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Priority Areas

Health Literacy, Plain Language, and Design March 19, 2019
Follow-up Materials
Below are the PDFs of the slides from each session:

Oregon’s Title V priorities for 2016-2020

Click on a priority area for background information, performance measures and resources. 


​The well-woman visit promotes health through disease prevention and preventive health care over the course of a woman's lifetime. Well-woman visits provide a critical opportunity to receive recommended clinical preventive services, screening and management of chronic conditions such as diabetes or depression, counseling to achieve a healthy weight and smoking cessation, and immunizations. High quality well-woman care increases the likelihood that any future pregnancies are by choice rather than chance and decreases the likelihood of complications for future pregnancies. Despite clinical recommendations for an annual well-woman visit and coverage guaranteed through the Patient Protection and Affordable Care Act (ACA) in Oregon, almost 30 percent of women did not receive a well-woman visit in the past year, a rate lower than the national average.
 
National Performance Measure:
Percent of women, ages 18 through 44, with a preventive medical visit in the past year
 
Background
Resources

Contact
Anna Stiefvater, anna.k.stiefvater@dhsoha.state.or.us

The American Academy of Pediatrics (AAP) recommends all infants exclusively breastfeed for about six months and continue breastfeeding at least a year as complementary foods are introduced. Human milk provides essential building blocks for brain d​evelopment and unique nutritional and immunological properties that provide protection against infection and illness. Breastfeeding facilitates a naturally responsive style of infant feeding. Breastfeeding strengthens the immune system, reduces respiratory infections, gastrointestinal illness, and SIDS, and promotes neurodevelopment. Breastfed children may also be less likely to develop diabetes, childhood obesity, and asthma. Maternal benefits include reduced postpartum blood loss due to oxytocin release, reduced risk for postpartum depression, and possible protective effects against breast and ovarian cancer and hypertension. Not breastfeeding increases risk for both infant and maternal morbidity and mortality.
 
National Performance Measures
A) Percent of infants who are ever breastfed;
B) Percent of infants breastfed exclusively through 6 months
Background

Resources

Contact
Unintentional injury is the leading cause of death for children ages 1 through 11. For those who survive severe injuries, many will have lasting challenges such as disability and chronic pain. Education, stronger laws, and safer environments can prevent and reduce serious injuries. Effective strategies, such as increasing knowledge and changing attitudes and behaviors, passing and enforcing legislation and policies that encourage safe behaviors, and changing the design of products and the environment, can prevent many injuries and improve the quality of life for children and adolescents, as well as their families.
National Performance Measure
Rate of hospitalization for non-fatal injury per 100,000 children, ages 0 through 9
 
Background
Bullying (and cyberbullying) is unwanted, aggressive behavior involving a real or perceived power imbalance among individuals. The behavior is repeated, or has the potential to be repeated, over time. Individuals who bully use their power— such as physical strength, access to embarrassing information, race or class privilege or popularity— to control or harm others. Bullying in school and other settings can often mirror systematic oppression in society at large. Power imbalances can change over time and in different situations, even if they involve the same people. There are negative outcomes for both people who bully and those who are bullied including: challenges with academic achievement, social isolation, and negative physical and mental health outcomes. In Oregon there are multiple policies to support students and staff in school settings to both understand and respond to bullying. Focusing on protective factors such as positive peer interactions, social competencies and low frequency of technology use, and sexuality education would significantly reduce bullying behavior.
 
National Performance Measures

Percent of 8th and 11th graders who report being bullied or harassed at school for any reason​ 

Background
Resources
Alexis Phillips, Alexis.W.Phillips@dhsoha.state.or.us
Social Determinants of Health and Equity

The social determinants of health (SDOH) refer to the social, economic, and environmental conditions in which people are born, grow, work, live, and age. These conditions significantly impact length and quality of life and contribute to health inequities. The social determinants of equity refer to systemic or structural factors that shape the distribution of the SDOH in communities. Maternal, child, adolescent, and family health are determined in large part by these social determinants – including access to social and economic opportunities; resources and supports available in homes, neighborhoods and communities; quality of schooling; safety of workplaces; access to clean water, food, and air; and social interactions and relationships. Women and children are particularly vulnerable and overrepresented among those impacted by poverty, homelessness, unhealthy housing, employment instability, family and community violence, and other social determinants. These factors amplify the impacts of adversity and inequity on women and children's health throughout the lifespan. Among SDOH, housing concerns consistently rank at or near the top of family and community concerns (including housing affordability and homelessness, health and safety of existing housing, and the neighborhood and physical environment). Housing instability and food insecurity are highly correlated. Recent studies show strong correlations between housing stability and child outcomes. Multiple aspects of housing quality and the social and physical environment of the home impact women and children's health. These include air quality, home safety, presence of mold, asbestos and lead. Poor-quality housing is associated with various negative health outcomes, including chronic disease and injury and poor mental health.

State Performance Measure
The percentage of children living in a household that received food or cash assistance 
 

Culturally and Linguistically Appropriate Services

The field of Maternal and Child Health (MCH) is grounded in a lifecourse framework which recognizes the need to eliminate health inequities to improve the health of all women, adolescents and children, including those with special health care needs (CYSHCN). Health inequities are systemic, avoidable, and unfair. These differences in health status and mortality rates are sustained over generations and are beyond the control of individuals. Institutional changes, including implementing culturally and linguistically responsive MCH services and systems are essential in addressing health inequities. The principal national standard for culturally and linguistically appropriate services (CLAS) is to: Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.

State Performance Measure
Percentage of children age 0 - 17 years who have a healthcare provider who is sensitive to their family's values and customs

Toxic Stress, Trauma, Adverse Childhood Experiences and Resilience

Trauma and adversity [including historical trauma, racism, adverse childhood experiences (ACEs), and adverse peer, school, and/or adult experiences] can create toxic stress. Toxic stress influences the biology of health and development, and may manifest in multiple mental, physical, relational, and productivity problems throughout the lifespan. Early childhood is a critical period when adversity and trauma can create toxic stress and interrupt normal brain development.

Individuals with multiple ACEs have higher rates of developmental delays and other problems in childhood, as well as adult health conditions such as smoking, alcoholism, depression, suicide, heart disease, cancer, diabetes, disability, and premature mortality.

Protective factors, at both the individual and community level, can build resilience and buffer the effects of adversity and trauma. Resilience can be enhanced by healthy relationships in early childhood, meaningful relationships for children and adolescents, and strong social support (i.e., connection to other people, community and culture) for adults. A public health response to trauma and adversity addresses systemic causes such as racism, discrimination, and structural inequities to prevent adversity and reduce toxic stress. It also promotes safe, stable, and nurturing relationships and environments that build resilience in individuals, families and communities.

State Performance Measure
Percentage of new mothers who experienced stressful life events before or during pregnancy



Resources
 
Contact
Wendy Morgan, wendy.morgan@dhsoha.state.or.us