Healthy Start programs are community-driven and located in the poorest neighborhoods in the United States. Since its initiation in 1991, Healthy Start has served hundreds of thousands of families. Over 90% of all Healthy Start families are African American, Hispanic, or Native American. Healthy Start specializes in outreach and home visiting — the surest way to reach the most at-risk women.

Healthy Start focuses on getting women into prenatal care as early in the pregnancy as possible. It is generally accepted by the medical and research community that early entrance into prenatal care is the single most critical factor in improving birth outcomes.

Healthy Start has pioneered the use of women living in the community as outreach workers and home visitors. This approach has three important advantages:

• It saves money (nurses' salaries are at least twice that of a paraprofessional or lay worker).
• Minority pregnant women respond better to women who have "walked in their shoes."
• It has given real jobs to hundreds of unemployed women, particularly those on welfare.

Every Healthy Start project has developed a consortium, composed of neighborhood residents, clients, medical providers, social service agencies, faith representatives and the business community. This ensures that not just Healthy Start but the whole community is committed to fight to reduce infant mortality and low birthweight. Major U.S. cities as well as urban counties have a disproportionate number of poor and minority families living within their boundaries. Yet, the amount of federal discretionary dollars going directly to these cities and counties has decreased dramatically in the last 20 years. Healthy Start represents one of the few health and social services programs that is funded directly to the localities by the federal government. Major urban cities desperately need the programs that Healthy Start provides.

Summary

The fact that African American and other minorities continue to have enormously increased rates of infant mortality and low birthweight poses a major public health issue for the U.S. The rate of low birthweight has not decreased significantly in the last decade and now appears to be rising. Low birthweight costs significant dollars, both short-term and long-term, and these costs are not well understood by the American public. Low birthweight can only be decreased by changing behavior — and behavior can only be changed by intense, ongoing interventions at the community level.