Matern Child Health J
DOI 10.1007/s10995-014-1565-1
COMMENTARY
Leading Maternal and Child Health (MCH): Past, Present
and Future
Donna J. Petersen
Ó Springer Science+Business Media New York 2014
The field of maternal and child health (MCH) was borne
out of leadership, leadership manifested in the foresight of
a group of women who applied passion, skill and evidence
to create a unifying vision for the nation’s children and
families and the means for continuous investment in this
vision [1, 2]. From these prescient social reformers to those
who nurtured the field through periods of opportunity and
strife, the ability of leaders to anticipate, to champion, to
negotiate and to advocate or exhort has shaped what may
be the most important sustained public health effort in our
nation’s history [3]. Maternal and child health would not be
without leaders, would not advance without leadership.
Two perspectives must be made clear: first, MCH as a
collective must don the mantle of leadership in recognition
of the enormous responsibility it holds as a statutorily
mandated program and a social movement to protect and
promote the health and economic vitality of the nation [3,
4]. We know intuitively, and increasingly empirically, that
the future of our society depends on the extent to which we
care for our children. The second perspective is an individual one, which posits that each of us in the collective
must cultivate our own leadership skills in order to create
and manage the change that is necessary within whatever
organizational, institutional or community setting we find
ourselves. Leadership is about creating and communicating
a shared vision for a changing future [5, 6], and while one
of the bulwark features of MCH is its endurance, it must be
understood that it is the vision and the mission that endure
while the means and the methods of achieving that vision
and mission evolve over time, over populations and over
D. J. Petersen (&)
College of Public Health, University of South Florida, 13201
Bruce B Downs Blvd, MDC 056, Tampa, FL 33612, USA
e-mail: [email protected]
circumstances. ‘‘Leaders’’ in MCH must crusade for the
vision and mission while deftly adapting and directing in
an ever-changing landscape.
The legacy of leadership left to our care by our
founders provides a useful framework for considering the
current challenges of leadership and suggests an urgent
demand for more leaders to emerge, to hone their skills,
and to act with courage and conviction in service to our
future [7]. The extensive collection of articles in this issue
reflects and defines a set of skills that are necessary, that
can be learned and that can be utilized in defense of
MCH. It is no accident that the federal MCH offices have
consistently invested in leadership development for
national, state, local and community leaders as a means of
shoring up these defenses [8, 9]. Recognizing even prior
to the enactment of Title V that training would be necessary to develop and nurture a workforce capable of
managing the new national investment, the Children’s
Bureau set a course for continual support of professional
and leadership development in MCH. The MCH Leadership Skills Training Institute that I was privileged to be a
part of for over 15 years emerged through conversations
among state and federal leaders committed to providing
MCH leaders all the tools necessary to effectively lead
MCH programs during a time of great change. Over the
years, the MCH Bureau has invested in an array of
leadership development programs with diverse foci
(regional, national), using mixed methods (classroom and
on-line learning opportunities), and addressing different
learner needs (emerging, current and mature leaders) [8,
9]. In every case though, the emphasis of the leadership
development has included both the collective leadership
responsibility and the cultivation of individual leadership
skills. Both are necessary for the preservation and future
advancement of our field.
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Matern Child Health J
Three collective leadership responsibilities bear mention
here, in the midst of this constellation of papers addressing
critically important individual leadership skills. The first
goes back to the original charge to the Children’s Bureau,
to investigate and report upon all matters pertaining to
child life and welfare among all classes of our people [2].
Data was, is and forever shall be the sine qua non of
leadership in MCH. Data creates information which generates knowledge and once knowledge is apparent, it is
difficult not to act upon that knowledge. The population
perspective of public health is most clearly demonstrated in
the vast array of data we gather, interpret and translate in
the development of knowledge to stimulate action in MCH
[10]. MCH leaders, whatever their level of intrapersonal
leadership skill, must be data sophisticates, able to manage
data systems large and small and effectively communicate
complex information in an ever-increasing digital and datarich world.
