Three Easy Pieces for Maternal and Child Health Policy: MACHs Roundtable 2012

Mum & egg

Three Easy Pieces for Maternal
and Child Health Policy:
MACHS Roundtable, Winnipeg, MB CANADA • December 11, 2012
by Dennis D. Embry, PAXIS Institute

Tuesday, December 11, 12

Maternal and Child Health Conference:
Leadership to Action
Disclosure
of
Poten/al
for
Conﬂict
of
Interest
• Name of Speaker: Dennis D. Embry, Ph.D.

• Title of Presentation: Three Easy Pieces for Maternal and Child Health Policy

• Date of Presentation: December 11, 2012

• Financial Disclosure

• Grants/Research Support: Yes, Co-Investigator, Towards Flourishing, PHAC

• Honoraria: I receive fees to speak at this conference and other Conference

• Consulting Fees: Yes, for multiple projects in Canada and the US

• Other: Training fees and royalties on multiple copyrights for publications


Foretelling my talk today
A new concept today of evolutionary
mismatch that honors wisdom and
science
Solving linked multi-problems or
syndemics instead of one-at-a-time
Using low-cost proven strategies for
all as public-health policy for
Maternal and Child Health (MACH)


My Three Easy Pieces for Today
• Policy Goal 1: Reduce multiple sources of neuro-inflammation before pregnancy,
during pregnancy and during childhood—using low-cost, scientifically proven
evidence-based kernels.

• Policy Goal 2: Recognize, reinforce and reward non-use of tobacco, alcohol & other
drugs among women of childbearing age —using low-cost, scientifically proven
evidence-based kernels.

• Policy Goal 3: Create public-private partnerships to promote specific nurturing
environments actionable strategies for children and their caregivers.


The ﬁrst low-cost, proven, evidence-based
kernel for maternal and child health

The Epidemiological Observation



Chlorine
Handwash

The Epidemiological Observation The Experimental Observation


Streptococcus
pyogenes
The culprit of massive morbidity and
mortality of mothers and children.

Image credit: CDC


Streptococcus
pyogenes
The culprit of massive morbidity and
mortality of mothers and children.
But the discover caused an
intellectual disease:

Semmelweis reﬂex
Image credit: CDC


A policy…
A course or principle of action adopted or proposed by a government,
party, business, or individual.

Also, archaic, prudent or expedient conduct or action: a course of
policy and wisdom.

ORIGIN late Middle English: from Old French policy ‘civil
administration,’ via Latin from Greek politeia ‘citizenship,’ from politēs
‘citizen,’ from polis ‘city.’
policy 2 |ˈpäləsē|
noun ( pl. policies )

ORIGIN mid 16th cent.: from French police ‘bill of lading, contract of
insurance,’ from Provençal poliss(i)a, probably from medieval Latin
apodissa, apodixa, based on Greek apodeixis ‘evidence, proof,’ from
apodeiknunai ‘demonstrate, show.’


Let us begin with some wisdom and careful observations


Elder wisdom about child-rearing selected Humans are everyday
scientists of their
by evolutionary mechanisms successes


www.thisviewoﬂife.com “Look up Evolutionary Mismatch”
Natural selection adapts organisms to their
past environments and has no ability to
foresee the future.
When the environment changes,
adaptations to past environments can
misﬁre in the current situation, producing a
mismatch that can only be solved by
evolving or by modifying the current
environment.
Mismatches are an inevitable consequence
of evolution in changing environments.


This creates an evolutionary mismatch in
the womb

Early incubator experiences for premies


Early incubator experiences for premies What did we learn?


What did this nurse notice about this premie?


What are we noticing with babies and mums more today?


Some observable trends:
• Increased postpartum depression

• More addictions

• More “inﬂammatory” diseases like
asthma, diabetes and obesity

• More children with disabilities such
as autism spectrum disorder

• Higher lifetime rates of mental,
emotional, behavioral, and related
physical disorders


Increases in Child Problems In Manitoba
Indicator Time Period Rates/Prevalence Change

ADHD 2000/01 to 2009/10 2.4% to 3.9% 66% increase

SP Educ 18.7/1,000 to
2000/01 to 2009/10 106% increase
Funding 38.4/1,000

Children in 2000/01-2002/03 to
3.7% to 4.0% 6% increase
Care 2006/07-2008/09


2006 Statistics Canada report on the Participation
and Activity Limitation Survey (PALS)
• According to Statistics Canada, more children in this country have a learning
disability than all other types of disabilities combined.

