Life on the Line

Before I begin this article, I would like to address why I find this topic so important; for the past year, I have been very active in the MIECHV space and I have collaborated closely with institutions seeking funding and affected by the issues I discuss in this article. Early childhood home visitors grapple with structural hardships on a day to day basis; gaps in funding make their crucial work even harder.

MIECHV (Maternal, Infant, and Early Childhood Home Visiting) funding is administered via the Health Resources and Services Administration (HRSA) and is generally authorized every 5 years. (1) The program is designated to improve health in 6 different ways: to improve maternal and child health, to prevent child abuse and neglect, to reduce crime and domestic violence, to increase family education level and earning potential, to promote children’s development and readiness to participate in school, and to connect families to needed community resources and supports. (2) Specifically, MIECHV funding supports maternal and early-childhood home visiting programs in communities throughout the nation.

The impact these programs have can hardly be overstated. Carolina’s Abecedarian Project provides data suggesting a sense of longevity to early-child home visiting programs.

Launched by the Frank Porter Graham Institute, the study suggests that high quality early care and early education have the ability to reduce the effects of poverty and marginalization. (3) In the study, children born between 1972 and 1977 were chosen to receive full-time supplementary programming from birth to age 5, which included educational activities designed to improve social, emotional, cognitive, and language development. Follow-up studies on the children who received the treatment, occuring at ages 12, 15, 21, 30, and 35, reveal remarkable long-term health improvements.

Children who received the supplementary education had decreased risk of cardiovascular and metabolic disease in their thirties and males in particular had healthier BMIs, persisting long after the conclusion of the study. The study cost roughly $67,000 back in 2002 proving that long-term preventative healthcare need not be expensive. Over the past 30 years, research driven interventions targeting young populations have skyrocketed and to maintain affordability, government MIECHV funding has supported the growing home visiting programs.

The number of home visiting programs has accelerated in recent years, and existing programs have expanded to reach new communities. This trend correlates with a rise in federal funding to support MIECHV authorized programs. Below, I include a chart documenting this trend and provided by the Brookings Institute. (4)

The Brookings Institute article I reference is titled “When Delay is Deadly.” The article highlights how MIECHV programs are crucial to maintain since communities depend on external support. Suppose a lower-income parent works multiple jobs and does not have time to take care of their children or does not know how; regardless, that family’s hope of long term success rides on continual MIECHV funding.

In fact, MIECHV is one of the few government-funded programs that has received bipartisan support. Recent polling suggests that 89% of Democrats, 68% of Republicans, and 73% of Independents support MIECHV and more broadly, subsidized early childhood education. (5) Thus, the issue might not be “will it be passed?” but more along the lines of “how much funding?” and “how many programs will be supported with MIECHV funds?”

In UNC’s Abecedarian study, researchers spent roughly $67,000 in 2002 for 111 children. To determine how much money this is in 2023 dollars, I used the Consumer Price Index or CPI. The CPI measures the market value of a basket of consumer goods every year; the CPI can thus be used to develop price ratios, converting a price in year 1 to a price in year 2 that is adjusted for inflation or deflation. In 2023 dollars, the Abecedarian study would cost roughly $114,354 for the 111 children. To put this value into perspective, it costs roughly $18,953 on average to treat cardiovascular disease in the hospital. (6) This means that while a patient might spend $19,000 at the hospital, an early-stage MIECHV intervention might have cost $1,030 (one twentieth as much).

Think about the symptom stage model from a while back: while an issue might be easily treated at its initial stage, the more it progresses, the more difficult it is to treat. (7) While home visiting might be a somewhat straightforward way to reduce economic, social, and health-gaps, when these issues present later, say when a patient visits the hospital for cardiovascular disease, the issue might be much harder to treat.

For the past year, I have attended the quarterly North Carolina Home Visiting Consortiums. I remember back in late 2022 when consortium members, leaders of prominent home visiting organizations that operate across the state, were discussing the impact of potentially losing MIECHV funding. Consortium members were wondering whether MIECHV would be reauthorized or not and how funding distribution across states and counties would affect existing programs.

MIECHV funding is crucial to reducing inequities in healthcare. More people can afford $1000 over 5 years for home visiting support yet not many can afford a hospital visit for long term cardiovascular care. Furthermore, most home visiting programs are free for families, as the financial burden is taken up by the government.

Unfortunately, with all the moving parts required to make a functional and successful home visiting program, including the large number of volunteers that must be trained and paid for home visiting, the structural barriers to enter the industry are high. Hopefully, I have impressed upon you the importance of evidence-based early childhood programs. So what might be the solution? I believe that the definitions of health and healthcare should be expanded to include supplementary programs that have clear long-term health implications upon those involved. By expanding the definition of healthcare, administrators might be able to allocate more funding to MIECHV programs while also performing additional research to investigate the true impact of these programs as well as best practices. Government action in this case has a trickle down effect, rewarding home visitors for their work and enabling them to target more communities, ultimately improving maternal and child health.

The importance of increasing funding for MIECHV programs cannot be overstated. Early childhood programs have the potential to reduce short-term and long-term disparities from reducing cardiovascular and metabolic disease prevalence to improving social mobility and income. With bipartisan support in the government, it is not as much a question of whether MIECHV should be reauthorized, but rather, how much funding should be allocated to sustain these programs. It is imperative that we recognize the value of these programs in a more holistic definition of healthcare, considering their potential to improve long-term health outcomes and address pressing societal challenges.