore/TitleVHistory.aspx

Category: Government and Policy


1946: Children's Bureau placed in Federal Security Agency

Background:

By 1945, the Department of Labor was in a seriously weakened state. Of the four bureaus that constituted the Dept. of Labor 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 the Department of Labor.

Impact:

By the late 1940s and early 1950s, the Department of Labor's reorganization had allowed them to gain control over the major labor functions of the federal government and improve the efficiency of the agency.

Related Links:

Related Pinpoints:

1921: Children's Bureau

Category: Government and Policy


1946: The National School Lunch Act

Background:

The National School Lunch Act, signed by President Harry S. Truman, was passed as a measure to ""secure the well-being and health of children as well as to encourage consumption of local 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 and the Child and Adult Care Food Program. Through its programs, it provides federal subsidies for every school lunch served, particularly for meals served to low-income children who meet income criteria set by the law. Moreover, federal payment and a set value of commodity assistance is required for meals/snacks served to children, elderly, and disabled persons in care facilities under this program. The National School Lunch Act also supports other activities which include meal supplements for children in after-school care, homeless children nutrition programs, and meal service for Department of Defense overseas dependents' schools.

Related Links:

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:

Facilities receiving the Hill-Burton funding had to comply to several requirements that impacted the funding of healthcare:Hospitals were not allowed to discriminate based on race, color, national origin, or creedFacilities with funding 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 payFederal funding was provided to hospitals where state municipalities were willing to match grants/loans for building renovationsParticipation in Medicare and Medicaid were also later added to the list of requirements for Hill-Burton fundingIn 1975, the Act was amended and became Title XVI of the Public Health Service Act.

Related Links:

http://en.wikipedia.org/wiki/Hill-Burton_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.

Impact:

Since its inception in 1912, the Children's Bureau had been active in international children's work. Thus, it was invited to help lay the foundation for the social programs of the United Nations, World Health Organization, and for postwar activities of the International Labor Organization. Dr. Martha May Eliot, associate director of the Children's Bureau, visited European countries to determine what kind of help was most needed.

Category: Government and Policy


1946: Center for Disease Control established

Background:

The Centers for Disease Control and Prevention (CDC), a government agency which grew out of Malaria Control Initiatives of World War II, was founded as the Communicable Disease Center on July 1, 1946 in Atlanta Georgia. Later in 1970, the Communicable Disease Center became known as the Center for Disease Control (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 promoting good quality of life through the prevention and control of disease, injury, and disability in America and throughout the world.

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, and Johns Hopkins University -- received grants from the Children's Bureau to establish MCH departments within their schools of public health. These departments' primary goal was to train administrators with a public health and child/family focus for the new programs being developed in the 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 leadership training programs across the U.S. in areas including Nursing, Nutrition, Public Health Social Work, and interdisciplinary training programs in Public Health, Neurodevelopmental Disabilities, Adolescent Health, and Pediatric Pulmonary Centers.

Related Links:

http://www.mchb.hrsa.gov/training/

Category: Government and Policy


1949: Formation of United Cerebral Palsy

Background:

The National Foundation for Cerebral Palsy was formed as a result of recruiting 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 of the organization was changed to United Cerebral Palsy as affiliates were formed across the nation.Leonard Goldenson was the founder of UCP. Leonard and Isabelle Goldenson helped to establish the National Institute of Neurological Diseases and Stroke, part of the National Institutes of Health.

Impact:

The United Cerebral Palsy is one of the largest health charities in America and has become a major advocate for the rights of persons with any disability.

Related Links:

http://ucp.org/

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. Later in 1952, she designed the first standardized method, known as the Apgar Score, of evaluating a newborn's transition to life outside the womb.

Impact:

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

Related Links:

https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_12.html

Category: Public Health and Medicine


1949: Sickle Cell Disease and Altered Hemoglobin

Background:

The association of sickle-cell disease with an alteration of hemoglobin is published by Linus Pauling and coworkers.

Impact:

This was the first time a genetic disease was linked to an alteration of a specific protein (hemoglobin) and was a milestone in the history of molecular biology.

Category: Public Health and Medicine


The 1950s

In spite of the medical and technological advancements during the 1940s, the 1950s were years of stagnation for child health. Infant mortality ceased to decline and the maternal mortality rates remained high for certain subgroups. An increasing number of new mothers chose to bottle feed their infants. Additionally, large numbers of children in low-income families received no medical or dental care.

Category: Milestones


1950: National Association for Retarded Children

Background:

As a result of the Mid-century White House Conference, the National Association of Parents and Friends of Mentally Retarded Children was formed.

Impact:

The National Association of Parents and Friends of Mentally Retarded Children began as a grass roots movement and now has over 140,000 members. At the time of it's formation there was little support or assistance available for mentally retarded children, adults or their families. The National Association of Parents and Friends of Mentally Retarded Children has continued to grow, support and educate people with mental retardation and their families. Today the organization is called The Arc of the United States and is devoted to promoting and improving supports and services for people with mental retardation and related developmental disabilities and their families.

Related Links:

http://www.thearc.org

Category: Public Health and Medicine


1950: Mid-Century White House Conference

Background:

The Mid-Century White House Conference, with the theme of ""the total well-being of children,"" focused on the mental and emotional development of children. Issues regarding the needs of retarded children were also considered throughout the conference. In addition, the conference addressed the problems of 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 versus The Board of Education. (see 1954, Brown v. The Board of Education)

Impact:

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

Related Links:

http://www.presidency.ucsb.edu/ws/index.php?pid=13677 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525921 http://www.cwla.org/advocacy/whitehouseconfhistory.pdf

Category: Government and Policy


1951: Martha May Eliot Becomes Bureau Chief

Background:

Martha May Eliot, a pediatrician, was instrumental in many postwar programs for maternal and child health. In 1951, she became Bureau Chief of the National Children's Bureau Division of Child and Maternal Health.

Related Links:

http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_99.html http://www.cdc.gov/MMWR/preview/mmwrhtml/mm4838a2bx1.htm

Related Pinpoints:

1924: Ricketts Demonstration Grant 1946: UNICEF established

Category: Government and Policy


1951: American College of Obstetricians and Gynecologists (ACOG)

Background:

In 1951 American College of Obstetricians and Gynecologists (ACOG) was founded in Chicago, Illinois.

Impact:

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

Related Links:

http://www.acog.com/from_home/acoginfo.cfm

Category: Public Health and Medicine


1952: DNA Identified as the Genetic Material

Background:

Before this important work by Oswald Avery, Colin MacLeod, and Maclyn MaCarty, many scientists believed that only protein was capable of enough variation to serve as the chemical carrier of heredity. Avery and his colleagues, experimenting on pneumococcus, demonstrate that DNA, not protein, carries the genetic message. In 1952, A. Hersey and M. Chase confirm this conclusion through a series of investigations using viruses.

Impact:

This work establishes DNA as the molecule of heredity -- the carrier of biological information and the mechanism for the transmission of variation -- and leads directly to the discovery of the structure of DNA and to the explosion of research in molecular biology.

Category: Public Health and Medicine


1953: Department of HEW

Background:

The Federal Security Agency became known as the Department of Health, Education and Welfare (HEW) in 1953, under the leadership of President Dwight Eisenhower.

Impact:

Related Links:

http://www.dwightdeisenhower.com/president.html

Category: Government and Policy


1953: The Structure of DNA

Background:

Research by Rosalind Franklin, Francis Crick, James Watson and Maurice Wilkins leads to the conclusion that the structure of the DNA molecule is a double helix composed of nucleotide bases pairing in two parallel strands. The four bases are: adenine (A), guanine (G), cytosine (C), and thymine (T);Aalways pairs withTandCalways pairs withG.

Impact:

A new understanding of heredity and hereditary disease was possible once it was determined that DNA consists of double helixes, of alternating phosphate and sugar groups and that the two chains are held together by hydrogen bonds between pairs of organic bases.

Category: Public Health and Medicine


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, an inactivated vaccine was developed by Dr. Jonas Salk. Two years later, Dr. Albert Sabin perfected a live attenuated vaccine.

Impact:

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

Category: Public Health and Medicine


1957: MCH-MR Demonstration Clinical Programs

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 mental retardation. The response was so prompt and organized, that new diagnostic, consultative, and educational clinics rapidly were established nationwide.

Impact:

The demonstration clinical programs raised awareness and quickly began to provide support, services and education to communities, families and individuals affected by mental retardation. Previously there had been little state or federal support.

Category: Government and Policy


1958: Full Time Working Mothers

Background:

By 1958, women were entering the job market in greater numbers than ever before. It was estimated that 4,037,000 children under age 12 lived in families in which 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 WWII the workforce so quickly opened up to women that there was little time for provisions for children to be made. Women began building careers, out of necessity or want, and driving rapid social change in the US.

Category: Public Health and Medicine


1958: Special Projects for Children with Mental Retardation

Background:

By 1958 special programs for children with mental retardation existed in 44 states.

Impact:

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

Category: Government and Policy


1955: The Vietnam War

The Vietnam War was a conflict where the Democratic Republic of Vietnam (North Vietnam) and its allies fought against the Republic of Vietnam (South Vietnam) and its allies. North Vietnam's allies included the Soviet Union and the People's Republic of China. South Vietnam's allies included the United States, Australia, New Zealand and South Korea. US troops were first killed in Vietnam in 1959 and the US remained in Vietnam until 1973. The Vietnam War was one of the most controversial conflicts in US history.

