Focusing "upstream" to Address Maternal and Child Health Inequities: Two Local Health Departments in Washington State Make the Transition

Two local health departments (LHDs) in Washington State, Spokane Regional Health District and Clark County Public Health, are transitioning their Maternal and Child Health (MCH) services from an individual-focused (mother-child dyads/family) home visiting model to a population-focused, place-based model. This paper describes the innovative process and strategies these LHDs used in applying existing MCH funding in new ways. The pilot communities selected in both jurisdictions for the initial transition were communities experiencing disproportionately high rates of maternal smoking, child abuse and neglect, births to single women, and low-income women on Medicaid. Available evidence suggested that the reach and effectiveness of existing, individual-level MCH approaches were not adequately improving these indicators in these communities. Using a population-based approach that addressed policy factors as well as social, organizational, and behavioral change; both counties developed neighborhood level initiatives directed at the root causes of health inequities. The approach included developing meaningful community partnerships, capacity building, and creation of a shared vision for community change. Both LHDs and their partners engaged county-wide groups in neighborhood selection, jointly established priority intervention areas, and actively engaged communities focused on reducing specific health inequities. With existing funding resources, the two county LHDs dramatically changed their practice to better address underlying conditions that threaten MCH. Early successes from these pilots have contributed to important local and state system-level changes in MCH programming as well as effective community-level efforts to reduce health inequities.