Cate Wilcox
President, The Association of Maternal & Child Health Programs
Maternal and Child Health Manager, Title V Director, State of Oregon

In the late 1980s I had the honor of living on a small island in the outer islands of Micronesia. There were four habited islands on this lagoon. I lived in Moch, which was a half-mile by a quarter mile, had 850 residents, and was 5 feet above sea level at its highest point. It was the tall island. While the other islands were larger in size and had more residents, none were as tall. Sometimes parts of those other islands would flood during prolonged storms. The flooding put the precious taro patches in jeopardy. Taro, the dietary staple, is grown in the center of these low-lying atolls where there is a freshwater lens. If saltwater enters the patch, it can ruin the taro crop, which is the main food source for the residents. This is food insecurity, island style.

I have not been back since leaving 30 years ago. I fear that due to climate change and the rising ocean levels, Moch is no longer tall. I fear more for the people who were my friends and family. And what about the people on the shorter islands? Do they still have their taro patches? Where will they go when their homes and land are permanently underwater?

The emerging issues we face today are taking on a new breadth and depth. Many of our needs assessments point to the key drivers of social determinants of health. But how they present are unique to each community. For example, housing issues and homelessness look very different in Oregon than they do in Micronesia. And the destruction Puerto Rico endured due to Hurricane Maria illustrates yet another version of housing issues and homelessness. Food insecurity is equally concerning across our communities, but it looks different at each local level and requires different solutions.

We still face traditional public health issues, both old and new in all our communities: Zika, measles, and  congenital syphilis; tobacco, marijuana, alcohol, opioid use, and other substance use; obesity; lead exposures; gun violence; and infant and maternal mortality. Although we have made progress in some areas, we are slipping in others.

So why is this so hard? We are smart. We have data. We have solutions. We also are burdened by history, racism, structural racism, bias, trauma, adversity, and toxic stress. We have urban/rural divide, gender and identity discrimination, and so many other inequalities. We are learning more and more about the effects these issues had and continue to have on our population’s health. These are not new. However, the intergenerational impact on our families and communities is hopefully getting the appropriate attention . We keep diving  deeper to address the impact these issues have on  the social, emotional, behavioral, mental, and physical health; and the well-being of our families and communities. We need to delve down even deeper to get closer to understanding and addressing the true foundations of lifelong health.

We know the path forward will not be easy.  What works in one community may work in another, or at least spark ideas of what could work to address our emerging issues—old, new, large, small, and those yet to come. With tools of resilience and preparedness along with our smarts and hearts, we can accelerate our impact as we move upstream together.

When I think of my island community, I remember a time of abundance, before the devastating effects of climate change. My heart breaks for what this community faces and yet soars because I know they will find the right solutions that work best for their mothers, children, families, and communities.