Category: Milestones


The 1960s

The 1960s were a time of unprecedented program and policy development in the MCH field. President Kennedy initiated programs for those with mental retardation. The Civil Rights Act prohibited discrimination on the grounds of race, color or national origin and transformed American society. 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, Children and Youth Projects, Medicaid, NICHD, and MCH Research all had their roots in the 1960s.

Category: Milestones


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


1960: White House Conference on Children & Youth

Background:

The 1960 White House Conference on Children and Youth was called by President Eisenhower who held office from 1953-1961. The conference was named the golden anniversary because it celebrated the 50th anniversary of the first, which was called 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 in poverty.

Impact:

The Golden Anniversary White House Conference on Children and Youth in 1960 addressed a myriad of problems facing children and youth considered within a context of deprivation, poverty, civil rights abuses, and racial discrimination, including:i) Drug abuse,ii) Inadequate opportunities for employment,iii) Concern for the environment,iv) Increased incidence of venereal disease, andv) The growing number of illegitimate births.The conference resulted in suggested programs and specific recommendations children and youth. Although issues of health were not addressed specifically in this conference, an urgent concern was expressed for the improvement of health services for mothers and children.

Related Pinpoints:

Category: Government and Policy


1960: Phenylketonuria (PKU) Detection

Background:

A widespread interest in metabolic disorders contributed to new mass case finding techniques for early detection of infants with phenylketonuria (PKU). If PKU is not detected and is left untreated in infancy, it can cause mental retardation and developmental disabilities for children. Although PKU was discovered in the early 1900s, a PKU screening test was not developed until later and it wasn't until the 1960s that the test became routinely administered to infants. Eventually the PKU test became the nation's first newborn screening test.

Impact:

The understanding of PKU and the development of a large-scale screening test has advanced modern medicine in that due to screening and early treatment efforts, mental retardation was prevented. This understanding of PKU also led to the development and support of cytogenetic and biochemical laboratories in 21 special projects. Follow-up of PKU patients who later became pregnant (and again required dietary changes) became a challenge for MCH public health agencies in future years.

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. Margaret Sanger founded the women's birth control movement and opened the first birth control clinic in the U.S.

Impact:

The approval and later widespread use of the birth control pill in the U.S. was revolutionary in that 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 and today it is the most popular non-surgical method of contraception in the U.S., used by 10.7 million American women.

Related Links:

http://www.pbs.org/wgbh/amex/pill/sfeature/sf_attitudes.html http://www.pbs.org/wgbh/amex/pill/sfeature/sf_history.html

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 Federal Children's Bureau, developed a test that was a relatively simple and inexpensive blood test to screen newborns for phenylketonuria (PKU). The test became known as the ""Guthrie Test"" and its methodology, including the later use of dried blood spots on pieces of filter paper, became widely used to screen newborns for many other conditions.

Impact:

Eventually the PKU test became the nation's first universal newborn screening test. Follow-up of PKU patients who later became pregnant (and again required dietary changes) became a challenge for MCH public health agencies in future years. NBS for PKU allows for the early treatment of the condition and the prevention of its harmful effects, such as severe mental retardation. NBS now occurs in virtually every developed country in the world. The Maternal and Child Health (MCH) Program has been actively involved in the evolution of newborn screening (NBS) from its very beginnings; MCH played a pivotal role in developing the PKU-NBS blood test and it has assisted states in developing statewide NBS programs.

Related Links:

http://www.pkuworldlink.org/history.html http://www.nlm.nih.gov/medlineplus/phenylketonuria.html

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, development of research and programs for mentally retarded, 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 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.

Related Pinpoints:

1963: Title V Appropriation for Research

Category: Government and Policy


1962: Child Abuse

Background:

In 1962, Henry Kempe describes the term ""Battered Child Syndrome"" in an article which describes a child that has been severely physically abused. This description marks the beginning of the recognition of child abuse in the U.S.

Impact:

This first description of child abuse by Kempe jump started the national 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.

Related Links:

http://www.fortunecity.com/meltingpot/macau/1192/id49.htm

Related Pinpoints:

1874: Society for the Prevention of Cruelty to Children established

Category: Public Health and Medicine


1962: NICHD Established

Background:

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

Impact:

The mission of the 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, free from disease or disability, and to ensure the health, productivity, independence, and well-being of all people through optimal rehabilitation."" The NICHD conducts and supports research with goals that fit their mission and sponsors training programs for doctors, researchers, and scientists.

Related Links:

http://www.nichd.nih.gov/default.htm

Category: Government and Policy


1963: Maternity & Infant Care Projects

Background:

Efforts to prevent mental retardation and to reduce infant mortality in low income areas led to the creation of Maternity and Infant Care (MIC) projects. These MIC projects were funded by the U.S. Children's Bureau and took a multidisciplinary approach to increasing access to prenatal care in the hopes to prevent infant mortality.

Impact:

These programs were designed as multidisciplinary models combining medical, dental, nursing, social work, and nutrition services. Before prenatal care was utilized routinely, some of these projects would send teams of professionals out to bring poor women in for what was the first prenatal care. These MIC projects developed programs for prenatal care, family planning, and baby-care, that later become models of care for the U.S.

Category: Government and Policy


1963: Measles Vaccine Licensed

Background:

The measles vaccine was licensed on March 21, 1963. Before 1963, it was commonplace to get the measles and each year 3 to 4 million Americans would get the measles and 450 people would die from the disease.

Impact:

Because of the extensive use of this vaccine, the number of reported cases of measles in the U.S. decreased from about 482,000 in 1962 to 22,000 in 1968. The number of cases rose again in 1971 to over 75,000. The only measles cases found in the U.S. today are brought in from outside of the U.S. and thanks to the vaccine, measles is no longer an epidemic in the U.S.

Related Links:

http://www.cdc.gov/nip/vaccine/vacc-timeline-poster.pdf

Category: Public Health and Medicine


1963: Title V Appropriation for Research

Background:

This public law authorized a new Title V program for projects essential to the research and evaluation of issues concerning the care and treatment of the mentally retarded. Recommendations from the Panel on Mental Retardation, appointed by President Kennedy, were the foundation for Public Law 88-156. Public Law 88-156 was signed by President Kennedy just 29 days before his assassination.

Impact:

These projects were dedicated to the health of the mentally retarted and aimed to combat and prevent mental retardation. The appropriation of funds to combat mental retardation made these aims a priority area for the nation.

Related Links:

https://mchdata.hrsa.gov/tvisreports/LearnMore/TitleVHistory.aspx

Category: Government and Policy


1964: The Civil Rights Act

The passage of the Civil Rights Act of 1964 was preceded by heated and controversial debates. The Civil Rights Act was the culmination of decades of work by individuals who believed everyone should have equality under the law.

The Act prohibited discrimination on the grounds of race, color, or national origin in public places and by employers and unions. This Act was a landmark legislation that transformed American society.

Category: Milestones


1964: School Lunch Act

Background:

The National School Lunch Act was passed in 1964 as a measure to ""secure the well-being and health of children as well as to encourage consumption of local food.""

Impact:

This Act provided states with funding for school lunch programs based on per capita income. In addition, this Act provided (and still provides) a low-cost or free nutritionally balanced lunch to children in school each day. In 1972, an amendment to the National School Lunch Act reemphasized that all schools with these programs provide free food, or at least provide reduced-priced lunches to all needy children.

Related Links:

http://www.fns.usda.gov/cnd/lunch/

Category: Government and Policy


1964: Head Start Developed

Background:

In 1964, a panel of child development experts were asked by the government to develop a program to help disadvantaged preschool children. The report that was disseminated from this panel was the blueprint for Head Start. In 1965, project Head Start, began as a summer program that was 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 poverty areas with significant attention devoted to learning, social development, and health care for economically disadvantaged preschool children.

Impact:

Recruiting children from age three to school entry age, Head Start was enthusiastically received by education, child development specialists, community leaders, and parents across the Nation. 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. In 1972, Congress mandated that at least 10 percent of the children enrolled in Head Start must be handicapped children.

Related Pinpoints:

1965: Children & Youth Projects

Category: Government and Policy


1964: Economic Opportunity Act

Background:

The Economic Opportunity Act (EOA) was passed in 1964 and acted as the main thrust of Lyndon B. Johnson's ""War on Poverty"". In an effect to eradicate poverty, the EOA provided job training, adult education, and loans to small businesses.

Impact:

The EOA developed over 1,000 community action agencies at that worked at the local level. Community action agencies varied from non-profits, to big-city agencies, to community groups. In addition, these agencies provided family centered health care to many communities.

Category: Government and Policy


1965: Neighborhood Health Centers Developed

Background:

Comprehensive Neighborhood Health Centers were created as part of the Partnership for Health Act and under the Office of Economic Opportunity. In 1965, the Office of Economic Opportunity established and supported eight neighborhood health centers to provide comprehensive health services to low-income individuals. The intent of these centers was to provide family-focused community health care.