• According to Statistics Canada, of all the children with disabilities in this
country, more than half (59.8%) have a learning disability.

• According to Statistics Canada, more than half a million adults in this country
live with a learning disability, making it more challenging for them to learn in
universities and colleges, and on the job.

• According to Statistics Canada, learning disabilities increased considerably
between 2001 and 2006 among Canadians aged 15 and over by almost 40
per cent to 631,000 people, making it one of the fastest growing types of
disabilities in Canada that isn’t related to aging.


With various early
childhood
disabilities
increasing, how
does that parents
and families?


With various early Impact of child's condition on parental
employment for parents of children with
childhood disabilities aged 0 to 14, Canada, 2006

disabilities
increasing, how
does that parents
and families?


Multi-Inﬂammatory Brain & Body Response

Major Connected Causes of the Adverse Trends Predicting MEBs & Related Illnesses

Reinforcement Antecedents Physiological Verbal Relations
more for anti-social cue anti-social inﬂuences trigger occasion perceived
than prosocial acts and threats adverse biological threats and related
behaviors mechanisms reactions

The Same Mismatches Predict Multiple MACH Disorders

Mood Lo Reward Lo Executive Lo Behavioral
Inattention Function
Instability Delay Competencies
Poor Immune-
Motor Healing
Skills Multi-Inﬂammatory Brain & Body Response Dysfunction




Substance Work Obesity,
Early Mental Illness Violence Cancer School
Abuse Problems etc
Sex Failure

Mood Lo Reward Lo Executive Lo Behavioral
Inattention Function
Instability Delay Competencies
Poor Immune-
STD’s Motor Healing Special
Skills Multi-Inﬂammatory Brain & Body Response Dysfunction Ed




Multi Anti-Inflammatory Brain & Body Response

Multiple Behavioral Vaccines Protect the Futures of ALL Children, Youth and Adults

more for prosocial cue prosocial influences trigger occasion perceived
behaviors behaviors protective biological safety and
mechanisms affiliation

Changing Conditions Protect and Prevent MACH

Mood Hi Reward Hi Executive Hi Behavioral
Attention Delay
Stability Function Competencies
Good Immune-
Motor Healing
Skills Multi Anti-Inﬂammatory Brain & Body Response Efﬁciency




Heart
Low Work Low
Delayed Mental health Prosociality Success
Health
Hi Sch.
Addictions etc Cancer
Sex Grad

Mood Hi Reward Hi Executive Hi Behavioral
Attention Delay
Stability Function Competencies
Good Immune-
Low Motor Healing Higher
Injuries Skills Multi Anti-Inﬂammatory Brain & Body Response Efﬁciency Ed




Solving some current mismatches affecting MACH


Richly Reinforce
Pro-social Behaviors Reduce Toxic Influences

Limit Problematic Behaviors Increase Psychological Flexibility
Biglan, A., B. R. Flay, et al. (2012). "The critical role of nurturing environments for promoting human well-being." American Psychologist.


Mothers and children
in Canada do not get
sufﬁcient Vitamin D
via sunlight

Mothers and children
in Canada do not eat
foods sufﬁcient in
Vitamin D

This evolutionary mismatch harms MACH


D. K. Kinney et al.
Mismatch, Latitude & Schizophrenia

Schizophrenia Bulletin vol. 35 no. 3 pp. 582–595, 2009
doi:10.1093/schbul/sbp023
Advance Access publication on April 8, 2009

Relation of Schizophrenia Prevalence to Latitude, Climate, Fish Consumption, Infant
Mortality, and Skin Color: A Role for Prenatal Vitamin D Deﬁciency and Infections?

