The Foundation of the Future of MCH
The accompanying article on the Future of Public Health is a timely call to action. It reminds us of our strong roots and also compels us to consider larger societal issues in pursuing our shared goals.
KeywordsMCH State federal partnership Social determinants of health Workforce development
Michael Lu has penned an important call to action upon his departure from the highest leadership position in maternal and child health in the country (Lu 2018). From 2011 to 2017, Dr. Lu served as the associate administrator of the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. From this vantage point, Dr. Lu developed both a broad and a deep understanding of the current approaches we use, individually and collectively, to promote and to protect the health of the nation’s women and children. His essay contains ample doses of science-based evidence, systems-thinking, and future visioning in the framing of an urgent agenda for all of us to follow to be better stewards of our shared responsibility, and as accelerators of transdisciplinary, translational, and precision science. He imagines the potential of science, technology, big data, and progressive improvements in society, all of which must be both championed and harnessed for good. He makes similarly compelling arguments around looming threats, including climate change, infectious diseases, chronic diseases, and crumbling infrastructures. In each case, he offers concrete steps that—if not immediately embraced universally—offer an important starting point for conversation.
In the end, his call is a call to lead, a call for leadership, and I might argue, a call to return to our roots and the legacy left us by our forefounders. The charge to the Children’s Bureau, the first agency of its kind in the world when created in 1912, was simple yet powerful: to investigate and report on all matters relating to child life and welfare among all classes of our people (U.S. Congress 1912). Not only has this charge stood the test of time, but these words strike a ringing chord as we seek to explore Dr. Lu’s exhortations. Building the evidence base and applying scientific knowledge to the wicked problems of today is to “investigate and report.” Addressing myriad social, structural, environmental, and political threats to maternal and child health is to boldly accept responsibility for “all matters relating to child life and welfare.” Insisting on population-wide commitments to health equity and social justice honors the responsibility to “all classes of our people.”
With an eye clearly on the future and our feet squarely on the foundation established over a century ago, I would enhance his powerful list by highlighting three imperatives suggested by Dr. Lu.
We can no longer be silent on the pernicious and pervasive effects of racism and poverty on the life trajectory of the nation’s children. Our zeal to achieve success in research, intervention design, and program management must be matched by equal fervor in the policy arena with intense focus on these essential determinants of health.
Workforce strategies must recognize and embrace the multi-disciplinary nature of maternal and child health work. Like “health in all policies” approaches, the time for “MCH in all educational programs” is long overdue. This is true in all of the health professions but it is equally true in all professional educational programs whose graduates can and will impact the factors that affect the lives of children and their families in communities across the country.
We must celebrate and fully optimize the strength that is the partnership between the federal Maternal and Child Health Bureau and the 59 state and territorial offices that are the backbone, the hands, and the heart of maternal and child health. With embarrassingly few resources, this army of passionate practitioners across the states needs to be continuously supported vertically and horizontally by the federal bureau. The energy, talent, and experiences of 59 natural laboratories should, with intense purpose, be harnessed, elevated, examined, and honestly evaluated for emergent trends, promising strategies and opportunities for collective action.
Dr. Lu has provided us with a precious gift, a thoughtful provocation for all of us in the maternal and child health field to stop what we are doing and consider how to have this very important conversation about our future and the futures of those we profess to serve. He has given us the why; he has also given us the when: the time is now.
- U.S. Congress. (1912). An act to establish in the Department of Commerce and Labor a Bureau to be known as the Children’s Bureau. 37 US Statutes 79.Google Scholar