Impact:

In 1971, the program was transferred to the Public Health Service and was renamed the Community Health Centers Program. Over time, the numbers of community or neighborhood health centers grew significantly.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 CentersHealth Care for the HomelessPublic Housing Primary Care ProgramFederally Qualified Health Centers -- FQHC's, or ""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. (NOTE:For more information on this topic select MCH Systems of Care from the ""In Depth"" pulldown menu at the top of this page)

Related Links:

http://kff.org/about-kaiser-commission-on-medicaid-and-the-uninsured/

Category: Government and Policy


1965: Children & Youth Projects

Background:

The 1965 amendments (P.L. Law 89-97) amended Title V of the Social Security Act by providing comprehensive health care for children and youth, the so-called Children and Youth or ""C&Y Projects"". There was a growing realization that comprehensive care was needed for children and youth, particularly in low-income areas. A primary directive was to make these services accessible, available and appropriate to the identified low-income neighborhoods

Impact:

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 persons over age 65 and Medicaid (Title XIX) was established to provide health insurance coverage to low income women and children (also, aged, blind and disabled). Both programs were signed into law by President Lyndon B. Johnson on July 30, 1965 as amendments to the social security legislation.

Impact:

The establishment of Medicare and Medicaid was monumental in that it led to the provision of health care to the majority of Americans over 65 years of age and has expanded health services to low income children, their caretakers, and the disabled. In addition, Medicare and Medicaid led to subsequent government policies that have increased health services to the public.

Related Links:

Category: Government and Policy


1965: MCH Sickle Cell Anemia Initiative

Background:

The Children's Bureau develops and disseminates two education 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 this important but largely neglected genetic disorder. The Children's Bureau's educational initiative gave a clear signal at the national level that sickle cell disease is an important disorder and requires attention. This federally-supported educational effort helped usher in an increasing awareness and acknowledgement of sickle cell disease among government officials, health care professionals, and the lay public. In 1971, President Nixon, in a presidential message to Congress, targeted sickle cell disease as a neglected disease.

Related Links: Related Pinpoints:

Category: Government and Policy


1966: Migrant Health Program

Background:

The Migrant Health Program was established in 1965 to provide prenatal and infant care services to migrants, seasonal farm workers and their families. In 1966, the first Migrant Programs were launched. These programs supported migrant health services including health and dental care, transportation, pharmaceuticals, occupational health and safety, and a variety of pediatric services.

Impact:

The Migrant Health Program provides funding to 134 organizations that support over 400 migrant health clinics in the United States and Puerto Rico. In 2004, these health clinics served over 675,000 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.

Category: Government and Policy


1966: Highway & Motor Vehicle Safety Acts

Background:

The Highway Safety Act and the National Traffic and Motor Vehicle Safety Acts were signed by Lyndon B. Johnson 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 the use of better line stripes and reflectors, increased use of lighting, guardrails, and better signage and poles. By 1970, motor-vehicle-related death rates were decreasing.

Category: Government and Policy


1966: Child Nutrition Act

Background:

The Child Nutrition Act was signed by President Lyndon B. Johnson on October 11, 1966 and was created in part due to the success of the National School Lunch Act signed by President Truman in 1946. The intent of the Child Nutrition Act was to ensure that children were provided with adequate food in order to promote better development and learning.

Impact:

The the Special Supplemental Food Program for Women, Infants and Children (WIC) was created in 1972 as an amendment to the Children's Nutrition Act of 1966. WIC provided nutritious food and nutrition education to eligible pregnant and nursing women and to children under five years of age.

Related Links: Related Pinpoints:

Category: Government and Policy


1967: Special Infant, Family Planning & Dental Projects

"
Background:

The Title V authorization of 1967 created three new clinical project grants: (a) infant care (neonatal intensive care)(b) family planning(c) 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:

A reorganization of the Department of Health, Education and Welfare (HEW) was instituted by administrative order. In addition, two years later in 1969, the Children's Bureau was disbanded.

Impact:

The health and welfare components of the Children's Bureau were separated, with some of the responsibilities of the Children's Bureau distributed among other agencies. In addition, the service funding was switched from the Bureau of Family Services to the Social and Rehabilitation Services. Duties that had 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.

Related Links:

https://www.ssa.gov/history/childb1.html

Category: Government and Policy


1967: Medicaid & EPSDT

Background:

The Medicaid statute (Title XIX) was amended in 1967 under President Lyndon Johnson to create the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program for needy children. 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 indigent children through the provision of periodic physical and developmental examinations. The program also provided funds for the treatment of illnesses and other health conditions. Only infants, children, or adolescents who are enrolled in Medicaid are eligible for EPSDT services.

Impact:

Although the Medicaid statue was amended in 1967 to include EPSDT, it was not until 1972 that the regulations for EPSDT were published. Some have called EPSDT child care program the most comprehensive program the government has legislated. Evaluation studies of EPSDT have shown mixed results. Some studies show that participation decreased referrals for specialized care over time and other studies demonstrated that EPSDT programs have not achieved their goals.

Related Links:

http://www.hrsa.gov/epsdt/default.htm

Category: Government and Policy


1968: Expansion of Lunch & Nutrition Act

Background:

In 1968, Congress expanded the School Lunch and Child Nutrition Act.

Impact:

A program was created to provide food for school-age children during the summer. Additionally, a year-round program was initiated to provide food to low-income children, as well as children in day-care centers and Head Start programs.

Related Links:

http://www.fns.usda.gov/cnd/lunch/ http://thomas.loc.gov/cgi-bin/cpquery/?&dbname=cp105&sid=cp105ZbqIY&refer=&r_n=hr633.105&item=&sel=TOC_54682&

Category: Government and Policy


1969: Conference on Food, Nutrition, & Health

"
Background:

In 1969, President Nixon convened a White House Conference on Food, Nutrition, and Health.

Impact:

The White House Conference on Food, Nutrition, and Health brought the importance of nutrition in maintaining a healthy nation to the forefront. Many landmark policies were developed from this conference, including further development of the food stamp program, the school lunch program, and food labeling. In addition, after this Conference, the Secretary of Agriculture established the Food and Nutrition Service in order to administer the federal food assistance programs.

Related Links:

http://www.nns.nih.gov/1969/conference.htm http://www.fns.usda.gov/cnd/lunch/ http://www.cfsan.fda.gov/label.html

Category: Government and Policy


1969: Rubella Vaccine Licensed

Background:

The rubella vaccine was licensed in June, 1969 and there were 57,600 reported cases of rubella that year. Rubella is a virus that is usually spread through mucus droplets expelled by coughing or sneezing into the environment.

Impact:

From 1963-1964, there was a rubella outbreak in the U.S. where 12 million people developed rubella and because some of those were pregnant women, 20,000 babies were born with serious disabilities and 11,000 fetuses died. After the rubella vaccine was licensed in 1969, the numbers of rubella cases fell dramatically. Today there are under 1,000 reported cases of rubella per year in the United States. Typically the rubella vaccine is administered together with vaccines for measles and mumps, however it may be administered alone as well.

Category: Public Health and Medicine


The 1970s

In the 21st century, historians have increasingly portrayed the 1970s as a ""pivot of change"" in world history focusing especially on the economic upheavals.[1] In the Western world, social progressive values that began in the 1960s, such as increasing political awareness and economic liberty of women, continued to grow.

Category: Milestones


1970: White House Conference on Children and Youth

Background:

The 1970 White House Conference focused on proposals for a national health care program for mothers and children. Part of the conference's agenda gave specific attention to the disadvantages of health and development suffered by minority and handicapped children.

Impact:

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

Related Pinpoints:

Category: Government and Policy


1970: Developmental Disabilities Service Act

Background:

The Developmental Disabilities Service Act, passed in 1970, created Developmental Disabilities Councils in each state that were to fulfill planning and advisory roles for generating new state plans. The goals of each of the state councils were to ""enable [disabled] individuals to achieve independence, productivity, integration and inclusion"" into society.

Impact:

The Developmental Disabilities (DD) legislation initiated a multifaceted mandate to organize services for individuals with developmental disabilities.By 1978, developmental disabilities were functionally defined and state DD Councils (which included individuals with disabilities and representatives of state & social service agencies like Title V and the Dept. of Education) developed a comprehensive state plan identifying the needs of the disabled population.

Related Links:

http://www.acf.hhs.gov/programs/add/states/ddcs.html http://www.acf.hhs.gov/programs/add/index.html

Category: Government and Policy


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 proved to be an important aspect of ensuring positive birth outcomes and a healthy start for infants. Publicly supported family planning services help women avoid unintended pregnancies.

Related Links:

http://opa.osophs.dhhs.gov/titlex/ofp.html http://opa.osophs.dhhs.gov/titlex/xstatut.txt

Category: Government and Policy


1972: Head Start to Serve Handicapped Children

Background:

In 1972, Congress mandated that at least 10 percent of the children enrolled in Head Start must be handicapped children.An amendment to the National School Lunch Act also reemphasized that all schools withthese programswere to provide free food, or reduced-priced lunches, to all needy children.

Impact:

Congressional mandates as such demonstrated the growing concerns and government attention towards providing resources for children with special needs.

Related Pinpoints:

1964: School Lunch Act

Category: Government and Policy


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

Background:

The Special Supplemental Food Program for WIC was created in 1972 as an amendment to the Children's 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 considered at nutritional risk.

Impact:

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

Related Links:

http://www.fns.usda.gov/wic/ http://www.cbpp.org/pubs/fa.htm

Related Pinpoints:

1966: Child Nutrition Act

Category: Government and Policy


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

Background:

Congress authorizes the National Sickle Cell Anemia Control Act of 1972. Despite its high prevalence, sickle cell disease received little attention in public health programs before the 1970's. This Act was the first Federal legislation concerned with a genetic disorder. Its purpose was to establish a nationwide program for the diagnosis and treatment of, counseling for, and research in sickle cell disease. Although responsibility for implementing the Act was delegated to the National Institutes of Health (NIH) using previously authorized funds, NIH transferred its monies to the Maternal and Child Health Program to develop community-based sickle cell education, screening, testing, and counseling programs.

