Remarks on the Healthy Start Program

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U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376


by HRSA Administrator Mary K. Wakefield

September 12, 2011
Washington, D.C.

I’m very happy to be here with the National Healthy Start Association to celebrate the good work of HRSA’s Healthy Start grantees in fighting high rates of infant mortality and disparities in perinatal health among Hispanics, Native Americans, African Americans and other minority populations.

And I’m happy, too, to join all of you in marking the 20th anniversary of the program.

HRSA’s oversight of the Healthy Start program began in 1991 when we funded 15 communities struggling with high rates of infant mortality.

Today HRSA is proud to support 105 Healthy Start providers in 39 states, Puerto Rico and the District of Columbia.

The program has grown because it has been successful in reducing infant mortality in communities at highest risk for adverse outcomes.

Healthy Start has developed a wonderfully effective model of innovation.  Grantees pull together a consortium of stakeholders committed to reducing infant mortality and eliminating disparities in perinatal health.  These stakeholders develop a plan to reach at-risk pregnant women and mothers in a culturally and linguistically sensitive manner.  Then they intervene with services that include direct outreach, case management, health education, interconceptional care and screening for depression.  And they take those services where the patients are – to their homes if necessary.

Those interventions bring results.

In 2009, the national infant mortality rate was 6.42 per 1000 live births.  But the infant mortality rate for Healthy Start participants was 6.0 per 1000 live births!  That means that the efforts of our Healthy Start grantees have driven mortality rates that were once far higher than the national average to below the current norm. 

It’s a great story.  And you’ll hear more about successes in their home communities from the people who’ll follow me here today.  

But let me highlight a few of them myself first.  From 2007 through 2009, 13 Healthy Start grantees reported no infant deaths in their communities.

And another 10 grantees reported no infant deaths in 2008 and 2009.

Those are important statistics and I congratulate anyone who is here from those grantee communities.  You have done good work and we at HRSA are proud to be your partners. 

Healthy Start is one of our best weapons in the fight to lower infant mortality, but the Administration is moving to improve the health of American infants and children and their mothers on many fronts.

You’ll remember that one of President Obama’s first actions on taking office was to push for and sign the reauthorization and expansion of the Children’s Health Insurance Program.  That act has boosted insurance coverage for children from low-income families from 7 million in 2009 to 11 million children now.

And by overseeing passage last year of the Affordable Care Act, he has guided U.S. health care into a new focus on expanding access, improving quality, and promoting wellness and prevention for all Americans.

All of us benefit from the Affordable Care Act, but parts of the legislation clearly aim to improve the health of mothers, infants and school-aged children.

The ACA’s most significant new program in this area is the Home Visiting program that HRSA operates in collaboration with the Administration for Children and Families.

Under the program, nurses, social workers and others will visit expectant mothers and their families in high-risk communities.  There, they will provide evidence-based counseling and intervention services designed to improve health outcomes for mothers, infants and families.  As the Healthy Start program has shown, it makes more sense to provide preventive care sooner rather than more costly clinical care later – that’s a theme that runs throughout the Affordable Care Act.

This year the Home Visiting program gets underway nationwide, supported by a first installment of $227 million of an anticipated $1.5 billion over five years.

HHS Secretary Kathleen Sebelius said the Home Visiting program “will give children a healthier start” – note the language there – “and give parents the help they need to succeed in the most important job in the world – parenting.  This effort builds on impressive research findings and is one more piece of our strategy to invest in prevention and early interventions that pay off.”

The ACA also mandated that new preventive health services be made available to women starting next year at no additional cost.  On the first of August, Secretary Sebelius released a list of covered services, which include breastfeeding support, domestic violence counseling, and routine screening for gestational diabetes, HPV, and a range of other conditions associated with poor birth outcomes.

And in a broader sense, the Affordable Care Act will impact infant mortality by expanding access to primary care for Americans everywhere.

For example, HHS recently awarded $95 million to 278 school-based health center programs in 42 states, the District of Columbia and Puerto Rico to renovate and expand their facilities in order to provide health care services to nearly a half-million more children.

These grants represent the first installment of $200 million through 2013 for the School-Based Health Center Capital Program.

Together with the 790,000 students already being served in federally supported school-based clinics, these additional funds will make it possible for more than 1.2 million young people to receive primary and preventive care where they go to school.  High school students make up about a third of that total – and among them are certainly pregnant teenagers who desperately need the care they find in school clinics.

Of course, the School-Based Health Center funds are just part of a five-year, $11 billion expansion of health centers nationwide.

Today, there are more than 1,100 health center grantees that provide care to 19.5 million patients.  Of that number, more than 11.4 million patients are women and girls – that’s about 6 of every 10 patients.  And health centers provide perinatal care to a half-million women every year.

With the new ACA investments, all of those patient numbers will increase in coming years – and those increases will impact women’s health and infant mortality rates.

I should add that this past Friday we announced the availability of about $700 million for renovation and construction at existing health centers across the nation. These ACA funds will increase access to primary care in underserved areas and create jobs in those communities as well.

To staff this expanding primary care infrastructure, HRSA received $1.5 billion through the ACA to increase the ranks of the National Health Service Corps.

The Corps is comprised of primary care advanced practice nurses, nurse midwives, physicians, dentists, psychologists and others who agree to provide primary care for at least two years in communities where health care is scarce.

In exchange, the federal government – through HRSA – gives them up to $60,000 tax free over that period to repay student loans.

Just three years ago, the Corps had 3,600 providers in the field.  Now, thanks to President Obama’s leadership, we’ve more than doubled the Corps’ ranks across America to 7,530, and we hope to have some 9,000 clinicians providing primary care to more than 9 million people by the end of FY 2011.

All of these programs complement the Healthy Start program by providing an array of important services and health care clinicians.  They’re also important going forward because even with the positive outcomes of the Healthy Start program, the rate of infant mortality in the United States remains stubbornly higher than the rate in other developed nations.  We trail all but a few European nations.  Without Healthy Start, we’d probably look even worse.

And we need further action because even though infant mortality in the United States has decreased in the last decade, the gap between white and minority Americans has not closed.  Infant mortality among African American women is more than twice that of white women.  And for Hispanics and Native Americans, rates of infant mortality and low birth weight are significantly higher than that of the white population.

So to fight infant mortality and reduce disparities in perinatal health, we need to continue our support of Healthy Start and Title V block grants to states.  And by bringing to bear additional resources made available through the Affordable Care Act – investments in health centers, Home Visiting nurses and National Health Service Corps clinicians among others – we can reduce infant mortality even further and, in the process, build a far healthier nation.

Thank you.

Date Last Reviewed:  April 2017