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Healthy Babies, Healthy Business: Cutting Costs & Reducing Premature Birth Rates


RADM Steven Galson M.D., M.P.H, Acting Surgeon General


Washington, DC


Tuesday, March 17, 2009


RADM Steven Galson M.D., M.P.H
Acting Surgeon General
U.S. Department of Health and Human Services

Morning Keynote to March of Dimes/U.S. Chamber of Commerce Luncheon

“Healthy Babies, Healthy Business: Cutting Costs
& Reducing Premature Birth Rates”

Tuesday, March 17, 2009

Thank you, Jennifer (Dr. Jennifer Howse, President, March of Dimes) for that gracious introduction.

And thanks also to you Bruce (Bruce Josten, Executive Vice President, US Chamber of Commerce) for your thoughtful welcoming remarks.

I know that Janis Bierman played an instrumental role in putting this session together. Thank you, Janice.

I am honored to be here. The effort to do more to prevent pre-term birth has been one of the most meaningful activities of my tenure as Acting Surgeon General.

Most of us in this room know at least one family impacted by a pre-term birth. I know a few.

The human costs are staggering. The medical costs are staggering. That’s why we’re here.

So I salute your organizations, your commitment, and your leadership - all that you bring to the table in this common effort. 

Today you’re going to hear that preterm birth is a not just a significant public health issue but that it also impacts businesses and employer health plans.

You’re going to hear examples of business, health and social service successfully working together to reduce premature birth.

This session is fitting successor to the Conference on the Prevention of Preterm Birth that my office convened last June with NIH/NICHD and the March of Dimes.

We know that in addition to its major impact on the infant mortality rate, preterm birth can  lead to an increased incidence of long-term disability, including congenital neurological problems such as cerebral palsy.

The most shocking aspect of this problem is the rate of preterm birth has increased 18 percent since 1990 – YES 18 percent since 1990.

Approximately one-half of preterm births occur in women with no known risk factors, and today no screening tests exist to accurately identify women who will deliver preterm.

Recent estimates by the Institute of Medicine (IOM) suggest that at least $26.2 billion -  that’s 26.2 BILLION- is spent each year for the hospitalization of preterm infants, not including re-hospitalizations and long-term care.

A good number of newborns covered by employee health plans are born prematurely.  That means more direct health care costs for premature babies during the first year of their lives.

Premature birth is not just about higher direct costs – these births lead to longer stays in the hospital and more visits to the doctor than a full-term baby.

This takes an emotional toll on the parent but it means more time spent away from work, frustrating employers,  parents and families.

Parents want to take care of their child, but they also need to put food on the table.

Businesses are sympathetic, but they don’t want employees gone or distracted from work.

So, the work that the March of Dimes and the Chambers of Commerce are doing to encourage businesses to address the problem of preterm birth is important.

Employees’ health insurance must provide adequate prenatal care. And employers should provide an environment where pregnant women and fathers are supported with educational materials related to having a healthy pregnancy and providing proper infant care.

In the long run, this approach will benefit you, the business owner, and it will also benefit the millions of children born in this country every year.

At the Department of Health and Human Services, the prevention of pre term birth continues to be a priority.


Our work, over decades, has involved scientists, researchers and public health officials from throughout the Department.

For instance, the Centers for Disease Control and Prevention data helps us better understand the connection between health disparities and preterm birth.

The National Institutes of Health—through its Eunice Kennedy Shriver National Institute of Child Health and Human Development—conducts research into the causes of preterm birth, the means to prevent it, and ways to treat the health problems of premature infants. 

Everyday the Agency for Healthcare Research and Quality works to improve the quality, safety, efficiency, and effectiveness of health care services for all Americans, among them pregnant women and their newborn children. 

The Maternal and Child Health Bureau of the Health Resources and Services Administration sponsors programs to help women conceive and maintain healthy pregnancies, and supports the healthy development of children. 

In addition, the Health Resources and Services Administration supports nearly 100 Healthy Start sites in the United States and Puerto Rico that provide case management, depression screening, and educational activities for women in communities with high rates of infant mortality and limited health care access.

