# Presentation: 586983

## Public Health In the Southwest:  Children’s Health Issues

- Mary E. Rimsza, M.D.
- Arizona State University
- 480-965-1622
**Mary.Rimsza@asu.edu**

## Southwestern Child Health

- Ethnic Diversity
- Urban, Rural, and Frontier Regions
- Border States with undocumented children
- Uninsured and Underinsured
- Antigovernment Culture

## Arizona Child Fatality Program

**Provides an ongoing multidisciplinary review of all child deaths   **
**Determines which deaths were preventable.**
**Develops data driven recommendations for prevention statewide.**
**Local teams develop community specific prevention strategies.**

## Child Fatality Review Program:  Mission

- To reduce  preventable child fatalities by reviewing child deaths and making data-driven recommendations for community-based prevention, education, legislation, and public policy.

## Preventable Deaths

- A child’s death is considered preventable if an individual or the community could reasonably have done something that would have changed the circumstances that led to the death.

## Child Fatality Review process

**Death certificate sent to team**
**Team requests records**
**Multidisciplinary local team reviews records **
**Standardized data form is completed **
**The data is entered into a state database**
**State team produces annual report**

## Composition of the State Child Fatality Review Team

- The Attorney General’s Office
- The Department of Health Services
- The Department of Economic Security
- The Governor’s Office for Children
- The Arizona Supreme Court
- The Department of Youth Treatment and Rehabilitation

- The Arizona Chapter of the American Academy of Pediatrics
- A medical examiner/ forensic pathologist
- A maternal and child health specialist involved with the treatment of Native Americans

## Composition of the State Child Fatality Review Team cont.

- Inter-Tribal Council of Arizona
- The Navajo Nation
- The United States Military Family Advocacy Program
- The Arizona Sudden Infant Death Advisory Council

- Prosecuting Attorneys advisory council
- Law enforcement officers advisory council
- Association of county health officers
- A child advocate not employed by the state
- A public member

## Southwestern Child Health

**Ethnic Diversity**
- Urban, Rural, and Frontier Regions
- Border States with undocumented children
- Uninsured and Underinsured
- Antigovernment Culture

## Ethnic Disparities in Total Death Rate

- Ethnicity				Death Rate
- Black					86.5/100,000
- Hispanic				81.6/100,000
- American Indian		70.8/100,000
- White,non-Hispanic		51.8/100,000

## Preventable Deaths:  1995-1999 

- 4,800 child deaths reviewed (95% of total)
- 1,400 preventable (29%)
- 5% of neonates-preventable
- 26% of infants 28 days to 1 year-preventable
- 33% of deaths in children 1 to 9-preventable
- 56% of children over 9-preventable

## Preventability of Leading Categories of Deaths (1995-1999)

| Motor Vehicle Crashes
 | >90% preventable   |
| --- | --- |
| Drowning  	 | > 85% preventable             |
| Child Abuse | 61% preventable |
| Medical Conditions
 | < 10% preventable    |

## Ethnic Disparities in Preventable Deaths

**Ethnicity****	**		**Preventable Death Rate**
- American Indian		33.6/100,000
- Black 			25.8/100,000
- Hispanic			23.4/100,000
- White				14.2/100,000

## American Indian Children

- Highest Preventable Motor Vehicle Crash Deaths (18.6/100,000)
- Highest Preventable Intentional Injury Deaths (8.4/100,000)
-  Average Preventable Medical Condition Deaths (4.7/100,000)
- Lowest Infant Mortality (446.3/100,000)

## Hispanic Children

- 2nd Highest Preventable Motor Vehicle Crash Death (15.2/100,000)
- Lowest Preventable Medical Deaths (2.3/100,000)
- Highest Total Adolescent Deaths (98.3/100,000)

## Black Children

- Highest Infant Mortality (1,083/100,000)
- Highest Preventable Medical Deaths (7.4/100,000)

## Southwestern Child Health

- Ethnic Diversity
**Urban, Rural, and Frontier Regions**
- Border States with undocumented children
- Uninsured and Underinsured
- Antigovernment Culture

## Rural Public Health Issues

- Tribal Governance and Public Health
- Limited Health Resources for everyone
- Injury-Prone Play Environments
- Reliance on Automobiles
- Access to Guns

## Guns and the Old West

## Urban Public Health Issues

- Limited Health Resources for uninsured
- Backyard Swimming Pools
- Reliance on Automobiles
- Access to Guns

## Southwestern Child Health

- Ethnic Diversity
- Urban, Rural, and Frontier Regions
**Border States with undocumented children**
- Uninsured and Underinsured
- Antigovernment Culture

## Border Issues

- Lack of Health Care Resources for undocumented
- Border Crossing Deaths (7 deaths in 2002)
- Unwillingness to cooperate with Public Health surveillance if undocumented
- Transporting Infectious Diseases across borders

## Additional Information

- Mary Ellen Rimsza MD
- School of Health Administration & Policy
- W. P. Carey  School of Business
- Arizona State University
- mrimsza_[@asu.edu](mailto:n@asu.edu)_
- 480-965-1622