Dennis K. Kinney1–3, Pamela Teixeira2, Diane Hsu2, Siena derlie variations in schizophrenia prevalence deserves high
C. Napoleon2,4, David J. Crowley2, Andrea Miller2, priority.
William Hyman2, and Emerald Huang2
2
Genetics Laboratory, McLean Hospital, Belmont, MA; 3De- Key words: epidemiology/etiology/immune function/
partment of Psychiatry, Harvard Medical School, Boston, MA; prenatal/geography/risk factor
4
Wellesley College, Wellesley, MA
Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality.
Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For the
Tuesday, December 11, 12 Introduction
Previous surveys found a large (>10-fold) America,in
regressionlinesinNorth variation those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having

D. K. Kinney et al.
Mismatch, Latitude & Schizophrenia
Semmelweis
Reﬂex



2
4
Fig. 1. Schizophrenia Prevalence and Latitude by Continent and Infant Mortality.
Note: South Asia sites were from India and Indonesia; those sites had higher infant mortality rates than all but one of the East Asian sites. For the
Previous surveys found a large (>10-fold) America,in
regressionlinesinNorth variation those withinfantmortalityrates above 30 per 1000 weregroupedas having a higherrate, those below30 as having

D. K. Kinney et al.
Mismatch, Fish Intake & Schizophrenia



2
4
Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake.
Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites with
Previous surveys found a largeintake, and 0.17 forin
moderate fish (>10-fold) variation sitesIntroduction intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 for
Tuesday, December 11, 12 with low fish

D. K. Kinney et al.
Mismatch, Fish Intake & Schizophrenia
Semmelweis
Reﬂex



2
4
Fig. 2. Schizophrenia Prevalence and Latitude by Fish Intake.
Note: Error bars represent 95% confidence limits. The slopes of linear regression lines were 0.03 for sites with high fish intake, 0.21 for sites with
Previous surveys found a largeintake, and 0.17 forin
moderate fish (>10-fold) variation sitesIntroduction intake. For the subset of Scandinavian sites, the slope of linear regression for was 0.03 for
Tuesday, December 11, 12 with low fish

e increased markedly economic status and healthcare, as indexed in our anal-
ysis by the infant mortality rate, appears to be a much
renia prevalence with weaker predictor of risk for schizophrenia than are lati-
d is not due simply to Mismatch, Skin Color & Schizophrenia
tude and winter temperature. A high infant mortality rate
tic and ascertainment
alysis of data collected
particularly informa-
t controlled for possi-
ences in prevalence at
investigative person-
were used to obtain
ent sites within the
studied schizophrenia

ites in the same time
iagnostic criteria and
data showedSkin very A Role for Prenatal Vitamin D Deﬁciency and Infections?
Mortality, and a Color:
with both latitude
w temperature (r =
cially wide variation in
2 Key words: epidemiology/etiology/immune function/
3
Genetics Laboratory, McLean Hospital, Belmont, MA; De-
he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor
partment of Psychiatry, Harvard Medical
4
Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.
at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the
Previous surveys found a large (>10-fold) variation in

e increased markedly economic status and healthcare, as indexed in our anal-
ysis by the infant mortality rate, appears to be a much
renia prevalence with weaker predictor of risk for schizophrenia than are lati-
d is not due simply to Mismatch, Skin Color & Schizophrenia
tude and winter temperature. A high infant mortality rate
tic and ascertainment
alysis of data collected Semmelweis
particularly informa- Reﬂex
t controlled for possi-
ences in prevalence at
investigative person-
were used to obtain
ent sites within the
studied schizophrenia

ites in the same time
iagnostic criteria and
data showedSkin very A Role for Prenatal Vitamin D Deﬁciency and Infections?
Mortality, and a Color:
with both latitude
w temperature (r =
cially wide variation in
2 Key words: epidemiology/etiology/immune function/
3
Genetics Laboratory, McLean Hospital, Belmont, MA; De-
he equator, prevalenceSchool, Boston, MA; prenatal/geography/risk factor
partment of Psychiatry, Harvard Medical
4
Fig. 3. Schizophrenia Prevalence and Latitude by Skin Color.
at is, for all groups and Note: Error bars represent 95% confidence limits. The slopes of the
Previous surveys found a large (>10-fold) variation in

Latitude and Infantile Autism

Grant, W. B. and C. M.
Soles (2009).
"Epidemiologic evidence
supporting the role of
maternal vitamin D
deﬁciency as a risk factor
for the development of
infantile autism."
Dermatoendocrinol 1(4):
223-228.


