Investing in Children to Improve the Nation's Health

Jan 27, 2014, 6:28 PM, Posted by Susan Dentzer

RWJF recently convened a panel of distinguished guests for a Google+ Hangout to examine targeted interventions that could help America’s youngest children live healthier, happier, and safer lives. Here's an archived version of the Hangout.

"It is easier to build strong children than to repair broken men," wrote Frederick Douglass, the 19th century African-American social reformer, writer and orator. A century and a half later, to improve the health of Americans, it's essential to start with kids.

That’s a preeminent conclusion of the new report of the RWJF Commission to Build a Healthier America called Time to Act: Investing in the Health of Our Children and Communities. The report focuses on ways to influence the upstream determinants of Americans' generally poor health, including low levels of education and incomes, unsafe environments, and non-nutritious food. Of the panel's three top recommendations, the first is distinctly child-centric: "Invest in the foundations of lifelong physical and mental well-being of our youngest children." Were he alive today, Douglass would surely agree.

Adverse Childhood Experiences: There are multiple ways to carry out the invest-in-children objective, given growing scientific understanding of the interactions among genetics, health and environment.

Consider the evidence gained from the long-running Adverse Childhood Experiences Study, collaboration between the U.S. Centers for Disease control and Prevention and Kaiser Permanente. The study followed 17,000 members of Kaiser’s HMO plans since 1995 and has yielded more than 50 scientific articles linking childhood abuse, neglect, and other stressors to such conditions as depression, heart disease, chronic lung disease, liver disease, and cancer. Alarmingly, more than two-thirds of study participants reported at least one such adverse childhood experience, including psychological, sexual, or physical abuses.

Such evidence strengthens the case for “major new initiatives” to strengthen families and communities, and to try to offset the effects of these debilitating stressors, the report says. Yet on one key indicator—public investments in early childhood education and development—the United States currently ranks 25th out of 29 industrialized countries. The report recommends that access be guaranteed for all low-income children under age 5 in high-quality child development and preschool programs by 2025. President Barack Obama and many state governors have proposed universal preschool for the nation’s 4-year-olds, while some communities and states have already taken action.

Building Social Capital: In Salt Lake City, for example, the investment firm Goldman Sachs, United Way of Salt Lake, the J.B. and M.K. Pritzker Family Foundation, and two local school districts created a partnership to open new preschool slots for more than 3,500 low-income children. Goldman’s Urban Investment program and the Pritzker Foundation will lend money through “social impact bonds” to United Way of Salt Lake City, which will oversee the school districts’ preschool programs. The money will eventually be repaid out of “avoided [public] costs,” as fewer children will need special education and remedial services later in their school careers.

Just as important as the launch or expansion of early childhood development and education programs, is ensuring that they are high quality. The report calls on federal and state government agencies to create and enforce quality standards, as the U.S. Department of Health and Human Services did in 2011 in adopting tougher rules for low-performing Head Start grantees.

Also, Head Start and related programs shouldn’t just focus on children’s’ educational attainment, the report says, but should also focus on “building the resources and capacities of parents and other caregivers to promote resilience in young children,” especially by “strengthening their ability to cope with adversity.”

Bridging Health, Community Development and Health Care: The two other key recommendations in the report focus on fully integrating health into community development, and incorporating a more health-focused approach to the financing and delivery of health care. For example, the report recommends that a new “innovation fund” financed by public and private funders could test innovations in community improvement, similar to the way that the Center for Medicare and Medicaid Innovation, created by the Affordable Care Act, is testing innovations in delivering and paying for health care.

To bring a focus on upstream health determinants into the health care system, pediatricians operating in a patient-centered medical home model could be paid additional fees to track and foster preschool attendance by children. And health professionals could adopt a new list of social determinant “vital signs,” including educational attainment, to better understand—and target interventions to mitigate—their patients’ risks for poor health.

“A stronger, healthier America hinges on our ability to build a sustainable foundation for generations to come,” the report says. And at the base of that pyramid must be healthier, happier, safer and more secure kids.