Intergenerational Health Care: Promoting Children's Longterm Health (Before They Are Even Born!) through Maternal Oral Hygeine
The rapid rise in preterm births over the past 25 years is probably the biggest *sleeper* health policy challenge facing the United States. Preterm births (less than 37 weeks gestation) now account for 12.5 percent of all births (up 30 percent since 1980). Lower end cost estimates of prematurity are around $26 billion per year (or $51,600 per preterm infant)--that is, just direct costs through early childhood, not counting long term educational and health effects that have been documented or lost productivity, and so on. And of course, racial and class disparities are large in this indicator (on the order of 2 to 1 for blacks vis-à-vis whites, for instance), so reducing the overall level will serve to better the health and education prospects of particularly vulnerable populations. This is especially the case since recent research (including my own) shows that there are very long term health and economic effects of prematurity and low birth weight (which often go hand in hand). For example, prematurely born individuals are at higher risk for a range of health and educational risks well into adulthood even!
The rise in prematurity can be attributed to a number of factors: increased use of assisted reproductive technologies (which makes this issue newly hot among highly educated middle aged white women), stress and increased levels of environmental toxins (for example, significant levels over 100 volatile compounds can be found in cord blood today). The good news is that after decades of beating our heads against the wall in trying to figure out what works in terms of prevention (which was nothing, basically, in most cases), we finally have an answer, and it is a strange one: Prenatal dental care! Significant new experimental evidence suggests that gum infections are an important trigger of preterm labor and that a deep cleaning (scaling) early in pregnancy (or prior to conception) reduces the risk of preterm delivery by eight-fold.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Product/procedure
Year the initiative began (yyyy)
2007
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Complex, expensive medicine
Which of the principles is the primary focus of your work?
Please select one
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
Name Your Project
Intergenerational Health Care: Promoting Children's Longterm Health (Before They Are Even Born!) through Maternal Oral Hygeine
Describe Your Idea
The rapid rise in preterm births over the past 25 years is probably the biggest *sleeper* health policy challenge facing the United States. Preterm births (less than 37 weeks gestation) now account for 12.5 percent of all births (up 30 percent since 1980). Lower end cost estimates of prematurity are around $26 billion per year (or $51,600 per preterm infant)--that is, just direct costs through early childhood, not counting long term educational and health effects that have been documented or lost productivity, and so on. And of course, racial and class disparities are large in this indicator (on the order of 2 to 1 for blacks vis-à-vis whites, for instance), so reducing the overall level will serve to better the health and education prospects of particularly vulnerable populations. This is especially the case since recent research (including my own) shows that there are very long term health and economic effects of prematurity and low birth weight (which often go hand in hand). For example, prematurely born individuals are at higher risk for a range of health and educational risks well into adulthood even!
The rise in prematurity can be attributed to a number of factors: increased use of assisted reproductive technologies (which makes this issue newly hot among highly educated middle aged white women), stress and increased levels of environmental toxins (for example, significant levels over 100 volatile compounds can be found in cord blood today). The good news is that after decades of beating our heads against the wall in trying to figure out what works in terms of prevention (which was nothing, basically, in most cases), we finally have an answer, and it is a strange one: Prenatal dental care! Significant new experimental evidence suggests that gum infections are an important trigger of preterm labor and that a deep cleaning (scaling) early in pregnancy (or prior to conception) reduces the risk of preterm delivery by eight-fold.
Innovation
Define the innovation
The rapid rise in preterm births over the past 25 years is probably the biggest *sleeper* health policy challenge facing the United States. Preterm births (less than 37 weeks gestation) now account for 12.5 percent of all births (up 30 percent since 1980). Lower end cost estimates of prematurity are around $26 billion per year (or $51,600 per preterm infant)--that is, just direct costs through early childhood, not counting long term educational and health effects that have been documented or lost productivity, and so on. And of course, racial and class disparities are large in this indicator (on the order of 2 to 1 for blacks vis-à-vis whites, for instance), so reducing the overall level will serve to better the health and education prospects of particularly vulnerable populations. This is especially the case since recent research (including my own) shows that there are very long term health and economic effects of prematurity and low birth weight (which often go hand in hand). For example, prematurely born individuals are at higher risk for a range of health and educational risks well into adulthood even!