Impact:

This funding resulted in: (1) development of 23 comprehensive sickle cell centers in 1978 (which were reduced to 10 federally funded study centers by 1986); and (2) establishment of screening and education clinics in 40 States and the District of Columbia by 1981.

Related Links: Related Pinpoints:

Category: Government and Policy


1973: Roe vs. Wade Supreme Court Case

After much deliberation, the United States Supreme Court decision in 1973 established that laws prohibiting abortion violated one's constitutional right to privacy and abortion was legalized. Roe vs. Wade was arguably one of the most controversial cases during its time and continues today. The debate continued as to whether terminating a pregnancy should be legal and whether it could be deemed illegal without compromising women's rights and personal freedom. The continuing discussion and national divide among ""pro-choice"" and ""pro-life"" supporters has inspired grassroots activism. The Supreme Court decision of Roe vs. Wade has thus become a milestone case in reshaping national politics in confronting the role of personal beliefs in Constitutionally interpreting the law. Also see: Case Law

Category: Milestones


1973: Screening for Sickle Cell Disease

Background:

Garrick et al report an electrophoresis technique for hemoglobin screening using filter paper blood spots. Taken as a group, sickle cell diseases are the most prevalent group of disorders identified by newborn screening, with over 1500 affected infants born in the United States each year.

Impact:

This electrophoresis technique opened the way for testing for hemoglobinopathies in newborn screening programs. Despite the success of these programs, sickle cell disease newborn screening 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.

Related Links:

Related Pinpoints:

1910: Sickle Cell Anemia Described, 1965: MCH Sickle Cell Anemia Initiative

Category: Public Health and Medicine


1973: Health Maintenance Organization Act

Background:

In the early 1970s, HMOs 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 those standards, an HMOhad to provide a comprehensive set of medical services for a prepaid fee or with minimal co-payments,could not deny coverage to people with preexisting illnesses,and 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, enacted under the Nixon administration, 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.

Related Links:

http://www.harp.org/hmoa1973.htm

Category: Government and Policy


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

Related Links:

Category: Government and Policy


1974: Food Stamp Nationwide Program

Background:

The Food Stamp Program (FSP), a government initiative, was established nationwide to improve the nutrition of low-income individuals and families, which generally included households with incomes below 135% of poverty. 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 was reduced and participation increased.

Related Links:

http://www.fns.usda.gov/snap/Default.htm

Category: Government and Policy


1974: Child Abuse Prevention and Treatment Act

Background:

Henry Kempe's publication of ""The Battered Child Syndrome"" in 1962 prompted national attention on the protection of abused children. By 1967, all states had child abuse reporting laws. But additionally 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 respondin 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 of identifying and managing child abuse cases, individual states continued to apply their own definitions of maltreatment and procedures of investigation.

Related Links:

Related Pinpoints:

1874: Society for the Prevention of Cruelty to Children established, 1962: Child Abuse

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 the 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 handicapped children and youth. As a result of this legislation, new collaborations were formed among teachers and healthcare professionals to better serve the interests of children with disabilities.

Category: Government and Policy


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

Background:

The Hemophilia Treatment Centers Act of 1975 authorizes 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 A, B and C. Von Willibrand disease (vWd) is another genetic bleeding disorder. Individuals with vWd are 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 - thereby improving health outcomes for people with hemophilia in the U.S. Over the years, more than 130 comprehensive hemophilia diagnostic and treatment centers have served about 80% of the nation's hemophilia patients and their families - with improved survival and reduced disability among affected individuals.

Related Links:

http://www.nlm.nih.gov/medlineplus/hemophilia.html

Related Pinpoints:

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

Category: Government and Policy


1975: The Public Health Service Act Establishing the Comprehensive Hemophilia Diagnostic and Treatment Center Program

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). HTCs were to provide 1) access to outpatient comprehensive diagnosis and treatment services, including vocational and social counseling; 2) programs for the training of 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, the HTCs provide comprehensive diagnosis, treatment, education, outreach, outcomes surveillance, research, and low cost pharmacy services to persons with hemophilia and related inherited bleeding disorders throughout the US and its territories.

Related Links:

http://history.nih.gov/research/downloads/PL94-63.pdf http://www.cdc.gov/Features/ComprehensiveCare/

Category: Public Health and Medicine


1976: The Supplemental Security Income (SSI) 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 a children with special health care needs. Through the program, the child was referred to the state's Title V agency and was ensured Medicaid services as well as benefits of 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 one that previously identified children with disabilities as a disease/condition to a focus on an individual child's special needs.

Related Links:

http://www.socialsecurity.gov/ssi/index.htm http://www.ssa.gov/pubs/10026.html

Category: Government and Policy


1976: Improved Pregnancy Outcome Projects

Background:

The Improved Pregnancy Outcome 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 the development of new statewide systems of care for mothers and infants. Specifically, one of its objectives was to utilize existing services more effectively through improved planning and implementation.

Impact:

The 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.

Related Pinpoints:

1970: Family Planning Act

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 consolidates separate 1972 Acts for sickle cell anemia (P.L. 92-294) and Cooley's anemia (P.L. 92-414), and adds six other genetic conditions in this legislation.P.L. 94-278 aimed ""to establish a national program to provide for basic and applied research, research training, [voluntary] testing and counseling, and information and educational programs with respect to genetic diseases including sickle ceil 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 Health and Human Services (HHS) and Congress of the importance of federal-state partnerships in building this new service program.These Acts reflect a recognition of the importance of screening, early diagnosis, management, and counseling of patients and families with genetic disorders. These Acts 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.

Related Links:

Category: Government and Policy


1977: HHS Genetics Coordinating Committee

Background:

The 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, and that the programs and activities were consistent with legislative mandates, e.g., P.L. 94-278.

Impact:

The Public Health Service (PHS) Genetics Coordinating 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.

Related Links:

Category: Government and Policy


1978: MCH Genetic Services Program Created

Background:

In order 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), a Genetic Services Branch (GSB) in the Maternal and Child Health (MCH) Program, Health Services Administration (HSA), was created.

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.

Related Links:

Statement by Peter C. Van Dyck, M.D.National Coordinating Center for the Genetics and Newborn Screening Regional Collaborative GroupsNational Newborn Screening and Genetics Resource Center

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 mankind, 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.

Related Links:

http://www.cdc.gov/mmwr/preview/mmwrhtml/00049694.htm http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp

Category: Public Health and Medicine


1979: Health Objectives for 1990

Background:

U.S. Surgeon General, Julius Richmond lead 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. Some of the objectives included efforts to reduce:rates of infant and maternal deathsneonatal 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 HP 2010 objectives continue to provide a framework for public health professionals and policymakers to address prevention, health disparities, and a wide variety of other pubilc health issues.

Related Links:

http://www.healthypeople.gov/

Category: Government and Policy


The 1980s

The Reagan Years: Medicaid expansions, block grants and budget reforms

Category: Milestones


1980: Select Panel: Child Health

Background:

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

Impact:

Related Links:

Category: Government and Policy


1981: Creation HHS

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 difficult.

Related Links:

http://www.hhs.gov/ http://www.ed.gov/index.jhtml

Category: Government and Policy


1981: OBRA '81

Background:

Title V of the Social Security Act was amended drastically in 1981 through the Omnibus Budget Reconciliation Act of 1981 (OBRA) (PL 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 (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.

Related Links:

Category: Government and Policy


1981: 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 our time. Pediatric issues included children living with HIV and those left behind by parents who die from AIDS.

Impact:

By 2004, more than half a million people have died from AIDS in the US alone. There are at least 39,000 new cases of AIDS each year. From 1981 through 2004, in children 13 and younger, there have been 9,443 reported cases of AIDS in the US. Through the same time period adult and adolescent cases total 934,862. This number grows every day. Since the mid 1990s significant advancements have been made in treating persons affected by HIV/AIDS. The use of antiretroviral medications has proven to prolong the lives of AIDS patients.

Related Links:

http://www.cdc.gov/hiv/topics/surveillance/basic.htm http://www.globalhealthreporting.org/diseaseinfo.asp

Category: Public Health and Medicine


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 & infant care.

Impact:

The National Healthy Mothers, Healthy Babies Coalition has become one of the most recognized leaders in Maternal and Child Health. ""From its inception, HMHB has focused attention on raising public awareness of the basic components of prenatal care""--early care, good nutrition, avoidance of drugs,including not drinking and not smoking, and promotion of breastfeeding. The Coalition has targeted low income and underserved communities in which women often do not receive early prenatal care and infant mortality rates are high. HMHB's educational materials and resources for providers assist them in serving these communities.""

Related Links:

http://www.hmhb.org/

Category: Government and Policy


1981: MCH Thalassemia Initiative

Background:

The Maternal and Child Health (MCH) Program develops and disseminates a publication that called attention to thalassemias in other population groups, such as people from Asia and the Middle East.Until the 1970's, 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-1970's 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, MCH 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, 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/refugee populations of diverse origin. Many of the educational efforts and service activities initiated under the MCH SPRANS grants are now supported by states and other institutions.

Related Links:

http://www.nlm.nih.gov/medlineplus/thalassemia.html

Related Pinpoints:

1976: Genetic Diseases Act (P.L. 94-278), 1988: MCH Ethno-cultural Initiatives Launched

Category: Public Health and Medicine


1983: Select Committee on Children, Youth and Families

Background:

This committee was formed in the U.S. House of Representatives to advise the House of Representatives on the problems and needs of children, youth, and families.

