Far From Gold Medal Performance

Jonathan Small

The Olympics were a source of great pride and entertainment for millions of people around the world. I was personally glued to the TV for two weeks and was filled with admiration and respect for these impressive athletes. I frequently found myself thinking about all the hard work and sacrifices needed for them to reach the pinnacle of their sport. I was inspired.

And then the director cut to commercial and I had the displeasure of seeing this ad from Cadillac. In it, actor Neal McDonough glorifies the value of hard work while berating the more leisurely lifestyle of other countries:

Other countries, they work. They stroll home. They stop by the café. They take August off. Off. Why aren’t you like that? Why aren’t we like that? Because we’re crazy-driven, hard-working believers, that’s why.

Then as he revs up his spanking new electric Caddy in the driveway of his ultra luxury home, he ponders the acquisition of material goods and posits they are “the upside of only taking two weeks off in August, n’est-ce pas?”

OK, fine. But what’s the downside? What price does our society pay for discouraging leisure time and mental health days? How much social capital do we lose when we don’t stop by the café?  How many families have dissolved under the pressure of our cultural norms? How many children lack the support systems necessary to achieve their optimal health? And don’t even get me started about maternity leave and childcare benefits.

The US has higher rates of infant mortality and childhood obesity than most other industrialized nations and lags behind in breastfeeding rates as well. These statistics are nothing to brag about. When viewed through a disparities lens, they are even more troubling. For example, the risk of infant death for babies born to non-Hispanic black women is more than two times greater than the risk of infant death for non-Hispanic white women. That’s horrific and embarrassing.

Maybe these “other countries” have something figured out about life balance, n’est-ce pas?

Certainly there is reason for optimism. Recent reports show obesity rates coming down and breastfeeding rates on the rise.  Infant mortality rates are also moving in the right direction and we are confident national initiatives will continue to drive them down.

But we have a long way to go before we get a gold medal in child health outcomes. I suggest we begin in a humble place – with the recognition that, while we may have much to teach other countries, we also have a lot to learn. Of course, this approach would not be very effective for selling cars.

9,000 Too Many

Earlier this week, members of the public health community rejoiced at a major victory for healthier Americans. After years of lobbying and the activism of public health professionals everywhere, we realized the fruits of our labor and paved the way for our children to live longer lives. I would have done cartwheels if I were coordinated, athletic, and wore proper cartwheeling shoes.

No, I am not talking about CVS’ decision to stop selling tobacco (although that’s pretty ground-breaking too).

I’m talking about this story. “Fewer U.S. children dying in car crashes.” According to a CDC report released on Tuesday, deaths occurring to children under 12 due to car crashes decreased by 43% from 2002 to 2011. Since crash deaths are the leading cause of child death in the country, this is a big deal.

As a public health advocate, there is nothing more I like better than seeing this kind of headline. But it was accompanied by this statistic: one in three children who died in car crashes 2011 were not wearing a seat belt. That means 3,000 car accident deaths of the 9,000 that occurred over the last decade might have been prevented if seat belts had been worn.

Even more startling was this study finding: Almost half of all black (45%) and Hispanic (46%) children who died in crashes were not buckled up. That’s 1 in 2 children between 2009-2010.

So how can we make sure we continue this downward trend in child deaths due to car crashes in the next decade? The evidence is very clear on public health strategies to prevent child deaths in car accidents. Parents should use appropriate car seats, booster seats and seat belts on every car trip. Strategies to reduce disparities in car accident deaths should also be developed and tested.

At NICHQ, we have applied quality improvement to some of the most daunting public health problems facing children, including childhood obesity, asthma, and sickle cell disease. When we start a project, it begins with a bold aim statement: What are we trying to accomplish?

Healthy People 2020’s objective is a good place to start: Increase age-appropriate vehicle restraint system use in children aged 0 to 7 years by 10% by 2020. But how can we get this done faster? How about 20% or even 30%? Let’s expand this goal to children aged 12 and under. Because 9,000 children is too many.

Weigh in on your ideas to realize this goal in the comments section. Or join our Facebook page and share your opinion!