Remarks to the Secretary's Advisory Council on Infant Mortality 

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Acting Administrator, Health Resources and Services Administration

SACIM Meeting
Washington, D.C.
November 14, 2001

It’s my great pleasure to welcome you all to this Secretary's Advisory Committee Meeting on Infant Mortality.  Thank you, Peter and Kerry, for asking me to join you today. You and your MCH team have shown such dedication in dealing with the many challenges facing the Nation’s mothers and children.  In so doing, you’ve kept MCH and the important work of this committee going. 

Your sustained commitment helps us at HRSA meet our fundamental mission of ensuring greater access to quality health care for some of the country’s most vulnerable families and individuals.

We all want an America where children everywhere are able to enjoy active, productive lives. And, at HRSA, we continue to work toward that goal. Our children are the hope of tomorrow, and we all must do what we can to help them meet their full potential.

Before I speak more about HRSA’s ongoing efforts to ensure a healthy start for all children, I’ve been asked to give you a brief update on some of our emergency response activities since September 11. I can tell you that maternal and child health concerns have been a high priority as we’ve garnered all our resources to meet the many challenges brought on by this national tragedy.

Secretary Thompson recently announced $10 million in emergency grants to 33 New York City and northern New Jersey health centers to help them continue to provide essential health services to area residents. These awards are part of the $5.1 billion in disaster-related funds released by President Bush on September 21.

As you know, HRSA-supported community health centers normally provide care to thousands of residents who would not otherwise have access to health services.  Following the attacks, area centers saw substantially higher demand for their health care services, and the increased demand is expected to continue in the coming months, especially for grief counseling and other mental health services.  Two centers near the World Trade Center had their operations briefly interrupted following the attacks.  Others sent staff members to assist at area hospitals and the disaster site.

We’re also looking closely at maternal and child health state block grants to see how we can best meet some of the emerging needs resulting from this crisis.  The New York state MCH office operates more than 100 school-based clinic sites in Manhattan for children from kindergarten through high school.  We know we need to bolster their mental health components. The emotional trauma will be great throughout the tri-state area for children and adolescents who have lost family and friends.

Additionally, MCH programs in the five states affected by the multiple attacks – New York, New Jersey, Connecticut, Virginia and Pennsylvania – are:

• monitoring the MCH hotline calls for increases in requests for mental health  counseling;
• assessing the need to distribute material on post-traumatic stress disorder to children and families; and
• checking their prenatal programs for increases in domestic violence and post-partum depression.

I’ve been so impressed by the everyday heroism of agency personnel -- not only of those who’ve been on the ground but also of those for whom simply coming to work each day has taken on a new dimension. We continue to work together undaunted in our effort to protect the public health.  I believe September 11 has given all Americans a renewed appreciation for the vital national role of our government, of the Department of Health and Human Services, and of our grantee partners.

To ensure that we continue to serve the American people well, President Bush and Secretary Thompson are determined to get as much of our money as they can into direct medical services for those most in need.

In President Bush’s proposed FY 2002 budget, HRSA will weave together an ever-tighter health care safety net for American families through three critical presidential initiatives:

• The first, the Health Centers Presidential Initiative, asks for $1.3 billion for health centers, an increase of $124 million above the FY 2001 appropriation.  These additional funds will allow health centers to create or expand 200 access points and serve up to 1 million additional patients, almost half of them uninsured.  The added funds represent the first installment of the president’s plan to increase or expand health center access points by 1,200 over five years and eventually double the number of people served.

• The second presidential initiative looks to reform and improve the National Health Service Corps.  This initiative will look at several issues, including the ratio of scholarships to loan repayments, and will consider amending the Health Professional Shortage Area definition to include non-physician providers and J-1 and H-1C visa providers practicing in communities.  These efforts will enable the NHSC to more accurately define shortage areas and target placements to areas of greatest need.

• The third presidential initiative, called the Healthy Communities Innovation Initiative, will create a partnership among agencies in the Department of Health and Human Services to target existing resources to areas where health needs are greatest.  Under the plan, HRSA would make available about $220 million through current grant activities, with other funding coming from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. HRSA activities that may contribute to the goals of this Initiative include the Maternal and Child Health Block Grant, Community and Integrated Service Systems, and the Healthy Start program.

The Secretary has also challenged us to find ways to improve health care access to the 65 million Americans who live in rural areas.   To meet this challenge, an HHS Rural Task Force was  formed with representatives from all HHS agencies and staff offices to develop strategies to enhance health care services in the Nation’s rural communities. Finding ways to strengthen rural families is a key part of the final report to the Secretary.

HRSA-supported programs are designed to serve women with low incomes as well as those who live in rural or other underserved areas. The goal is to help them get the care they need to improve their health and the health of their babies. While we’ve made great progress on this front, the infant mortality rate remains too high in the United States. 

Secretary Thompson is passionate in his resolve to narrow the racial and ethnic divide that persists in infant mortality.  And, of course, we at HRSA have made this one of our top priorities.

According to preliminary data from 1998/99, mortality rates among white infants decreased 3 percent to 5.8, while the 14.6 rate for blacks was not statistically different from 1998.  That means, although the trend in infant mortality rates among blacks and whites has been on a continual decline throughout the twentieth century, two and a half times more black babies than white babies die each year in this country.

And access to first-trimester prenatal care by black and Hispanic mothers remains behind access for white mothers.  HRSA puts special emphasis on reaching out to women who’ve previously gotten late or no prenatal care.  The agency seeks to bring them into the health care system for life, whatever barriers have previously stood in their way. 

Our Healthy Start Initiative has had much success in getting rural, isolated, teenage or urban women from many different backgrounds into prenatal care. Whether it’s anxiety over receiving care, the inability to pay for care or find transportation to get to the doctor or health clinic, HRSA programs and personnel have and will continue to come up with innovative ways to meet these challenges right in a woman’s own community.  

In closing, let me emphasize how much we value your expert advice and counsel as we continue the fight to take down the barriers to quality prenatal care. As an Advisory Council, you play a central role in helping to meet the goals we all share. Your work has great importance to the Secretary and to all of us who are committed to improve the health care and status of women and infants in communities all across America.

I urge you to continue to let us know what is important to you ... what works and what doesn’t...and what problems need to be overcome.

At HRSA, our pledge to you is this: when you talk, we will listen and respond.