The US lags behind other developed countries in key indicators of child health and well-being, including infant and child mortality, poverty, and obesity. A defining feature of children’s health in the US is tremendous disparity by race and ethnicity, undercutting the goal of providing all children with equal opportunities for success. This month’s Health Affairs explores children’s health and well-being and provides a road map for future improvement.
Road Map For Improvement
James Perrin and coauthors summarize and identify crosscutting themes in four recent reports from the National Academies of Sciences, Engineering, and Medicine on strengthening child and adolescent health and well-being. Focusing on poverty; mental, emotional, and behavioral health; adolescence; and young family health and education, “the reports make clear that many evidence-based solutions allowing changes to current trajectories and outcomes already exist.”
“When it comes to supporting the health of children and families, what Americans say is not what we do,” Janet Currie notes. She posits that closing the gap between Americans’ stated preferences for spending on children’s health and actual levels of spending requires overcoming limited trust in government, unrealistic expectations regarding returns on investment, and ideological divisions.
Dolores Acevedo-Garcia and coauthors present and analyze the Child Opportunity Index 2.0, a composite measure of children’s neighborhood opportunity. Inequities are profound, with an overall Child Opportunity Score of 73 for White children compared with 33 for Hispanic children and 24 for Black children in the largest 100 metropolitan areas. Noting that variation within metropolitan areas exceeds variation across the country, the authors conclude that “policy solutions at higher levels of government are needed to mitigate the consequences of fragmentation.”
Neal Halfon and coauthors report on the health development of kindergarteners as recorded by data collected by their teachers. The percentage of children with vulnerability grows linearly with declining neighborhood income, with models showing that “racial/ethnic groups differ substantially in levels of vulnerability, even when income is controlled for.”
Jason Fletcher and Katie Jajtner examine child development through the lens of intergenerational mobility, or the degree to which children’s outcomes diverge from or follow those of their parents. For children whose parents are in poorer health, upward health mobility is limited if those parents are also socioeconomically disadvantaged, whereas when parents are in better health, downward health mobility is more likely if the parents are also socioeconomically disadvantaged. Regardless of one’s own background, “living in a community with low [socioeconomic status] among classmates reduces upward health mobility and increases downward health mobility.”
Linda Sprague Martinez and coauthors partnered with twelve Black and Latinx youth researchers, ages 13–18, to conduct a youth needs assessment in six Boston neighborhoods. Although two-thirds of survey respondents agree that mental health is important for young people’s well-being, only 29 percent think it is easy to get help. The authors conclude that “young people are acutely aware of the conditions that produce ill health, as well as racial inequities in health and social factors that determine health.”
Programs such as Medicaid, SNAP, and WIC provide critical support to children. Jeremy Barofsky and colleagues seek to determine whether the Trump administration’s announcement of plans to consider use of these programs in considering whether a lawful permanent resident is a “public charge” led to reductions in enrollment. They find statistically significant declines in Medicaid and WIC enrollment, with a 1-percentage-point increase in the share of a county’s population that are not US citizens associated with a 0.1-percentage-point greater decline in Medicaid enrollment.
Coverage And Access
Despite significant coverage gains between 2008 and 2015, the proportion of children in the US with health insurance has fallen in recent years. Observing that “policy makers have made enormous strides in coverage of children, but there is still a distance to go,” Joan Christina Alker and coauthors propose strategies ranging from a unified, national program to policies that expand on Medicaid, CHIP, and the ACA Marketplaces.
James Crall and Marko Vujicic examine children’s oral health. They report declines during the past thirty years in dental carries—the most common pediatric oral disease—with particular improvement among poor and near-poor children and Mexican American children. Yet major gaps in coverage and care remain, leading the authors to recommend a range of payment, delivery system redesign, and education reforms.
Health Affairs thanks Christopher Forrest of the Children’s Hospital of Philadelphia and Lisa Simpson of AcademyHealth for serving as theme issue advisers. We also thank Nemours, Blue Shield of California Foundation, Children’s Hospital Association, the Episcopal Health Foundation, and the W. K. Kellogg Foundation for financial support of this issue.