Following its board’s months-long strategic planning exercise last year, the New Hampshire Children’s Health Foundation is embarking on a new initiative to assemble and use data to advance the state of children’s health in New Hampshire.
“The potential for this new body of work is exciting,” said foundation president Gail Garceau. “We anticipate the evidence-based data we will be able to provide to stakeholders, government officials and other funders has tremendous potential to advance the health and wellbeing of all New Hampshire children.”
The foundation has hired its first Director of Research and Community Impact, Alisa Druzba, to lead the project. Druzba previously served as the director of the Rural Health and Primary Care Section at the New Hampshire Department of Health and Human Services Division of Public Health Services for 18 years. She has a background in youth development, childhood trauma, strategies to improve access to quality healthcare, geographic equity issues, and health workforce development.
Druzba’s work will involve research and analysis of data, developing research insights for use in internal foundation planning and external stakeholder engagement, and convening the foundation’s external stakeholders to advance the state of children’s health in New Hampshire.
The Children’s Health Dashboard
Among her first projects will be the development of a NH Children’s Health Dashboard. The purpose of the dashboard will be to present data representing elements of children’s health ranging from factors like mental health to gaps in economic well-being and educational achievement. The dashboard will be refined and updated on an ongoing basis.
“Our goal with this project is to transcend the traditional, one-dimensional statistical scorecard and shed light on how the intersecting social determinants of health shape children’s health and well-being in our state,” said Druzba.
Specific social determinants of health include economic and housing stability, employment status, educational attainment, access to health care, access to healthy foods, exposure to crime and violence, and other environmental conditions.
Example: data used to develop lead paint public health response
For example, Druzba noted, lead paint was banned in the U.S, in 1978, but low-income and immigrant families are at much higher risk of exposure to lead because they tend to live in older housing stock. This exposure may come in the form of lead dust from lead-based paint, or pipes, faucets, and plumbing fixtures containing lead.
Young children are highly susceptible to poisoning from lead paint dust because their bodies are developing rapidly and more susceptible to taking in lead if exposed. The most common form of lead poisoning among young children stems from them swallowing lead dust after putting their lead contaminated hands in their mouths.
“No safe blood lead level in children has been identified,” noted Druzba. “Even low levels of lead in blood have been shown to affect learning, ability to pay attention, and academic achievement — and the effects of lead exposure may be permanent and include damage to the brain and nervous system.”
Using the available data, the public health solution, Druzba said, was to strategically increase blood lead level testing among young children.
For example, in 2015 the data indicated that 660 (5%) of children under the age of 6 in New Hampshire were reported to have blood lead levels at or above the level then recommended for public health action by the Centers for Disease Control and Prevention. Yet, statewide, only 53% of one-year-olds and 26% of two-year-olds were tested in 2015, suggesting that the actual number of children under 6 years old with elevated blood lead levels was likely much higher.
Using state blood lead surveillance data, the New Hampshire Healthy Homes and Lead Poisoning Prevention Program identified the five largest communities with lowest testing rates: Concord, Dover, Nashua, Manchester, and Rochester.
The program then worked with pediatric practitioners in those cities to raise awareness of the importance of blood lead level testing for young children. This resulted in a significant increase in testing rates for one- and two-year-olds by 2018 in all target cities.
“This is a great example of using data to identify a public health issue affecting children and bringing public health and health systems together to address it,” Druzba said.
“Obviously we are just beginning our project, but this is a good example of the type of issue we might identify using data which could be the catalyst for either a public policy or systems approach to addressing it,” she noted.
To that end, the foundation plans to promote the dashboard results to increase public awareness about deficiencies, inequities, and opportunities in children’s health, and partner with stakeholders to develop high-priority policy changes, investments, and interventions.
Druzba and the foundation are currently reaching out to stakeholders for input on the dashboard with an eye to developing a product that will be useful in leveraging the private and public investment and systems change needed to improve children’s health in the state.