HRSA programs are dramatically growing under the President’s Economic Stimulus program – over the next two years, a total of $2 billion in Recovery Act funding will be invested in Community Health Centers to support renovations and repairs, investments in health information technology, and critically needed health care.  This is good news for the more than 16 million people in the U.S. treated at Community Health Centers every year – some of them pregnant mothers.

The Recovery Act also includes investments in electronic health records, prevention, comparative effectiveness research, and health workforce training -- foundations for a 21st century health care system. 

We have made progress in our efforts to find the causes of preterm birth and the means to prevent it.

However, we recognize more needs to be done.

Pre-mature birth remains a challenge.

The preterm birth rate rose again in 2006, to 12.8 percent of all births, from 12.7 percent in 2005.

Advances in perinatal and neonatal care have improved survival for these preterm infants; however preterm infants who survive have a greater risk than other infants for developmental disabilities, health problems and poor growth.

And disorders related to short gestation and low birth weight continue to be the second leading cause of infant mortality.

The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions.

Our situation underscores the need and continuing value of collaborative, cross-disciplinary approaches to reduce preterm birth rates.

That’s why you’re here today.

The collaborations between the March of Dimes and the U-S Chamber is a fine example of a working partnership to bring attention to an issue that affects everyone from every region, every race and every socio economic status.

And we need more collaboration if we are going to do something about the rising rates of preterm birth.

Now, where do we go next? 

How do we most effectively build momentum and measure the Nation’s progress in eliminating premature birth as a public health challenge? 

During our conference to address preterm birth last summer, conference participants established an agenda. 

That agenda included recommendations for biomedical research, refining and testing clinical interventions, addressing racial and ethnic disparities in preterm births,  and the need to better understand how to design, implement and evaluate the impact of community interventions.

It also includes the need for health systems and providers to incorporate quality measures to evaluate their care.  These measures must be based on the best available knowledge and must continue to evolve as our understanding of effective interventions improves.


Education and Training

Continuing education of health care providers is needed.

Education will improve the ability of health care providers to discuss the risks and hazards of preterm birth with their patients, clients, families and communities.

However, we also need to educate the workforce. As I said earlier, the workplace environment should be a place where mothers and fathers can receive information on how to maintain a healthy lifestyle and prevent the incidences of preterm birth.

A mother should be made aware of the complications associated with stress, poor prenatal care, smoking, and drug use during pregnancy and the importance of having a strong social support network.

I believe that in this country we can provide a work environment that educates our mothers and fathers about how to have a healthy pregnancy.

Creating a health-benefit program for your employees is a win-win proposition for everyone especially with the rising rates of premature birth. It’s more important than ever to promote healthy childbearing in the workplace.

A healthy workplace improves morale and productivity and reduces absenteeism.

I encourage you to create a healthy work environment for your workers. In the long run it will benefit your company, your employees, and most importantly – the workforce of tomorrow our children.

Think of a future in which rates of preterm birth in the United States are below 5 percent in all groups. 

Think of a future in which the heartbreak of infant mortality from preterm birth is an infrequent occurrence. 

Think of a future in which the developmental consequences of preterm birth are uncommon. 

Think of a future in which all children are born at the appropriate time and develop optimally across their life course. 

Again, however, our success in creating the future that we only imagine today hinges on strong and enduring partnerships across multiple organizational levels.

I urge everyone here to redouble your efforts to do all we can to reduce the prevalence of preterm birth and, in time, prevent it entirely.

Before I close, I want to bring up one more item that is very important if we are to build a better, stronger America.

We need your support in creating healthy work environments. But there is a significant shift that needs to happen across our nation.

I’m talking about health care reform. In the last eight years, health insurance premiums have grown four times faster than wages and one million more Americans have lost their health insurance each year. 

Health care costs have forced small businesses to close their doors and compelled corporations to ship jobs overseas.

President Obama has committed to reforming health care this year and has already acted to make health care more affordable and accessible.  For instance, he signed a law to provide and protect health insurance for 11 million American children through the Children’s Health Insurance Program. 

We must support health care reform and finally get health care costs under control. Reform cannot wait. It must happen now.  We all have a part to play in that reform and we can start with the workplace.

Thank you for being here today and bringing attention to these important issues.

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