Mark Horton

Viewpoints: Nurse visits at home can pay big dividends

Published: Wednesday, Jul. 16, 2014 - 12:00 am

It is well known that in the United States, women and children in low-income families have significantly higher death rates than women and children of affluent families. However, new research shows that we have a well-established and evidenced-based program that can reduce those higher death rates.

A recent study, published in the journal JAMA Pediatrics by David Olds, found that the nurse-family partnership – a voluntary nurse home-visiting program for young first-time moms and their babies – reduces preventable death among that group. The study tracked both mothers and children who took part in the program until the children were 20 years old.

More than three decades of data show that the program improves health behavior, status and education, and reduces criminal offenses and reliance on public assistance. The recent study adds reduced maternal and child mortality to the list of proven benefits.

Clearly the support of a nurse during pregnancy and through the child’s first two years results in lasting positive changes in the lives of these young families. Also, investing in the program generates significant benefits to society.

For every dollar invested in the program, a $4.60 savings occurs as a result of reduced services to these families from governmental agencies and health care providers. The wise choice is to invest in prevention to give mothers and their babies a healthy start, rather than to incur the costs of health care, criminal justice, social welfare and educational services later on.

So why aren’t more low-income first-time mothers receiving these services?

In California, about half of all births are to mothers covered by Medi-Cal, the state’s Medicaid program serving low-income families, and about 40 percent of those births are to first-time mothers. With roughly 500,000 births every year in California, 100,000 or more moms and newborns could potentially benefit from the nurse-family program.

Currently, 21 counties have implemented the program, with a total of 3,650 mother-child pairs enrolled. With the support of their home-visit nurses, many of the mothers have finished their educations, obtained stable jobs, left abusive relationships and eliminated or decreased risky behaviors to become the best mothers they can be. Their children are better prepared for school, have higher academic achievement and are less likely to suffer from mental health problems or get involved in crime.

But with so few enrolled in the program, we’ve just scratched the surface.

As a pediatrician and public health officer in Orange County some years ago, I saw firsthand the program’s benefits. Since, I have watched with considerable satisfaction the modest expansion of the program throughout the country and in California. But we are still far from making the program available to all who could benefit from it.

By helping only 5 percent of eligible families, we are missing a huge opportunity to improve health and well-being. I believe the state of California must make expanding this program a priority. We should look to existing funding sources such as the First 5 program, as well as new potential “social impact” investments that would be created by Senate Bill 593, to fund a major expansion. I urge state and local officials, health and social welfare agencies, health and social services providers, professional organizations, and foundations to come together to create a groundswell of support.

The nurse-family program is a proven tool that can change the lives of many lower-income families in California. It’s time to act and change our future.


Mark Horton is a pediatrician and former director of the California Department of Public Health.

Read more articles by Mark Horton



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