November is Prematurity Awareness Month and November 17th marks World Prematurity Day. This day is designated to draw awareness to the devastating affects of this major public health issue. Prematurity, or preterm birth, is any birth prior to 37 weeks gestation. It is the leading cause of death in children before their first birthday, and it can lead to a vast array of long term developmental and health problems for the infant that can severely impact his or her future health and well-being.
The emotional effects on the families of preterm babies are unimaginable and the financial effects can be overwhelming. The financial costs include medical and health care costs for the baby, labor and delivery costs for the mother, early intervention services for developmental delays, special education services, and lost work and wages.
Of the ten counties in California with the highest rates of preterm birth, Fresno County has the highest number of preterm births.
A conservative estimate of the cost of preterm birth in Fresno County is $78 million annually.
In our county, significant racial / ethnic disparity exists in preterm birth rates. The rate for African Americans is 12 %, compared to 7.3% for non-Hispanic whites. Also, 60% of preterm births in Fresno County are Hispanic. But ALL races and ethnicities in Fresno County experience preterm birth at rates higher than the state overall rate.
The exact causes of preterm birth are not well understood, but multiple risk factors have been identified.
Risk Factors Include:
- The age and health of the mother before and during pregnancy
- Number of pregnancies and intervals between pregnancies
- Numerous environmental and societal factors, factors that will require the sustained, common will of the entire community to adequately address.
A very fortunate and timely opportunity to address this critical public health issue in Fresno County, through all eight of the Pillars of Public Health, presented itself in June of 2014. At that time the University of California San Francisco (UCSF) was awarded a substantial 10 year gift to address preterm birth globally. In July of 2014 Fresno County was considered, along with two other counties, as to the feasibility for a collective impact approach to the problem.
Fresno County was selected because of the significant work put into coalescing the collaborative environment in recent years. A steering committee to initiate this collective impact approach to reducing preterm births in Fresno County was launched on April 9th of this year.
This 20 member steering committee represents all eight Pillars of Public Health, individuals, families, educators, retailers and businesses, medical and mental health providers, employers, community leaders, and public officials.
The committee has fashioned a set of guiding principles to direct the collaborative work. The guiding principles establish that, in Fresno County, every baby deserves a healthy start and every woman and family equitable access to life opportunities. The guiding principles establish that this is the shared responsibility of the entire community. These guiding principles further establish that the initiative will seek to
1) Engage all systems that directly affect women, infants, and families.
2) Collaborate directly with, and listen to, women and their families.
3) Focus on approaches that are inclusive, equitable, innovative, and responsive to
women and their families.
4) Leverage and align our community's significant assets.
5) Create changes that will be adopted and sustained by the people and
institutions of Fresno County.
The steering committee has also selected a strong, independent organization to serve as its backbone support, which will act to implement the initiative's vision and strategy, support aligned activities, establish shared measurement practices, build public will, advance policy, and mobilize resources.
Currently the steering committee is finalizing its vision and goal and establishing focus areas toward achieving that goal, with input from virtually every sector of the community. From this common agenda of goal and focus areas, workgroups will be formed, under steering committee direction, and using shared measurements, mutually reinforcing activities, and continuous communication, to determine ways to address the various aspects of preterm birth in Fresno County.
These workgroups may well link with collaboration efforts and public health partners already focused on infant and maternal health, early childhood and academic success, and other areas of public health.
The opportunity to engage the entire community in all areas of our community's health and well-being is here. I look forward with great anticipation to the outcomes.
Here's to your health!
Dr. Ken Bird, Fresno County Health Officer
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