Dr. Washington Hill Writes: Save Healthy Start

The following guest column appeared in today's Sarasota Herald-Tribune. Dr. Washington Hill, director of maternal-fetal medicine and medical director of labor and delivery at Sarasota Memorial Hospital, has been a long time friend and supporter of Healthy Start Coalitions. Please read his evidence based call to action for consumers and legislators to act now to stop the elimination of this life saving organization.

Florida enacted the nation's most comprehensive maternal and infant health-care program on June 4, 1991. It was called the Florida Healthy Start Initiative. The goal of Healthy Start is to reduce infant mortality, reduce the number of low birth- weight babies and improve health and developmental outcomes. It does all of these very well.

The key components of Florida's Healthy Start include universal prenatal and infant risk screening, care coordination and services, community-based prenatal and infant health-care coalitions, children's medical services expansion, and increasing Medicaid eligibility for pregnant women.

Florida has reached a crossroads with this program. The state House of Representatives has eliminated Healthy Start Coalitions in its budget and transferred the direct-service dollars, minus 15 percent of those dollars, to county health departments. Some health departments are not equipped to do this and in some instances are restricted from performing some of these activities.

The Senate budget has no such cuts. Over the next weeks, as the legislative conference committees are being formed, the fate of Healthy Start is really unknown.

Keep in mind that 1,912 infants in Florida did not even survive to celebrate their first birthday in 1990. That same year, 5,341 women did not receive any prenatal care whatsoever during their pregnancy and an additional 8,567 woman in Florida did not receive prenatal care until their third trimester. The Centers for Disease Control and Prevention identifies lack of prenatal care as one of the leading causes of infant mortality.

In the past, the Legislature recognized the need to reduce infant mortality and promote healthy childhood development and created the Healthy Start program to address those needs. For 19 years it has worked well and we need it to continue.

If the change proposed in the House budget occurs, program costs will increase, opportunities for additional fundraising will be diminished, community decision-making, education and partnerships to meet local needs here in Sarasota and around Florida will cease, and the momentum to decrease fetal and infant mortality prematurity and low birth weight babies in Florida will also be lost forever.

Thirty Healthy Start Coalitions now cover 64 of the 67 counties in Florida. These coalitions remove barriers to health care and effectively promote healthy outcomes and a healthy start for babies. While 25 of the 67 county health departments do not even provide prenatal care, Sarasota County is not one of them. We are blessed with a superb obstetrics program called Mother's Care Center.

Healthy Start Coalitions have also established provider networks to ensure all pregnant women have access to care. In Sarasota County this occurs through numerous, very competent healthcare providers and maternal-fetal medicine specialists. A change in delivery of the services would mean the loss of millions of additional dollars. In one year alone coalitions raised $32 million from other funding sources. This money was used to support projects targeted to meet the needs of individual communities. In Sarasota County more than $80,000 in in-kind services were provided to pregnant women or new moms in Healthy Start. More than $47,000 in additional grants and donations helped us run our programs. This is a perfect example of how public/private partnerships promote a "less government" approach to services.

The success of Healthy Start speaks for itself. I see that success every day at Sarasota Memorial Hospital and the county. Infant mortality has decreased 20 percent since the coalitions were established in 1991. By increasing access to care, Healthy Start prevents maternal and child health issues that are not only devastating but costly. First-year medical costs for a premature birth alone are about 10 times those for a full- term infant. The work of Healthy Start decreases the number of preterm births, high-risk infant births and high risk mothers. Sarasota County cannot afford to lose the benefits gained from Healthy Start Coalitions. If Healthy Start Coalitions are eliminated or their budget decreased as proposed, we will lose out on the benefits of this model, which has proven to be successful. This is a best-practice model that Sarasota County and Florida cannot do without.

We need to all make sure that the proposed elimination of funding for Healthy Start Coalitions around the state does not occur and recognize that the coalitions are a valuable resource in improving maternal and child health.

All of us understand the difficult decisions that our legislators have to make regarding the Florida budget. However, it makes no fiscal or ethical sense to eliminate Healthy Start Coalitions. The fiscal reality is that if Florida does not pay upfront for the prevention of maternal and child problems, it will pay after delivery an even higher cost to treat them.

Sarasota County and the rest of Florida need Healthy Start.