Nurse-Led Public Health Vision for Philadelphia

Several home visiting programs in Philadelphia address the needs of pregnant and parenting low-income women by offering comprehensive family supports over time. A strategic alliance of maternal-child home visiting programs has the potential to create a collective impact that benefits the families we serve. Since 2016, NLP has hosted the Brunch and Learn series, which brings together home visiting providers citywide for networking, resource sharing, training and systemic advocacy. The NLP seeks to catalyze and further support strategic collaboration among home-visiting and family support programs in the city.

According to a 2015 report by the Philadelphia Department of Public Health, poor housing quality and housing instability are the most consistent and strongest predictors of emotional and behavioral problems in low-income children and youth. Many Philadelphia families live in unsafe and unstable living conditions contributing to their poor health and well-being. Of particular concern are high blood lead levels among children living in homes with lead exposure, which carries a significant risk of impaired cognitive functioning and behavior. Unsafe housing can also contribute to high maternal stress levels.

Housing instability for low-income families is driven by limited access to affordable housing. Rental costs continue to increase across the city while low-income renter’s wages have stagnated and access to supports has not kept pace. Dramatic tax increases in rapidly gentrified neighborhoods force longtime homeowners out of their homes and communities. While programs exist to help families remain in their homes, they often have long waitlists and the most vulnerable Philadelphians often lack the support needed to successfully access these programs.

Inadequate funding and complicated processes present overwhelming barriers for many families attempting to access the city’s preventive services like rapid rehousing and emergency financial supports. Too often, families that do qualify for assistance are unable to access the funding in a timely enough fashion to prevent the loss of their housing. Emergency housing for homeless residents, particularly pregnant and parenting women who are victims of domestic violence, is scarce and significantly underfunded. Assisting families in maintaining and remaining in their home needs to be prioritized. The NLP supports policies to increase the availability and affordability of safe, stable and sanitary housing options for low-income families.

Many low-income families rely on public benefits, including Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Medical Assistance, and Early Learning Resource Center (ELRC) subsidies, to supplement their incomes. These supports are currently inadequate to provide the assistance that low-income families truly need. Home visiting clients frequently report miscommunication and confusion when navigating County Assistance Office services. Efforts to improve communication can foster mutual understanding and ultimately benefit home visiting clients and their babies. The NLP supports policies to ensure that low-income families have uninterrupted access to public benefits, especially during the critical early years of child development.

Over 22,000 Philadelphians give birth each year. Despite having strong community-based organizations and excellent academic medical centers, the city’s maternal mortality rate is far above the national average. In recent years, drug overdoses have significantly contributed to this rate. Over the last eight years, there were at least 155 maternal deaths. Three in 10 were directly related to pregnancy — over half caused by cardiovascular conditions or cardiomyopathy, hemorrhage, or infection.

Racial disparities in maternal health outcomes are stark and persistent. Non-Hispanic black women experience maternal deaths at a rate three to four times that of non-Hispanic white women. Maternal deaths have tragic physical, emotional and socio-economic impact on children, families and our communities. In 2018, nine state maternal mortality review committees estimated that over 60% of pregnancy-related deaths are preventable. The NLP seeks to support all programs and policies working toward reducing health disparities, improving maternal health and preventing maternal deaths.

Philadelphia ordinances protecting workers, such as the Promoting Healthy Families and Workplaces law, which requires employers to provide sick leave, often go unenforced because of the workers’ fear of retaliation and lack of knowledge of their rights. The city recently passed a Fair Workweek Employment Standards bill, which guarantees employees of the retail and hospitality industries advance notice of their work schedules, among other things. The Fair Workweek ordinance is scheduled to go into effect on January 1, 2020. The NLP seeks to inform stakeholders and support the implementation of city ordinances offering worker protections.

Poor access to healthy food in the home, school and community, contributes to obesity, chronic health conditions, stress and poor health. Most clients of Philadelphia home visiting programs live in neighborhoods with limited options to purchase healthy food. The NLP supports the development and funding of healthy nutrition initiatives in childcare centers and schools, and efforts to ensure the availability of healthy food in all neighborhoods throughout the city.

High-quality pre-kindergarten (Pre-K) programs are especially important to those who are economically disadvantaged or dual-language learners. Pre-K programs encourage development of language, cognitive, and motor skills, and children begin to master social and emotional skills fundamental to kindergarten success. However, many families do not understand the importance of Pre-K or are unaware that free or affordable programs exist. While quality Pre-K has become accessible to more families, barriers persist. Program applications are often lengthy and require extensive supporting documentation. Many neighborhoods still lack high-quality Pre-Ks and those that exist often have lengthy waitlists. The NLP support policies to increase families’ access to affordable, high-quality Pre-K programs.

Most schools in Philadelphia and throughout Pennsylvania do not provide adequate support for lactating students to pump milk and feed their babies while at school. If students are not able to regularly express milk, their supply decreases and health complications may ensue for both parent and baby. Due to actual or perceived lack of institutional support, parenting students often must choose between continuing their education and nursing their infants. In 2018, the NLP established the Coalition for Lactation-Friendly Schools with several other organizations. In the 2018-19 school year, the School District of Philadelphia enacted Policy 234, which aims to support lactating students. However, this does not reach students in other educational institutions. The NLP supports policy changes that remove barriers to lactating students in support of their ongoing pursuit of their education as well as the health and wellness of their families.

Climate change is a serious public health issue that impacts the life of every person. Globally, the number of deaths directly related to weather-based events has tripled since the 1960s. Climate change due to increasing global temperatures affects public health in many ways: increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health. Children, the elderly, people with chronic illnesses, and low-income and racial and ethnic minority communities are especially at risk.

In order to diminish the effects of climate change, a coordinated effort is needed to mobilize individuals within the public and private sectors to establish a sustainable and healthy future. Public health professionals can be powerful educators and advocates for climate-smart policies that build community health and resilience to the effects of climate change. The NLP seeks to support policies and emerging legislation that protects vulnerable populations from the burden of climate change.

Since 2016, the Philadelphia NFP and Mabel Morris-PAT home visiting collaborative has sponsored Community Action Day, where clients come together to talk about the vitality of their communities and describe issues needing to be addressed, including unsafe and unsanitary abandoned buildings and outdoor public spaces. Families said they need greater safety and improved sanitation in public spaces like parks and playgrounds. This includes: more public trash cans that get emptied regularly; streetlights in parks; environmentally-friendly street cleaning; and fully-funded and open local libraries. The NLP supports family civic engagement and calls for increased funding for revitalization activities by city agencies, foundations, and community-based organizations to improve the safety and cleanliness of public areas.