Child abuse and maltreatment is a silent and hidden morbidity and mortality issue today. A new report has shed light on this taboo subject, the dramatic statistics we have compared to other countries and the difference domestically between states.

Currently, the child maltreatment death rate is 11 times higher than Italy’s and 3 times higher than Canada’s. In the past 10 years, more than 20,000 children have died because of household abuse. Texas has a child abuse death rate of 4.05/100,000, 4 times higher than New Hampshire and Vermont.

So why these rates, why these disparities?

Many believe the answer is in our child protection service (CPS) workforce. Employees are overworked and the system is slow and ineffective. But as the investigation explains, these critics forget the fact that these services were made to protect children after abuse, not prevent them from being harmed in the first place.

Prevention: the key public health value. Child abuse must be seen as an issue in which the public health field can intervene, even more specifically with a Maternal and Child Health focus. What can MCH leaders focus on to help this phenomenon from continuing to escalate? What are areas with low child maltreatment rates doing that work?

1. The United States has a weak public system— our home visiting programs could be expanded, and until the Affordable Care Act goes fully into effect, we have no universal health care. Texas has low taxes, and high numbers of keeping families together. Compared to other countries, the U.S. has low taxes. Children are more likely to be uninsured, incarcerated, to not finish high school, and to die from abuse if public service programs do not have funding.
2. Child abuse has been found to be interlinked with these factors affecting families, including poverty and teenage pregnancy. When families do not have resources, education, training, or an understanding, children are at greater risk. High stress is also associated with these factors.
3. Education and training of adults who work with children. Diagnosis is difficult when injuries are internal, thus it is important for workers to understand the risks of abuse. This includes pediatricians, social workers, teachers, and counselors.
4. Cutting budgets has been the major focus of 2011, and more states are reducing prevention effort funding. Legislatures are not educated on the consequences of abuse, including the future costs to states in working down-stream. If you work with families early on, it is possible to reduce child abuse and neglect, affecting the life course. States with low child abuse rates invest in working up-stream.

We cannot lobby legislatures to increase funding if we do not have the general public behind us. As MCH leaders, we must work to reverse child abuse as a taboo and silent topic. Media campaigns, outreach, and education must be expanded. In the 20^th century, breast cancer was unmentionable, and now there is a month dedicated to battling it. Spread the word-here is the link to the BBC report: http://www.bbc.co.uk/news/world-us-canada-15288865.