FIMR FACES Carol Brady, MA


Carol is the Executive Director of the Northeast Florida Healthy Start Coalition and has served in this position for 15 years. Carol was an invited participant at the 2008 National Life Course Summit and is currently a member of the CDC’s Select Panel on Preconception Health, which developed recommendations to improve the health of women before pregnancy. She is also a founding member of the Everywoman Florida and Everywoman SE which were established to promote pre- and interconception health strategies in the state and region. Before taking her current post, she served as Executive Director of Florida Healthy Mothers, Healthy Babies, a statewide maternal/child health advocacy group, for eight years. Most recently, the Coalition has adopted a life course approach in its


IN THE LITERATURE


Rethinking MCH: The Life Course Model as an Organizing Framework Concept Paper U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau November, 2010.


According to the Maternal and Child Health Bureau: “This concept paper was commissioned by MCHB to provide a mutual understanding about MCH life course from which the broad MCH community can begin to shape its public health approaches for the 21st century. The paper clarifies and synthesizes the best thinking on MCH life course and outlines how the theory might be used to frame MCHB’s upcoming strategic planning process. The paper provides a series of examples for how a life course perspective might be incorporated into MCH research, programs, policies, and partnerships to optimize health outcomes and reduce


6


disparities across the population.” Read more here.


Lu M, Halfon N. Racial and ethnic disparities in birth outcomes: a life course perspective. Maternal and Child Health Journal 2003:7(1):13-30


This is the seminal research that introduced life course theory: In the United States, Black infants


have significantly worse birth outcomes than do White infants. The cause of these persisting racial disparities remains unexplained. Most extant studies focus on differential exposures to protective and risk factors during pregnancy, such as current socioeconomic status, maternal risky behaviors, prenatal care, psychosocial stress, or perinatal infections. The authors note that these risk factors during pregnancy, however, do not adequately account for the disparities. The authors conducted a literature


review for longitudinal models of health disparities, and presented a synthesis of


two leading models, using a life-course perspective. Traditional risk factors during pregnancy are then reexamined within their life-course context. The article concludes with a discussion of the limitations and implications of the life-course perspective for future research, practice, and policy development.


The authors identified two leading longitudinal models of health disparities. The early programming model posits that exposures in early life could influence future reproductive potential. The cumulative pathways model conceptualizes decline in reproductive health resulting from cumulative wear and tear to the body’s allostatic systems. They propose a synthesis of these two models, using the life-course perspective. They propose that disparities in birth outcomes are the consequences of differential developmental trajectories set forth by early life experiences and cumulative allostatic load over the life course.


A publication of the National Fetal and Infant Mortality Review Program • 202.863.2587


planning and service delivery, including the development of a grassroots leadership academy, an advocacy strategy for addressing social determinants that impact maternal and infant health. According to Carol: After nearly two decades, the fetal and


infant mortality review (FIMR) process continues to shape the way we look at poor birth outcomes and the strategies developed to improve the health of babies born in Northeast Florida. The community review process has helped us move beyond medical issues to consider—and attempt to act on—the social determinants that underlie many of the risk factors that contribute to infant mortality. I remain amazed at the adaptability


and relevance of FIMR. When we finally understood that disparities were driving our high infant death rate in Jacksonville, FIMR provided information that was an important


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8