Category: Government and Policy


1983: First gene is mapped

Background:

The gene for a human genetic disease is mapped to a specific human chromosome. Study of a family shows that the gene responsible for Huntington disease is on the short arm of chromosome 4.

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 genomes.

Related Links:

Category: Public Health and Medicine


1983: MCH Regional Genetics Networks

Background:

Utilizing mostly Special Projects of Regional and National Significance (SPRANS) demonstration grant funds dispersed by the Maternal and Child Health (MCH) Program, ten regional genetics networks and a national coordinating organization, Council of Regional Networks for Genetic Services (CORN), are created to build infrastructure to support genetic services.

Impact:

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

Related Links:

Category: Government and Policy


1984: Baby Doe Rules

Background:

Increasing concern that newborns with handicapping conditions were being denied life-sustaining treatment led to the development of Baby Doe Rules.

Impact:

These rules, issued by the Department of Health and Human Services in January 1984, were developed to ensure that the withholding of treatment to these infants would no longer occur.

Category: Government and Policy


1984: DEFRA

Background:

The Deficit Reduction Act of 1984 mandated state Medicaid coverage for: all children under the age of five (including children in two-parent families), whose families' incomes and resources meet the States' AFDC financial eligibility test, and all pregnant women with their children living with them who would qualify for either the AFDC or AFDC-Unemployed Parent programs.

Category: Government and Policy


1984: Child Safety Seats

Background:

State laws requiring all children under the age of 4 years to be in a child safety seat when riding in any vehicle were passed throughout the country.

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


1984: Deficit Reduction Act of 1984

Background:

The Deficit Reduction Act of 1984 (DEFRA) included provisions that expanded eligibility for the Medicaid program.

Impact:

DEFRA mandated state Medicaid coverage for children up to age five who were eligible for the Aid to Families with Dependent Children (AFDC) program and pregnant women who would qualify for AFDC once their children were born. The act also made infants born to mothers covered by Medicaid automatically eligible for one year of coverage.

Related Links:

http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14255

Category: Government and Policy


1985: Preventing Low Birth Weight IOM Report

Background:

The Institute of Medicine (IOM) 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 conclusion of the committee was that preventing low birth weight in the United States would significantly reduce infant mortality rates and improve child health.

Related Links:

http://www.iom.edu/

Category: Government and Policy


1986: CCS 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 (CCS).

Impact:

Category: Government and Policy


1986: COBRA

Background:

The Consolidated Budget Reconciliation Act of 1986 (COBRA) extended Medicaid coverage to all pregnant women with family incomes below AFDC eligibility levels.

Impact:

Category: Government and Policy


1986: SOBRA

Background:

The Sixth Omnibus Budget Reconciliation Act 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 AFDC eligibility levels, but were less than the federal poverty level.

Impact:

Category: Government and Policy


1986: Education of All Handicapped Children Act Amended

Background:

The new Early Intervention and Preschool Programs under P.L. 99-457, were part of the re-authorization of P.L. 94-142, Education of All Handicapped Children Act (EHA).

Impact:

This new Federal mandate was established to assist states in the development and implementation of a comprehensive program of early intervention. It also provided incentives for states to serve all children three-to-five years of age with handicaps.

Category: Government and Policy


1986: Sickle Cell Disease Consensus Statement

Background:

Gaston et al, publish Prophylaxis with oral penicillin in children with sickle cell anemia: A randomized trial. This study causes 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 of 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 CORN Committee Conference on Newborn Screening for Hemoglobinopathies. At the time, the Genetics Services Branch (GSB) of the 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 NEJM by Gaston et al. and two conferences noted above played a significant role in the effort to improve regional and statewide NBS efforts for SCD and other hemoglobinopathies. In part due to the publication of the paper and the consensus statement, Congress earmarked, in the Omnibus Budget Reconciliation Act of 1986 (OBRA ‘ 86; P.L. 99-509), money 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, GSB dedicated virtually all of 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.

Related Links:

Related Pinpoints:

1965: MCH Initiative on Sickle Cell Anemia

Category: Government and Policy


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

Background:

The Surgeon General's Report on Children with Special Health Care Needs addressed the unique health care needs of certain children.

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.

Related Links:

http://www.surgeongeneral.gov/library/reports.htm

Category: Government and Policy


1988: "The Future of Public Health"

Background:

This seminal report from the Institute of Medicine described a public health system in disarray and outlined three core functions needed in public health: assessment, assurance and policy development.

Impact:

The book The Future of Public Health contained ideas and proposals for making a strong health care system, a health care system that would continue, overtime, to be effective and accessible. The book brought attention to the current state of the health care system and called for a change.

Related Links:

http://www.iom.edu/

Category: Government and Policy


1988:

Background:

In order 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 funds a series of projects beginning in the late 1980's to ""overcome ethno-cultural barriers and increase access to and utilization of genetic services for populations confronted by cultural and language barriers.""

Impact:

GSB/MCHB provided the 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 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 of 1989, the March of Dimes Birth Defects Foundation, Mid-Atlantic Regional Human Genetics Network, and the Genetics Services Branch (GSB) of the Maternal and Child Health Bureau (MCHB) 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 individuals and families with genetic disorders. The proceedings were a very useful resource for future program and project planning at the national, state and local levels. One additional outcome was the ""The National Dialogue on Genetics"" conference held in 1998 to establish a dialogue among ethnically diverse communities and genetic policy makers in the United States, and also to empower these communities for the future planning and implementation of genetic services, nationwide.

Related Links:

http://genes-r-us.uthscsa.edu/LTGmaterial.htm

Related Pinpoints:

1965: MCH Initiative on Sickle Cell Anemia

Category: Government and Policy


1989: Mapping the Human Genome

Background:

The National Human Genome Research Institute is established. In 1990, this Institute launched the international effort toward mapping of the human genome. Project goals are to discover all human genes (the human genome) and make them accessible for further study and to determine the complete sequence of the 3 billion DNA bases in the human genome.

Impact:

The next decade and a half see remarkable advances. In 2000, a rough draft of the human genome is completed and published by the Human Genome Project and Celera. The project was planned to last 15 years, but rapid technological advances accelerated the expected completion date.

Related Links:

Category: Public Health and Medicine


1989: OBRA '89

Background:

With the Omnibus Reconciliation Act (OBRA) of 1989, Congress linked greater flexibility of the MCH Block Grant with greater accountability. This 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 89 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.

Category: Government and Policy


1989: Rights of Children

Background:

Globalization of MCH ""Rights of Children"" ratified by the United Nations.

Impact:

The ratification of ""Rights of Children"" by the United Nations reaffirmed ""...that children's rights require special protection and call 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...""

Related Links:

Category: Government and Policy


1989: 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 special focus on providing appropriate prenatal care for high risk pregnancies and outlined the medical, psychological, and social factors that could put pregnancies at risk for poor birth outcomes. The report shaped the future of prenatal care and its recommendations were used to enhance the health of mothers, infants, and families.

Related Links:

Related Pinpoints:

Category: Government and Policy


The 1990s

In the 1990s, there was a tremendous emphasis on needs assessment and reporting evolved into performance measures. This trend was evident in both the public and private sectors. This emphasis on performance measures in MCH led to the development of health indicators, uniform surveillance strategies and data sets, a partnership of systems, and an improvement of grant accountability. There was an overall call to be better organized in data management and reporting. Nationwide meetings were held concerning performance measurement and national recommendations for program performance measurement were developed as a result.

Category: Milestones


1990: Bright Futures Initiated

Background:

Initiated in 1990 and guided by MCHB, four interdisciplinary panels of experts in infant, child, and adolescent health developed Bright Futures, a comprehensive set of child health supervision 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; andEnhance health professionals' knowledge, skills, and practice of developmentally appropriate health care in the context of family and community.To this end, Bright Futures has developed and disseminated materials for health professionals, families, and communities and has trained these same groups to collaborative and work together towards optimal child health.

Related Links:

Category: Government and Policy


1990: Individuals with Disabilities Education Act (IDEA)

Background:

The Individuals with Disabilities Education Act (IDEA) provides money to the states to help pay for special education for children with disabilities from birth to age 21. The basis for the legislation is the Education for All Handicapped Children Act of 1975, which required that children from ages 6-21 with disabilities receive ""free and appropriate public education,"" based on individual needs. In 1986, a preschool mandate and an Infants and Toddlers Program component were added and included systems planning and services for infants and toddlers with developmental delay or ""at-risk"" for a disability. IDEA provisions enacted in 1986 included establishment of Interagency Coordinating Councils (ICCs) at the federal, state, and local levels.In 2004 the IDEA was amended, aligning IDEA more closely to the No Child Left Behind Act, including special education students in school performance measurement.

Impact:

Services for infants, toddlers, children and youth with disabilities continue to be provided through IDEA. IDEA services for children ages 3-21 include Individualized Education Plans (IEP) 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. For additional information, see the Systems of Care In Depth Issue, IDEA chapter.

Related Links:

Related Pinpoints:

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). EEOC is responsible for enforcing Title I's prohibition against discrimination against people with disabilities in employment.

Impact:

The ADA has been described as the Emancipation Proclamation for the disability community.

