Loretta J. Fuddy, A.C.S.W., M.P.H.

Loretta most recently served as Chief of the Family Health Services Division, Hawaii Department of Health (DOH). She holds degrees in sociology, social work, and public health from the University of Hawai'i and Johns Hopkins University. Loretta is a recognized leader in the public health field having served as Chair of the Hawai'i Public Health Association, President of the Association of State & Territorial Public Health Social Workers, Treasurer and Secretary of the Association of Maternal and Child Health Programs. She is a recipient of various awards including the Hawaii Outstanding Advocate for Children and Youth, and the DOH Sustained Superior and Exemplary Performance Award. Raised in Kaimuki, she is a graduate of the Sacred Hearts Academy.

Loretta J Fuddy, ACSW, MPHChief, Family Health Services DivisionHawaii State Department of Health 

I first entered the field of Maternal and Child Health in the mid seventies. The models were ones of direct delivery of care through an interdisciplinary approach. It was common to have nursing, social work, nutrition and therapist consultants on staff. Over the past 35 years I have seen the emphasis from the bureau change. The eighties ushered in the era of decreasing the direct service approach with greater emphasis on creating systems of care especially in perinatal health. Regionalization of perinatal health care moved the Hawaii Department of Health to close its Maternity & Infant Care and Children and Youth Projects and contract services with private health care entities. The closure of state operated clinics also helped to initiate community-based services and the development of several community health centers. Fiscally, the eighties introduced the Title V MCH Block Grant; although it had little impact on how Hawaii expended its funds, it resulted in changes to the reporting format. 

Systems building and coordination continued throughout the nineties with a greater emphasis on community planning, data and measurement. New opportunities were available through discretionary grants to improve the early identification of childhood disorders and the prevention of injury. There was a focus on improving cultural competencies. For Children with Special Health Needs the emphasis was and continues to be on the promotion of medical home, family centered community-based and coordinated care.  

The new century ushered in the promotion of best practice with the funding of programs like Healthy Start and the greater use of advanced technology like Tandem Mass Spectrometry for the identification of metabolic disorders. We began to also recognize the power of data; how to translate data into information to drive policy formation and legislation to improve the health of women and children. The core public health functions of needs assessment, policy development, and assurance of health care influenced greater partnerships among other departmental programs and private health care providers. 

As a public heath social worker, what excites me about this decade is the focus on the root causes of illness and the social determinants of health. There is an acknowledgement that public health alone cannot successfully address many of society’s complex health problems, without working with human services, mental health, educational, labor and housing institutions. The life cycle approach calls for cross systems integration, and approaches that address women’s health issues before pregnancy and provision a system of care beginning in infancy and all stages of development through adulthood. The prevention of chronic disease is critical to the containment of health care cost. While the challenges are many there are many promising opportunities for success when Title V and the field of Maternal and Child Health utilize the strategies already mentioned and we leverage improvements through health care reform, health technology and communications.