Latitude and Infantile Autism
Semmelweis
Grant, W. B. and C. M.
Soles (2009).
Reﬂex
"Epidemiologic evidence
supporting the role of
maternal vitamin D
deﬁciency as a risk factor
for the development of
infantile autism."
Dermatoendocrinol 1(4):
223-228.


Estimated deaths
per year would fall
by 37,000 people,
or about 16%-22%
of annual mortality
in Canada.

And, $14 billion


Estimated deaths Semmelweis
per year would fall
by 37,000 people, Reﬂex
or about 16%-22%
of annual mortality
in Canada.

And, $14 billion


Among pregnant women, lower Vitamin
D is associated with:
• Adverse fertility • Primary cesarean section
parameters (n = 2), (n = 1),

• Preeclampsia (n = 5), • Few days' (n = 2) shorter
gestation,
• Gestational diabetes or
higher blood glucose • And, postpartum
(n = 6), depression (n = 1)

• Bacterial vaginosis
(n = 4),
Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/
aogs.12000. Epub 2012 Oct 17.
The impact of vitamin D on pregnancy: a systematic review.
Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.


Among pregnant women, lower Vitamin
D is associated with: Semmelweis
• Adverse fertility • Primary cesarean section Reﬂex
parameters (n = 2), (n = 1),

• Preeclampsia (n = 5), • Few days' (n = 2) shorter
gestation,
• Gestational diabetes or
higher blood glucose • And, postpartum
(n = 6), depression (n = 1)

• Bacterial vaginosis
(n = 4),
Acta Obstet Gynecol Scand. 2012 Dec;91(12):1357-67. doi: 10.1111/
aogs.12000. Epub 2012 Oct 17.
The impact of vitamin D on pregnancy: a systematic review.
Christesen HT, Falkenberg T, Lamont RF, Jørgensen JS.


• Reduced postpartum
depression

• Reduced lifetime
depression, including
bipolar disorder

• Increased child IQ

• Better academic success

• Reduced childhood
Vitamin D with mental, emotional, and

Omega-3 (ﬁsh) behavioural disorders

Hibbeln, J., J. M. Davis, et al. (2007). "Maternal seafood consumption in pregnancy and neurodevelopmental
outcomes in childhood (ALSPAC study): an observational cohort study." The Lancet 369(9561): 578-585.

Hibbeln, J. R., L. R. Nieminen, et al. (2006). "Healthy intakes of n-3 and n-6 fatty acids: estimations considering
worldwide diversity." American Journal of Clinical Nutrition 83(6 Suppl): 1483S-1493S.


• Reduced postpartum
depression

• Reduced lifetime Semmelweis
depression, including Reﬂex
bipolar disorder

• Increased child IQ

• Better academic success

• Reduced childhood
Vitamin D with mental, emotional, and

Omega-3 (ﬁsh) behavioural disorders

Hibbeln, J., J. M. Davis, et al. (2007). "Maternal seafood consumption in pregnancy and neurodevelopmental
outcomes in childhood (ALSPAC study): an observational cohort study." The Lancet 369(9561): 578-585.

Hibbeln, J. R., L. R. Nieminen, et al. (2006). "Healthy intakes of n-3 and n-6 fatty acids: estimations considering
worldwide diversity." American Journal of Clinical Nutrition 83(6 Suppl): 1483S-1493S.


Semmelweis
Reﬂex


How might we reduce
alcohol, tobacco, and
other drugs among
women of child
bearing age


Which warning labels might work?

Trendline for humorous warnings on
binge drinking by women of child-rearing

No Warnings Humorous Warnings


Trendline for humorous warnings on
binge drinking by women of child-rearing

No Warnings Humorous Warnings
20

16
Percentage

12

8

4

0
1995 1997 1999 2001 2002 2003 2004 2005 2006 2007


Rewarding Clerks & Stores for Not Welling to Minors
Youth Who Smoked During the Last 30 Days
Baseline Reward and Reminder
Youth Who Smoked Every Day the Last 30 Days
Baseline Reward and Reminder
45.0% 18.0%
Wyoming Wyoming
40.0% Youth Who Smoked During the Last 30 Days 16.0% Youth Who Smoked Every Day the Last 30 Days
35.0% Baseline Reward and Reminder 14.0% Baseline Reward and Reminder
45.0%
30.0% 18.0%
12.0%
Source: Youth Risk 25.0%
40.0%
Wyoming
16.0%
10.0%
Wyoming