Related Links: http://www.ada.gov/

Category: Government and Policy


1990: MCH Genetic Lay Advocacy Groups Funded

Background:

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

Impact:

Lay support groups have and continue to play an important and successful role in the partnership involving affected individuals, families, communities, providers, public health officials, elected officials, and others to improve the lives of individuals with genetic disorders. They can provide a valuable consumer prospective that is knowledgeable, articulate, and savvy.

Related Links:

Category: Government and Policy


1990: NIH Office of Research on Women's Health

Background:

In the late 1980s, advocates fought to increase the representation of women in clinical studies of diseases, disorders, and drug treatments. Women were often excluded from clinical trials because researchers feared that their hormonal cycles would interfere with study results and drug treatments could negatively impact pregnancies. This meant that many health interventions were tested only on men before being released to the public. To address the exclusion of women from clinical research, the National Institutes of Health (NIH) Office of Research on Women's Health was established in 1990.

Impact:

The Office of Research on Women's Health promotes and supports biomedical and behavioral research on women's health. It coordinates research on women's health issues and ensures that women are appropriately represented in research projects carried out at the NIH and in other institutions. The office also supports recruitment and advancement of women in biomedical careers.In 1993, Congress reinforced the NIH's policies on women's health with the NIH Revitalization Act. The Act required that women and minorities were included in all clinical research projects funded by the NIH.

Related Links:

http://orwh.od.nih.gov/

Category: Government and Policy


1990: 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 referrals for treatment. In 2000, Congress passed an act that allows women participating in the NBCCEDP to receive cancer treatment through the Medicaid program.

Related Links:

http://www.cdc.gov/cancer/NBCCEDP/about.htm

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% over the five-year period and to improve the health and well-being of women, infants, children and their familiesSince its inception, the Healthy Start Program has been located in HRSA. Healthy Start is a component of the Maternal and Child Health Bureau and resides in the Division of Healthy Start and Perinatal Services.Originally funded under the authority of Section 301 of the Public Health Services Act, Healthy Start was recently authorized by the Congress as part of the Children's Health Act of 2000.

Impact:

The Healthy Start Program is located in HRSA and is a component of the MCH Bureau. Since its inception, Healthy Start has provided services to hundreds of thousands of people in what now amounts to 96 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. These women are located through outreach and homevisiting. Services provided range from preconceptional care to postpartum to infant care. About 90% of Healthly Start constituents are people of color.

Related Links: http://www.nationalhealthystart.org/

Category: Government and Policy


1991: Teen Pregnancy Rate Rises

Background:

After decades of rapidly declining rates, teen pregnancy 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 not only have significant costs for individuals and society, but they also affect the health of mothers and infants. When compared to mothers in other age groups, teens are less likely to receive early and regular prenatal care and 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.

Related Links:

Category: Government and Policy


1992: Family Voices Established

Background:

Amidst national discussions of health care reform, a group of parents of children with special health care needs establishes 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, advocates 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, that among other activities, provides technical assistance to family run Family-to-Family Health Information Centers across the country.

Related Links:

http://www.familyvoices.org/

Related Pinpoints:

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

Category: Government and Policy


1992: Health Care Reform

Background:

In his 1992 run for presidency, Bill Clinton campaigned heavily for health care reform, an issue of national concern to most Americans. Following his election in 1993, President Clinton established a task force to come up with a plan to provide universal health care for all Americans.The result was a complex and complicated proposal of more than 1,000 pages. It mandated employers to provide health insurance coverage to all employees through competitive but closely-regulated health maintenance organizations (HMOs). The plan received a mixed response by voters and policy makers. An effective and well-organized campaign opposing Clinton's ""Health Security"" plan criticized it as being overly bureaucratic and restrictive of patient choice. In 1994, the Senate announced the plan was dead.

Impact:

The loss of the health care reform plan weakened President Clinton and the public was frustrated with the state of health care in the U.S. and what seemed like Congressional gridlock. There have been no attempts to pass a universal health care system in Congress since then. As a result to the failed health care reform plan, individual states began their own health care reform efforts. One example is TennCare which came out of Tennessee. TennCare extended Medicaid to poor and working individuals who could not acquire health insurance. State efforts like this one were said to greatly reduce uninsured residents in Tennessee and save lives as a result.

Related Links:

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, 21.1 million families received $39 billion in refunds from the EITC.

Category: Government and Policy


1993: Reinventing Government

Background:

The decade of the 1990's 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, in which they argued that public institutions and systems could benefit from the use of competition, customer choice, and other non-bureaucratic mechanisms to heighten the 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 which filtered into the public sector with moves to privatize. Widespread reorganization occurs with Environmental Health and other Environmental Programs, Human Services in large umbrella agencies, and ""Children's Cabinets""/Agencies.

Category: Government and Policy


1993: Emphasis on Performance

Background:

The Government Performance and Results Act (GPRA) of 1993, Public Law 103-62, for the first time held agencies accountable 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 decisionmaking. For the first time the federal government was demanding indicators of performance and outcomes and budgets were linked to the outcomes. Many states developed similar requirements.

Impact:

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

Related Links:

http://www.whitehouse.gov/omb/mgmt-gpra/gplaw2m.html

Category: Government and Policy


1994: MCH Genetics for Primary Care Providers

Background:

Most primary care physicians in the early 1990's 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 the Maternal and Child Health Bureau (MCHB) posited that: 1) primary care physicians frequently did not know about and/or did not fully appreciate the importance 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 referral for genetic services. In 1994 the GSB, therefore, funded grants to create new and/or improved genetics continuing education programs for primary care physicians and other providers. The expectation was and continues to be increased primary care physicians training 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 SPRANS demonstration grants were funded. Need 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 they continued on after Federal funding ended, e.g., GENE Tools®, GeneTests/GeneClinics®, Genetics& Your Practice®, and others. GeneTests/GeneClinics® has become one of the best and most widely used clinical genetics web sites in the world.

Related Links:

Related Pinpoints:

1998: MCH Genetics in Primary Care Faculty Development

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.

Related Links:

http://www.ovw.usdoj.gov/

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 percent of infants who were placed on their backs to sleep increased dramatically and the SIDS rate declined by 50 percent.

Related Links:

https://www.nichd.nih.gov/sts/

Category: Government and Policy


1995: Healthy Child Care America (HCCA)

Background:

In the period between 1975 and 1995, increasng numbers of women entered and remained in the workforce and more were single parents. Consequently, more families need to rely on non-material care for their infants and children. In 1975, 39% 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 (a campaign that was impilemented in 1995-2005), introduced the idea that families, child care 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, the Healthy Child Care America Program promoted the healthy development of young children through child care education and training, and increased access to preventive health services, safe physical environments, and medical facilities for all children.

Related Links:

http://www.healthychildcare.org/

Category: Government and Policy


1996: Aftermath of Defeat of Health Care Reform

Background:

After health reform at the federal level failed, 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:

This Act attempts to make health insurance more portable to those who change or lose their jobs and also strives to provide patient confidentiality. If an insured person loses their job and tries to acquire new health insurance through a new job or private plan, under HIPAA, they are not subject to the preexisting conditions clause. However, HIPAA regulations pose new challenges. Many have criticized HIPAA for unintended consequences such as insurance companies raising prices which may have actually left more people uninsured.

Related Links:

http://www.dol.gov/dol/topic/health-plans/portability.htm

Category: Government and Policy


1996: Welfare Reform

Background:

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

Impact:

TANF provides states and territories with funds ($16.5 billion per year) to operate programs that serve needy families. States must use TANF funds towards the purposes of TANF which include helping families to care for their children, limiting the dependency of parents through encouraging work, marriage, and two-parent families, preventing pregnancies that occur between people who are not married, and through reducing teen pregnancy. In order to receive cash assistance, TANF requires people to work and it also limits how long people can receive welfare. Since its development, millions of Americans have entered the workforce and, as a result, there is less dependence on welfare.

Related Links:

Category: Government and Policy


1996: Education Reform

Background:

The 1990's era of ""reinventing government"" gave rise to major reforms in public education. Education reform meant new legislation with new policies, procedures, and standards. Education reform at this time 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 issues of the scores that students received on statewide assessments.

Impact:

Reform efforts included new standards, assessment, 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.

Category: Government and Policy


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

Background:

The Council of Regional Networks for Genetic Services (CORN) organizes a conference to define and develop guidelines for genetic services and education at the national, regional, and state levels. The guidelines provide state and territorial public health agencies, other public 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 - and also for infrastructure-building including organization, administration, funding, and the public health core functions (assessment, policy development and assurance). Over the years, the guidelines have been slightly revised, modified and/or updated, and re-published using similar titles by state genetics programs.

Related Links:

Related Pinpoints:

1983: MCH Regional Genetics Networks

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 the abstinence-only-until-marriage approach, and over the course of his tenure, 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 sex 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) 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 insure children in the U.S. SCHIP is financed by both Federal and State governments but is administered by the States. Each State designed their own program, defined their eligibility groups, benefit package, coverage amount, and program procedures. The advent of SCHIP greatly reduced the numbers of uninsured children in the U.S.

Related Links:

Category: Government and Policy


1997: Conference on Genetic Services and Managed Care

Background:

enetic services, in the U.S. A conference is convened in 1997 by the Council of Regional Networks for Genetic Services (CORN) and the Genetic Services Branch of MCHB. The conference (and its proceedings) present a broad overview of clinical genetic services and managed care, including affordability, availability, accessibility, quality (standards versus guidelines for care), awareness, sources of funding, 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.

