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

Annual Meeting
Washington, D.C. 
April 8, 2002

Thank you for this opportunity to share my thoughts on how critically important it is for us to continue working together to provide quality health care for all those mothers and children who count on us to get the job done.

I commend you all for your commitment and perseverance. Your work has great importance to Secretary Thompson and to all of us who are committed to improve the health care and status of women and infants in communities all across America.

You give your communities invaluable service. And we at HRSA are proud to call you partners. We are working together to ensure the health and well-being of our youngest citizens. As health care professionals, nothing we do could be more important.

I am honored that I speak to you today as HRSA Administrator. As you know, I had been serving as Acting Administrator since last March when Secretary Thompson asked me to come to HRSA.  When he appointed me Administrator last month, I was delighted to become part of the HRSA family. We are fortunate that we have such passionate support from Secretary Thompson for the work we do at HRSA. I can assure you that he cares deeply about our efforts to reduce the Nation’s infant mortality rate.

As you know, the President’s 2003 budget reflects some very tough choices that had to be made as the Nation and the Department focus on a series of new priorities.  We needed funds to strengthen the overall public health system, and we needed to immediately address many preparedness issues associated with the realities of the world after September 11.  However, in spite of all the new demands, I am happy to report that for 2003 the President has maintained funding for the Healthy Start program at the fiscal year 2002 level of  $99 million. This is a compliment to your dedicated efforts on behalf of healthy moms and babies everywhere.

The President’s FY 2003 budget also includes the new $20 million Healthy Communities Innovation Initiative, an effort to bring together community-wide resources to help prevent diabetes, asthma and obesity. This initiative builds on the model established by our Healthy Start demonstration program. And we know that imitation is the sincerest form of flattery.  Funds will target creation of healthy environments to improve the health outcomes in areas where death rates for asthma, diabetes, and obesity are too high.  HRSA has responsibility for this new effort in collaboration with the Centers for Disease Control and Prevention and the HHS Office of Disease Prevention and Health Promotion.

Currently 96 high-risk communities in 37 states, the District of Columbia, Puerto Rico, and the Virgin Islands participate in Healthy Start.  Beginning with prenatal care and continuing through the infant’s second year of life, we know that the Healthy Start communities are implementing evidence-based practices to reduce disparities. For example, projects focus on smoking cessation, screening and referral for depression, case management, and outreach to reduce behavioral and medical risk factors and to promote healthy outcomes for young women and their families. 

We are also working to increase prenatal provider screening for alcohol, to develop systems of care for addressing domestic violence, and establish state level infrastructure for women’s health – all activities that compliment the work you do with pregnant mothers.

To date, Healthy Start projects have made great strides in reducing infant mortality and helping mothers to have healthy infants. The provisional infant mortality rate for the year 2000 reached a historic low of 6.9 deaths per 1,000 live births.  This resulted predominately from a 4.1 percent decline in the rate for black infants -- from 14.6 to 14.0.  However, the preliminary mortality rate for black infants was 14.0, over twice the 5.7 rate for white infants.

Just last month, the Washington Post heralded the unprecedented decline of the infant mortality rate in the District of Columbia – the rate dropped by 20.7 percent from 1999 to 2000, reaching its lowest record level ever.  And the District’s Health Department Director reported that the local Healthy Start program achieved a zero infant mortality rate among its clients in 2000. We can all celebrate this kind of progress.

You know well the effects of low birthweight and preterm babies. I would like to comment briefly on a new study published in the January issue of Pediatric and Perinatal Epidemiology titled “Birthweight and Gestational Age Effects on Motor and Social Development.”  The research for this study was conducted by a team at the National Institute of Child Health and Human Development and included HRSA’own Dr. Mary Overpeck.  This new research indicates that babies born less than 5 ½ pounds or before 37 weeks of pregnancy may experience delays in motor and social development throughout early childhood, up to age 4. 

The researchers urge health care providers to consider both low birthweight and preterm delivery when evaluating development in young children -- a message I know you will take back to the providers in your community.

In closing, I share with you my belief that strengthening partnerships is the best way to create healthy families and communities. We must continue working together to reach the goals we all share. We all want to see an America where good healthcare is a steppingstone to childhood success and a future of fulfilled ambitions. We all want an America where children everywhere are able to enjoy active, productive lives. Our children are the hope of tomorrow, and we must do all we can to help them meet their full potential.

We can be proud that our work improving maternal and child health has a tremendous payoff for the Nation.  With you -- and people like you in communities across America -- working collectively and collaboratively to build quality systems of care, I am confident we can do an even better job of meeting the needs of mothers and babies.