The rise in prematurity can be attributed to a number of factors: increased use of assisted reproductive technologies (which makes this issue newly hot among highly educated middle aged white women), stress and increased levels of environmental toxins (for example, significant levels over 100 volatile compounds can be found in cord blood today). The good news is that after decades of beating our heads against the wall in trying to figure out what works in terms of prevention (which was nothing, basically, in most cases), we finally have an answer, and it is a strange one: Prenatal dental care! Significant new experimental evidence suggests that gum infections are an important trigger of preterm labor and that a deep cleaning (scaling) early in pregnancy (or prior to conception) reduces the risk of preterm delivery by eight-fold.
Context for Disruption:
I propose a longterm, intergenerational cohort study in which pregnant women are treated for gum disease (with a control population) early in their pregnancy, and their babies are then followed up through school age to determine the intergenerational impacts of maternal periodontal health on offspring's health and education as mediated through risk for prematurity. This experimental "disruption" will allow us to know the "true" effects of prematurity since the differences between the treatment and control groups will be experimentally induced and thus not confounded with other health risk factors. In this way, a whole new intergenerational strategy of prevenative health care will be opened up. And if current non-experimentally based estimates of the social and individual costs of prematurity hold up, then this may be the most important health care savings initative to date.
Delivery Model
When I first heard about the epidemiological studies that linked gum disease to preterm labor, I thought it was bunk--that gum disease was just acting as a proxy for poverty and poor health generally. However, recent research has demonstrated the effectiveness of the intervention through clinical trials (an intervention of deep gum cleaning between weeks 18 and 20), and we now have an understanding of the pathways that connect gum infection to labor (the inflammatory agents called cytokines released in the gum tissue faced with infection travel through the blood stream and affect the receptors on the endometrial cells of the uterine wall since they are of the same type). I intend mimic this intervention and then follow the children born to the treatment and control groups for six years (through kindergarten) in order to determine the effects of prematurity on the health (and cognitive) outcomes of the children. This experimental design will tell us how important prematurity is per se (as opposed to the risk factors that covary with it) since the differences in the treatment and control groups will be the result of an experimental intervention (a disruptive innovation, if you will).
Key Operational Partnerships
I will work with NYU dental school to recruit the treated population.
Impact
Financial Model
The intervention will consist of gratis dental treatment. There will be no revenue. However, I expect that the education and health care systems will reap significant savings as a result of this relatively cheap intervention. A scaling can be done by NYU dental students for minimal cost as part of their training (just supplies). The real costs will be in following these children up for a six year longitudinal study of their health and cognitive outcomes.
What is your annual operating budget?
%
What are your current sources of revenue? (please list any sources that are foundation grants)
I am supplying grant money from my federal funding from the Alan T. Waterman award.
Effectiveness
None. It has not started yet.
Which element of the program proved itself most effective?
This intervention has been proven effective in reducing prematurity. However, the *true* impact of prematurity is not known since it is usually confounded with a number of other disadvantages (such as poverty or other ill health conditions). This intervention will tell us how important prematurity per se actually is and how much money it will save the health care system (and society more generally) by reducing it.
Number of clients in the last year?
None as of yet.
What is the potential demand?
Nationwide. I hope that if the demonstration project is successful, oral health care for women (or at least pregnant women) will become a policy that is implemented as part of comprehensive health care reform.
Scaling up Strategy
The strategy is to show that this generates significant health care (and special education) savings and then to use these results as a lobbying tool (assuming the results are robust) to effect oral health care reform through the legislative process.
Stage of the initiative:
0
Expansion plan:
I will be seeking funding from other sources such as NIH.
Origin of the Initiative
As a researcher in the social causes and consequences of perinatal health, when I first heard about the epidemiological studies that linked gum disease to preterm labor, I thought it was bunk science--namely, that gum disease was just acting as a proxy for poverty and poor health generally. However, recent research has demonstrated the effectiveness of the intervention through clinical trials, and we now have an understanding of the pathways that connect gum infection to labor. At a recent maternal and infant health conference I had to eat my hat, so to speak, and now I am a believer and want to seize this opportunity to address the elusive question as to the actual effects of prematurity / low birth weight.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
(1) Keeping sample attrition low and (2) communicating the results to the relevant policymakers and polticial entrepreneurs.
How did you hear about this contest and what is your main incentive to participate?
Through the
The Story
Do you have an annual financial statement?
NYU does.
Do you currently have an annual financial statement that tracks profit/loss?
0
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
There is no activity associated with this entry
