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The United States 2012 General Election: Making Children's Health and Well-Being a Priority for the Candidates

  • Tumaini R. Coker
    Correspondence
    Address correspondence to Tumaini R. Coker, MD, MBA, UCLA/RAND Prevention Research Center, 10960 Wilshire Ave, Suite 1550, Los Angeles, CA 90024.
    Affiliations
    Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, Calif

    RAND, Santa Monica, Calif
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  • Paul J. Chung
    Affiliations
    Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, Calif

    RAND, Santa Monica, Calif

    Department of Health Services, UCLA School of Public Health, Los Angeles, Calif
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  • Cynthia S. Minkovitz
    Affiliations
    Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health and Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
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      In the first half of the 20th century, perhaps the most vulnerable group in the United States was elderly constituents. More than one-third were living in poverty, and fewer than one-half had health insurance.

      United States Census Bureau. Historical Poverty Tables. Available at: http://www.census.gov/hhes/www/poverty/data/historical/people.html. Accessed May 8, 2012.

      • Cohen R.
      • Makuc D.
      • Bernstein A.
      • et al.
      Health insurance coverage trends, 1959-2007. Estimates from the National Health Interview Survey.
      Democratic and Republican presidents, including Theodore Roosevelt, Franklin Roosevelt, and Lyndon Johnson, convinced Americans that there was a moral imperative for our country to care for its elderly.

      Social Security Online. Address by Theodore Roosevelt in Chicago 1912. Available at: http://www.ssa.gov/history/trspeech.html. Accessed May 8, 2012.

      Social Security Online. Historical Background and Development of Social Security. Available at: http://www.ssa.gov/history/briefhistory3.html. Accessed May 8, 2012.

      Centers for Medicare & Medicaid Services. History of Medicare and Medicaid. Available at: http://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/History/. Updated March 27, 2012. Accessed May 21, 2012.

      Through Social Security (enacted in 1935) and Medicare (enacted in 1965), a transformational shift in the well-being of seniors occurred. The percentage of seniors living in poverty decreased from 35% in 1959 to 9% in 2010.

      United States Census Bureau. Historical Poverty Tables. Available at: http://www.census.gov/hhes/www/poverty/data/historical/people.html. Accessed May 8, 2012.

      But for more than 40 years, the most vulnerable population in the United States has not been the elderly. It has been our children. The prevalence of poverty among children was 27% in 1959. In 2010, it was 22%, and 24% of children were living in households that were “food-insecure.”

      United States Census Bureau. Historical Poverty Tables. Available at: http://www.census.gov/hhes/www/poverty/data/historical/people.html. Accessed May 8, 2012.

      Child Trends. Children in Poverty. Available at: www.childtrendsdatabank.org/?q=node/221. Published 2011. Updated September 2011. Accessed May 8, 2012.

      Child Trends. Food Insecurity. Available at: www.childtrendsdatabank.org/alphalist?q=node/363. Published 2011. Updated October 2011. Accessed May 8, 2012.

      To date, there has been no call to arms, no nationally accepted moral imperative, no apparent sense of collective shame.
      When children are supported by society, their potential is boundless. The evidence, however, that the United States does not fully support children is overwhelming.
      • Cheng T.
      The wisdom, the will, and the wallet: leadership on behalf of kids and families.
      The childhood poverty prevalence is nearly twice as high as the average childhood poverty prevalence of 13% among developed countries. The United States ranks at the bottom of this group in public spending on early childhood, and is below average in the percentage of 15 to 19 year olds who are either in school or employed.

      OECD. OECD Family Database. Available at: www.oecd.org/social/family/database Published 2011. Accessed May 8, 2012.

      Children's health and well-being are determined by a range of factors, including biological, behavioral, and environmental.
      Committee on Evaluation of Children's Health, National Research Council
      Children's Health, the Nation's Wealth: Assessing and Improving Child Health.
      There is a growing recognition of the importance of social and economic circumstances on child health and well-being.
      Key factors in childhood, such as access to a safe home, healthy food, caring adults, and quality education, may influence health and well-being not only in childhood but throughout life. By investing in children, we can affect life trajectories, generations, and the long-term health of the nation.
      In this climate of hyper-partisanship, it seems a fool's errand to search for agreement on how to improve the lives of children in the United States. However, even at the extremes of our political spectrum, there should at least be consensus on this one core value—that every child in the United States should be afforded the foundations of health, including responsive caregiving, safe and secure environments, appropriate nutrition, and the opportunity to adopt health-promoting behaviors to achieve optimal health and well-being.
      • Mistry K.
      • Minkovitz C.
      • Riley A.
      • et al.
      A new framework for child health promotion-the role of policies and programs in building capacity and foundations of early child health.
      Public and private policies, partnerships, and programs are needed to achieve these goals, but how they should be shaped and what policies should be implemented at the corporate, federal, state, and local levels are critical questions that remain unsettled. Unfortunately, a constructive discussion of these issues central to children has been largely absent from political discourse.

      Voices for America's Children. Election 2012 Debate Watch Update–Moving America's Children into the Spotlight: The Presidential Election as an Opportunity for Dialgue About America's Future. Available at: http://www.voices.org/category/news/. Published 2012. Accessed April 30, 2012.

      Before voters go to the polls on November 6, 2012, they should know how candidates propose to tackle the major issues affecting health and well-being of children in the United States.
      We propose a starting list of 6 questions for candidates to spur a constructive political dialogue aimed at improving children's lives:

      Childhood Poverty

      Facts: 22% of children live in poverty in the United States, and 24% of children live in food-insecure households.

      Child Trends. Children in Poverty. Available at: www.childtrendsdatabank.org/?q=node/221. Published 2011. Updated September 2011. Accessed May 8, 2012.

      Child Trends. Food Insecurity. Available at: www.childtrendsdatabank.org/alphalist?q=node/363. Published 2011. Updated October 2011. Accessed May 8, 2012.

      Poverty is associated with reduced health; 42% of children in poor families are in excellent health, compared with 64% of children in families that are not poor.

      Bloom B, Cohen R, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2010. Vital Health Stat: National Center for Health Statistics; 2011. Available at: www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf. