Strategies for Disease Prevention and Health Promotion in Maternal and Child Health: The "Ecologic" versus the "High Risk" Approach

Abstract

This article advocates an ecological approach to prevention of maternal and child health problems such as adolescent pregnancy low birthweight developmental disabilities and child abuse. Over the past decade the most widely used strategy for addressing these problems has been based on the concept of high risk. This approach assumes that retrospective data can identify a relatively small number of families that will produce the majority of child health and developmental problems in a community and concentrates resources on this group. However this approach tends to produce either a large at risk group most of whom will not develop the outcome under question or a small group with a higher incidence of problems but representative of only a tiny fraction of the total number of children in the community who develop problems. The difficulties inherent in attempting to predict who is at risk of developing what conditions has led to the search for more effective preventive strategies. The ecological approach assumes that child health and development outcomes are related to parent functioning which is influenced by both formal (health and human service providers) and informal (family and friends) community support systems in turn influenced by cultural values and government policies. Interventions based on this model aim to improve community resources that can strengthen family functioning. In addition to primary health care services such a program should include 5 components at the local community level: 1) a representative community council; 2) a community-wide health education program; 3) basic parent support services (parent-child centers birthing centers home visitors homemaker services transportation); 4) a consumer advocacy organization; and 5) a reliable assessment system. Forming a coordinating council and advocacy group involves little or no extra governmental expense and existing data sources can be used for needs assessment and program monitoring. Different agencies (agricultural extension health and social services) could donate a portion of their budgets to health education and parent support and these services could be organized into a community-wide delivery system.