Category: Public Health and Medicine


1998: Folic Acid Fortification

Background:

Folic acid supplements have long been recommended for women who were pregnant, or planning to become pregnant, as a way to reduce the risk of neural tube defects (NTDs). 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.

Related Links:

Category: Government and Policy


1998: Revitalization of Public Health

Background:

Public health, like many fields, has gone through numerous reorganizations over the last two decades. In 1988 the Institute of Medicine clearly defined public health's mission, purpose, and the three core functions of public health, assessment, policy development, and assurance. Around 1998, ten years later, these core functions evolved into ten essential services which were written by a group 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. Around that same time, the Association of Maternal and Child Health Programs (AMCHP) wrote its own ten MCH essential services and 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:

Public health has gone through many changes over the years and 1998 was a time of revitalization for public health. The events of that time, including the development of the essential services, presented public health with a clearer mission and purpose which has further unified public health.

Related Links:

ASPH,AMCHP

Related Pinpoints:

1988: ""The Future of Public Health""

Category: Government and Policy


1998: Tobacco Settlements

Background:

Since 1964, the U.S. Surgeons General have reported the deleterious effects of smoking. Although tobacco is one of the most preventable causes of death, deaths from smoking continue. In November 1998, a settlement agreement was reached between the tobacco industry and 46 states.

Impact:

The settlement involved prohibiting youth targeting in marketing and advertising, a change in tobacco corporate culture, as well as the provision of around $246 billion dollars to states over a 25 year period. Interestingly, the amount provided to each state takes into account the total amount each state has spent on health. The amount given per year is also determined by price index and the decrease in U.S. tobacco sales. Some states have used settlement dollars for MCH-related projects.

Related Links:

Category: Government and Policy


1999: MCH National Newborn Screening and Genetics Resource Center

Background:

The Maternal and Child Health Bureau (MCHB) establishes a National Newborn Screening and Genetics Resource Center (NNSGRC) through a cooperative agreement with the Department of Pediatrics at the University of Texas Health Science Center at San Antonio.INNSGRC provides a resource to which public health professionals, consumers, and policymakers routinely turn for advice and information on both newborn screening and clinical genetics. Ongoing collaborations with government agencies, academic institutions, professional organizations, consumer advocacy groups, and private service providers are all included as essential elements within the NNSGRC infrastructure. Well known for providing external assistance to state public health departments seeking to refine the newborn screening activities, the NNSGRC also works to enhance states' capacities to incorporate new developments in genetics and disease prevention into ongoing public health policy assessment, development and assurance. Other activities of the NNSGRC include a comprehensive website, various topical Listservs, a searchable genetics education materials database, and a national online data system for newborn screening.

Impact:

The NNSGRC has served successfully as a national focal point for newborn screening and public health genetics activities.

Related Links:

http://genes-r-us.uthscsa.edu/

Category: Public Health and Medicine


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 individuals 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.

Related Links:

http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm109795.htm

Related Pinpoints:

1991: Teen Pregnancy Rate Rises

Category: Government and Policy


1999: Newborn Screening Task Force Report

Background:

In May 1998, the Genetic Services Branch (GSB), Maternal and Child Health Bureau, requests that the American Academy of Pediatrics convene a Newborn Screening 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 Forcewas 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, to establish a national agenda for newborn screening systems.

Impact:

The Task Force evaluation and its recommendations established the framework for activities regarding the newborn screening 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.

Related Pinpoints:

1999: MCH National Newborn Screening and Genetics Resource Center 2000: MCH Heritable Disorders Program Authorized

Category: Government and Policy


The 2000s

From left, clockwise: The World Trade Center on fire and the Statue of Liberty during the 9/11 attacks; the euro enters into European currency in 2002; a statue of Saddam Hussein being toppled during the Iraq War; U.S. troops heading toward an army helicopter during the War on Terror; social media through the Internet spreads across the world; a Chinese soldier gazes at the 2008 Summer Olympics commencing; an economic crisis, the largest since the Great Depression, hits the world in 2008; a tsunami from the Indian Ocean following an earthquake kills over 250,000 on Boxing Day, 2004. SOURCE: https://en.wikipedia.org/wiki/2000s_(decade)

Category: Milestones


2000: MCH Heritable Disorders Program Authorized

Background:

Title XI of the Children's Health Care Act of 2000, ""Screening for Heritable Disorders,"" establishes the Heritable Disorders Program ""to strengthen States' newborn screening programs and improve States' ability to develop, evaluate, and acquire innovative testing technologies, and establish and improve programs to provide screening, counseling, testing and special services for newborns and children at risk for heritable disorders."" Title XI enacts three sections of the Public Health Service (PHS) Act: sections 1109, 1110, and 1111.Section 1109 of the Act authorizes 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 establishes an Advisory Committee on Heritable Disorders in Newborns and Children (Committee). The Committee's purpose is to provide to the Secretary advice and recommendations concerning the grants and projects authorized under the Heritable Disorders Program and technical information to develop policies and priorities for this program that will enhance the ability of the State and local health agencies to provide for newborn and child screening, counseling and health care services for newborns and children having or at risk for heritable disorders. In addition, the Committee gives advice and guidance to the Secretary 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 04 appropriations language, Congress directed MCHB to use 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.

Related Links:

http://www.nccrcg.org/

Related Pinpoints:

2004: MCH Heritable Disorders Program Implemented

Category: Government and Policy


2000: MCH Genetic Literacy Initiatives

Background:

Community Based Educational Projects are funded by the Genetic Services Branch (GSB) of the Maternal and Child Health Bureau. The GSB utilized community based participatory research (CBPR) theory to enhanced the ability of communities to incorporate genetic information, resources and services into the consumers and their families' everyday lives in order to make 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 as well as develop culturally and linguistically appropriate genetics educational materials and programs. Examples of the programs include the GENE project; the family history project,Does it Run in the Family;and the newborn screening materials,This Test Could Save Your Baby's Life.

Related Pinpoints:

1988: Ethno-cultural Barriers in Genetic Services

Category: Government and Policy


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

Background:

HIPAA (Public Law 104-191) enacted on August 21, 1996, 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:

The federal law, HIPAA, expanded patient's authority over personal health information. The regulations emphasized privacy and protection of personally identifiable information while not compromising on the quality of health care.

Related Links:

http://www.hhs.gov/ocr/hipaa/

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 have helped educate, motivate and mobilize the public to more effectively deal with those issues.

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 in regards to oral health and ensuing overall health issues. Based upon these findings, the Surgeon General called for action to promote access to oral health care for all Americans, especially the disadvantaged and minority children found to be at greatest risk for severe medical complications resulting from minimal oral care and treatment

Related Links:

http://www.surgeongeneral.gov/index.html

Category: Government and Policy


September 11, 2001 Terrorist Attack

"
September 11, 2001, was a day of unprecedented shock and suffering in the history of the United States."" It began the war on terrorism and led to increasing awareness and surveillance of terrorist threats on the U.S. homeland.

Category: Milestones


2001: MCH Genetics Workforce Study

Background:

The Genetic Services Branch (GSB) of the Maternal and Child Health Bureau launches 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, roles of health professionals in delivering those services and identify measures for the demand of those services.

Impact:

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

Category: Government and Policy


2001: MCH Translational Genetic Research

Background:

To address challenges, concerns and issues relevant to the translation of genetics research into clinical and public health practice, 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, several policy projects.Advances in DNA and other technologies in the last decade have allowed 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, as well as the ethical, legal and social, implications of genetics. Health educators and health care 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 utilize that 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 to 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 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 practices that will promote positive family adaptation and interaction within the newborn screening system.

Related Links:

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) authorizes Congress to appropriate two million dollars to fund a Sickle Cell Disease Program consisting 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, four million dollars was appropriated in Fiscal Year 2003 to fund 17 community-based programs and one cooperative agreement for two years and; in 2005, four million dollars was appropriated to fund 17 community-based programs and one cooperative agreement through Fiscal Year 2008.

Impact:

The Sickle Cell Disease Newborn Screening Program has:(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.(4) Established networks that are models for replication

Related Links:

Related Pinpoints:

Category: Government and Policy


2002: No Child Left Behind Act

Background:

President George W. Bush proposed the No Child Left Behind (NCLB) plan in 2001 to ensure that children in every classroom receive the benefits of well-prepared teachers, a research-based curriculum and safe learning environments. The NCLB Act was signed on January 8, 2002, providing nearly $1 billion a year to strengthen public schools.

Impact:

Related Links:

http://www.ed.gov/nclb/

Category: Government and Policy


2002: Program Assessment Rating Tool (PART)

Background:

Building upon the Government Performance and Results Act (GPRA) of 1993, the Program Assessment Rating Tool (PART) was developed by the U.S. Office of Management and Budget (OMB) in 2002. The purpose of the PART is to assess the performance of every government program in order to improve program performance and inform budget decisions.

Impact:

Federal government funding is now linked with performance in a very direct way. Every Federal program is held accountable for improvement. Every government program is assessed once every five years and rated into one of 5 categories: Effective, Moderately Effective, Adequate, Ineffective, or Results Not Demonstrated.

Related Links:

http://www.expectmore.gov

Category: Government and Policy


2002: Obesity Epidemic

Background:

According to the Center for Disease Control, childhood obesity/overweight has more than tripled since 1980 and is still rising. The 21st century indicates record numbers (16% or over 9 million young people) of children and teens aged 6-19 years of age as obese or overweight. See below for Obesity Trends in the US and the 2004 obesity percentages per state:

Impact:

Increasing rates of obesity raise concern for the health of the American public since studies show overweight people are more at risk for diseases and chronic health conditions such as hypertension, type 2 diabetes, heart diseases, stroke, and some cancers. If current obesity trends persist, children of the 21st century may become the first generation of Americans whose life expectancies is shorter than those of their parents'. Recognition of the obesity epidemic has led to an increased number of campaigns for healthy eating and changing lifestyles to fight obesity.

Category: Public Health and Medicine


2002: MCH and Family History

Background:

The Maternal and Child Health Bureau (MCHB) proposes the: Consumer-based Family History Tool and Education Process which results in Healthy Choices through Family History Project. The goals and objectives of this initiative were to use a non-medical model approach to increase family member access to genetic health related information and give 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. Family history and in particular family health history are important parts of the genetic medicine landscape.

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 individuals 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. The family history tool is being tested within the communities throughout 2007.

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 an individual'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. Since introduced, life course has become a prominent framework for conceptualizing health, and scholars and practitioners are exploring application to MCH practice.

Related Links:

Category: Government and Policy


2002: Response to Bioterrorism Threats

Background:

Amidst concern over the threat of bioterrorism, President George W. Bush made $2.9 billion available to the Department of Health and Human Services to prepare for and counteract potential biological and chemical attacks.

Impact:

Much of the new funding was used to strengthen the nation's public health infrastructure and build new systems for emergency preparedness and response.

Category: Government and Policy


2004: MCH Sickle Cell Disease Treatment Program

Background:

HRSA awards $1.9 million through the 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 individuals with the disease and one national center to coordinate network collaborative activities. The coordinating center, in partnership with the grantees are 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 persons with sickle cell disease as well as in methods of screening for persons 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:

Since this is a newly funded activity, the full impact is yet to be realized.

Related Links:

http://www.sicklecelldisease.org

Related Pinpoints:

Category: Government and Policy


2004: MCH Heritable Disorders Program Implemented

Background:

Legislation authorizes the establishment of The Heritable Disorders Program “to enhance, improve or 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 funds 7 Regional Genetics and Newborn Screening Services Collaboratives (RC), inclusive of all States in each region, and 1 National Coordinating Center (NCC), to implement the Heritable Disorders Program.The purpose of the Regional Genetics and Newborn Screening Collaboratives (RC) is to enhance and support the genetics and newborn screening capacity of States across the nation by undertaking a regional approach to determine and resolve the needs and maldistribution of genetic resources and expertise across the region. The seven regions identified are as follows:Region 1: CT, MA, ME, NH, RI, VT.Region 2: DC, DE, MD, NY, NJ, PA, VA, WV.Region 3: AL, FL, GA, LA, MS, NC, PR, SC, TN, VI.Region 4: IL, IN, KY, MI, MN, OH, WI.Region 5: AR, IA, KS, MO, ND, NE, OK, SD.Region 6: AZ, CO, MT, NM, NV, TX, UT, WY.Region 7: AK, CA, HI, ID, OR, WA, Guam.

Impact:

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

Related Links:

Related Pinpoints:

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.

Related Links:

Category: Government and Policy


2005: Gulf Coast Hurricanes

In 2005, the United States experienced an unprecedented emergency, which resulted from its worst hurricane season 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 wrenched 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.

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, the Maternal and Child Health Bureau (MCHB) contracts with the American College of Medical Genetics (ACMG) to analyze the scientific literature and gather expert opinion to:

Examine the available information concerning the scope of newborn screening programs and anticipated future directions, including the delineation of the best evidence for screening specified conditions.

Develop a set of recommendations based on this best evidence that will address

  1. A uniform condition panel (including implementation methodology
  2. Model policies and procedures for state newborn screening programs (with consideration of a national model)
  3. Model minimum standards for state newborn screening programs (with consideration of national oversight)
  4. A model decision matrix for consideration of state newborn screening program expansion

Impact:

The project has been has been 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 the State newborn screening programs in the recommendations put forth by the ACMG panel.

Related Links:

http://mchb.hrsa.gov/screening/summary.htm

Related Pinpoints:

1999: Newborn Screening Task Force Report

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 include delayed childbearing and high rates of multiple births associated with the use of assisted reproductive technologies.

Related Links:

Related Pinpoints:

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.

Related Links:

Related Pinpoints:

Category: Government and Policy


2005: Deficit Reduction Act of 2005

Background:

The Deficit Reduction Act of 2005 (DRA) was designed to decrease the national debt and included significant changes to the Medicaid program.

Impact:

The DRA made more than $26 billion in Medicaid cuts over 10 years and increased premiums and cost sharing for beneficiaries. It also gave states the option to replace their benefits packages with a scaled-down benchmark plan. In addition, the act introduced health savings accounts and more stringent citizen documentation requirements into the Medicaid program.

Related Links:

http://www.kff.org/medicaid/upload/7465.pdf

Related Pinpoints:

1965: Medicare and Medicaid Established

Category: Government and Policy


2006: New developments in vaccines

Background:

New vaccines have been developed to improve the health of women and children. Two live, oral, attenuated vaccines against rotavirus infection were licensed by the US Food and Drug Administration in 2006 and are being introduced in routine immunization programs. The U.S. Food and Drug Administration also approved the first vaccine for cervical cancer for women between the ages of 9 and 26. The newly licensed vaccine is recommended for girls ages 11 and 12.

Impact:

Implementation of these recommendations in the United States should 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 is aimed at preventing the nearly 10,000 new cases of cervical cancer and 3,700 deaths that occur in the US each year.

Category: Government and Policy


2006: Increase in Autism Awareness and Funding

Background:

In 2006, the Combating Autism Act was authorized to fund autism research, surveillance, diagnosis, and treatment, as well as improved interagency collaboration.

Impact:

Increased advocacy efforts and additional funding contributed to enhanced autism awareness. In 2007, the Centers for Disease Control and Prevention (CDC) found that autism affects 1 in 150 children, a significant increase over past years. The CDC reported that improved detection, increased public awareness, and a broader diagnostic definition have contributed to this increase.

Related Links:

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.

Related Links:

http://www.fns.usda.gov/wic/regspublished/foodpackages-interimrule.htm

Related Pinpoints:

Category: Government and Policy


2008: Newborn Screening Saving Lives Act

Background:

The Newborn Screening Saves Lives 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.

Related Pinpoints:

1999: Newborn Screening Task Force Report

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.

Related Links:

http://www.amchp.org/AboutAMCHP/PressRoom/Documents/AMCHP-PART.pdf

Related Pinpoints:

2002: Program Assessment Rating Tool (PART)

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 (CHIP-RA), and President Obama signed it into law on February 4, 2009.

Impact:

CHIP-RA increased funding for the Children's Health Insurance Program and changed the way that program funding is allocated to states. CHIP-RA provided additional funding for CHIP outreach to increase enrollment of eligible children and gave states the option to cover pregnant women and children of legal immigrants. Over the course of five years, CHIP-RA is expected to provide coverage for an additional 4 million children who would have otherwise been uninsured.

Related Links:

Related Pinpoints:

1997: State Children's Health Insurance Program

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 a number of 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.

Related Links:

http://www.recovery.gov/

Category: Government and Policy


2014: Autism CARES Act

Background:

In August of 2014 the Autism Collaboration, Accountability, Research, Education and Support (CARES) Act of 2014 was signed into law. This bipartisan effort reauthorizes earlier autism-related legislation and continues research initiatives and service provisions for those with an autism spectrum disorder. The law also furthers autism training and monitoring efforts by federal health agencies.

Impact:

The law promotes needed research into identifying risk factors and meeting the needs of the growing population of young adults with an autism spectrum disorder who are transitioning out of school-based care. It also ensures consistent representation by individuals with an autism spectrum disorder and their families within organizations, including the Interagency Autism Coordinating Committee (IACC).

Related Links:

https://www.whitehouse.gov/blog/2014/08/11/president-obama-signs-bill-support-needs-people-autism

Category: Government and Policy


2014: Birth to Five: Watch Me Thrive!

Background:

Birth to Five: Watch Me Thrive! is a coordinated federal initiative promoting developmental and behavioral screening for children. The initiative encourages families to monitor children’s milestones, promotes universal screening, aims to detect delays as soon as possible, and works to enhance the supports available to children. Birth to Five: 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 Five: Watch Me Thrive! will play an important role in increasing the diagnosis and treatment of children with developmental delays. Its resources for families, education providers, communities, and more will allow for the use of much-needed tools in a variety of settings.

Related Links:

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. These transformative changes will be phased in over the course of two Application/Annual Report years, beginning with the submission of the fiscal year (FY) 2016 MCH Block Grant Application/FY 2014 Annual Report in July 2015. Key revisions will include 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. The Block Grant Transformation will continue the strong legacy of Title V.

Impact:

These changes will allow leaders in State Title V MCH programs to better align their programs with the vision for improved maternal and child health nationwide. It will allow for a stronger response to current and future challenges faced by mothers and children. The revisions to the 2015 Title V MCH Block Grant Application/Annual Report Guidance are 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. One area of focus is revising the program’s National Performance Measures (NPMs) is for the Federal MCH program to assume lead responsibility in ensuring that each measure has a National data source, which will allow for more timely, more reliable, and more valid data reporting. In addition to being more actionable and providing greater accountability, the new performance measure framework is intended to track areas where the State MCH programs can best demonstrate the impact of their Title V investments.

Related Links:

Category: Government and Policy

MCH Timelne end

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