Children are our future

Children are the poorest age group in the country, according to the Children’s Defense Fund. Nearly 22% of all US children live in families with incomes below the federal poverty level– $23,550 a year for a family of four. Current and future health risks are greatest for children who experience poverty when they are young and/or when they experience persistent poverty, according to several reports. Where do these dismal trends fit into the national dialogue about building a healthier America?

According to the Robert Wood Johnson Foundation’s (RWJF) 2014 report, improving the health of all Americans should start with an investment “in the foundations of lifelong physical and mental well-being in our youngest children.” Investing in the very young fosters success in later life and may reverse the negative health consequences of prolonged exposure to adversity (e.g. the Adverse Childhood Experiences study was among the first investigations to report a strong link between adverse early childhood experiences and conditions such as depression, addiction, diabetes, and heart disease). Support for vulnerable young children should therefore be a national health priority. The building blocks for a lifetime of good health should include education and “direct interventions designed to improve health and protect the developing brain from significant adversity that can lead to illness.” Health initiatives may include strategies to decrease widespread childhood obesity– a key risk factor for numerous chronic conditions. The New England Journal of Medicine reported that” incident obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight [1].”

The RWJF report focused on factors that must be addressed in order to prevent the United States from slipping even lower than its 2009 ranking of 27th place in terms of life expectancy at birth (out of 34 of the world’s affluent countries). The recommendations are:

1.       Make investing in America’s youngest children a high priority

2.       Fundamentally change how we revitalize neighborhoods, fully integrating health into community development

3.       The nation must take a much more health-focused approach to health care financing and delivery. Broaden the mindset, mission, and incentives for health professionals and health care institutions beyond treating illness to helping people lead healthy lives

The health and educational rewards of meeting the first objective are currently being measured in different states. For instance, a longitudinal study (2006-7) of the outcomes associated with 3 cohorts of 4-year olds in 11 Utah schools most impacted by poverty, showed that at-risk children (who attended high quality preschool programs) used special education services at significantly reduced rates compared with those who did not receive high-quality early tuition (cost savings of about $1 million). Moreover, the SY06-07 Preschool Cohort had closed the achievement gap by the 3rd grade. Social impact investments, along the lines of the Early Childhood Innovation Accelerator, could increase the access, availability, and quality of early childhood programs for disadvantaged children. The aim of the Accelerator is to “rapidly increase the availability of high-quality early childhood learning opportunities, while building measurable successes backed by evidence, accountability and results.”

The priorities for meeting all the health objectives were summarized in a recent Google hangout and the full report of the RWJF commission can be viewed here.

Reference

1.            Cunningham, S.A., M.R. Kramer, and K.M.V. Narayan, Incidence of Childhood Obesity in the United States. New England Journal of Medicine, 2014. 370(5): p. 403-411.