Behavior Survey 20.0%
35.0%
8.0%
14.0%
(YRBS), Centers for 15.0%
30.0%
10.0%
6.0%
12.0%
4.0%
Disease Control 5.0%
25.0% 2.0%
10.0%
0.0%
20.0% 8.0%
18.0%
Wisconsin Wisconsin
40.0% 16.0%
15.0% 6.0%
35.0% 14.0%
10.0% 4.0%
30.0% 12.0%

5.0%
25.0% 2.0%
10.0%
20.0% 8.0%
0.0%
15.0% 6.0%
18.0%
10.0% Wisconsin 4.0% Wisconsin
40.0% 16.0%
5.0% 2.0%
35.0%
0.0% 14.0%
18.0%
30.0% United States 12.0% United States
40.0% 16.0%

25.0%
35.0% 10.0%
14.0%

30.0% 12.0%
20.0% 8.0%
25.0% 10.0%
15.0% 6.0%
20.0% 8.0%

10.0%
15.0% 4.0%
6.0%

10.0% 4.0%
5.0% 2.0%
5.0% 2.0%
0.0% Source: YRBS, US Centers for Disease Control Source: YRBS, US Centers for Disease Control
0.0% 0.0%
1995 1997 1999 2001 2003 2005 2007 18.0% 1995 1997 1999 2001 2003 2005 2007
United States United States
40.0% = Trend = Wyoming
16.0% = Wisconsin =United States

35.0% 14.0%

Tuesday, December 11, 12 30.0% 12.0%

Wait for the Timer for tobacco addictions with SMI/CMI

Antecedent
Kernel

Happens
BEFORE the
behavior


Teaching Psychological ﬂexibility by cognitive defusion
the thought
d put it on s and
a f an fee ling
le
the s “s
tre
on am
g ”

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ee
af
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a
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ug
tho
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Write
I am h
avin
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no
f…

I am ha
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at…
a fe
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ug
tho
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I am

Copyright © 2007-2012, PAXIS Institute. All rights reserved.
May be reproduced but not sold. www.paxtalk.com


Lifespan example of one kernel for
prevention, intervention and
treatment
Reinforcement
Kernel

Happens AFTER
the behavior

Available from Amazon.com for $45


Mobilizing
for MACH


Implementation & Logic Models
See:

Multi-problem analyses Predict Create Plan Population-
Identify Benefits: Level Change:

Nurturing
Environments
Logic Model for
population-level
benefits Cultivate
Create Community
Prevention
Identify Score/Dashboard
Update Research
Databases for Proven
Prevention Solutions

Document

Launch Social Marketing: Advocacy & Media
Population-Level Targeting
Products Performance
B Developmen
Birth Childhood
ta l stages Low
Report Adolescence
Adulthood Intensity
Hi
Multiple reach

Fa
Sc Place Price

els
m
ho

ilie
Settings o

lev
Or

s
ga ls
A Co ni
mm atio

ach
un ns
itie

/re
s
C Promotion

sity
en
Recognize & Reward

Int
successes in/by High Intensity
Low reach
Note: Workforce development efficiency achieved
by broad use of similar/same evidence-based Create Monitor & Coach
strategies or evidence-based kernels. &

Developed by PAXIS Institute © 2010-2012, all rights reserved. May be freely reporduced in total with attribution and notice


Epigenesis Social Biological
Environmental Inputs
These
Genesis
Epigenetics are Nurturing or Toxic polygenes
Environments,
heritable Disease, or can be
changes in Threats “added”,
gene expression “subtracted”,
caused by “divided”, or
mechanisms “multiplied.”

M
g

or
lin
Phosphorlyation
other than

ph
na

og
Acetylation
changes in the
Sig

en
Methylation
underlying DNA

sis
Histone Remodeling
sequence. Chromatin Stucture Changes
Development Immunity Stem Cell Changes Imprinting
These changes
Parent,
can pass 1st Generation
Three
through multiple Generation Baby,
generations. Effects 2nd Generation

Reproductive Cells,
3rd Generation


Thank you

Dennis D. Embry
dde@paxis.org


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