The second is also a legacy responsibility and that is to
the partnership between the states and the federal government [11]. The United States was created as a federation of
states and responsibility for public health rests at the state
level. Collectively, MCH has always recognized the power
of state flexibility and accountability for its own MCH
efforts while embracing the notion of a shared vision and a
shared set of national goals. While tensions occasionally
flare, the power of the partnership—to attend to the few
without ignoring the many—has served us well over a
series of challenges and threats since our beginnings
100 years ago. MCH leaders must understand the nature of
this partnership, the reasons it must be nurtured and continually strengthened, and the nuanced ways state autonomy can be championed within a cooperative federal
structure.
The third has to do with the notion of systems. In public
health in general and MCH in particular, leadership success
is dependent on the extent to which leaders can think at a
systems level [12, 13]. The promises of a reformed health
system will be quickly negated if we cannot sustain and
enhance investments in the other spheres essential to the
promotion of health. MCH leaders have always understood
that their responsibility extended well beyond the walls of a
health department—housing, transportation, education,
jobs, safety, mental health and substance abuse services,
the environment, food security—all of these are as
important, if not more important than access to high
quality, affordable health care services. MCH leaders live
in all of these worlds and must be adept at navigating
complex structures and politics to create comprehensive
and connected approaches to the promotion of optimal
health of children and families.
The academic institutions who have served as stalwart
partners throughout the evolution of MCH have a particular
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responsibility to nurture future leaders and leadership
attributes within all MCH professionals, at all levels of
degree production. Even beyond the leadership development efforts noted earlier, students in graduate, and
increasingly in undergraduate programs, are a ripe audience for the development of a leadership philosophy and
the honing of leadership skills. Though traditional academic MCH ‘‘departments’’ are now a rare commodity,
MCH programs are flourishing in academic health centers—in schools of medicine and nursing, public health and
allied health professions—with and without federal financial support [14]. Given the co-dependence of the federalstate partnership and the academic programs that prepare
future professionals, it behooves all of us to take this
responsibility seriously and create with great deliberation
and Godspeed, the means to assure leadership competence
for current and future generations of families.
This responsibility can be addressed in myriad ways. A
set of leadership competencies in MCH has already been
developed and can serve as a guide to education in leadership development [9]. This same source provides leadership development modules which can be assigned and
then discussed or applied in practical situations. MCH
‘‘leaders’’ can be brought to academic institutions to share
their leadership journey and leadership lessons. Students
can be presented with leadership challenges. In every case,
it must be impressed upon students of MCH that they can
and will be in a position to exert leadership because the
population they serve demands and deserves no less. It is
our job as educators to make this message clear and to
provide pathways to leadership success, regardless of
career path or positions held.
Leaders need vision integrity, charisma and energy, this
is true. But MCH needs leadership, horizontally and vertically and these skills can be learned. The articles in this
issue provide a useful starting place for this critical learning. Placing these skills in the context of our past and of
our future shines a clarifying light on where we need to be
today—unapologetic, persistent, undaunted and unabashed
champions of the nation’s enduring investment in its children and its future, fierce guardians of the legacy handed to
us by our founders and tireless motivators of all those
around us who share in this grand vision.
References
1. Lesser, A. J. (1985). The origin and development of maternal and
child health programs in the United States. American Journal of
Public Health, 75(6), 590–598.
2. U.S. Congress (1912). PL 92-116: The Children’s Bureau Act.
3. U.S. Congress (1935). PL 74-271: The Social Security Act,
Title V Grants to States for Maternal and Child Welfare,
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Sheps, M.P., & Alexander, G.R. (2001). Landmark federal MCH
legislation. Delta omega classics series, www.deltaomega.com.
Association of Schools of Public Health. MPH core competency
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Hayes, M., & Walker, D. K. (1997). The role of public health in
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Walker, D. K. (2003). Public health strategies to promote healthy
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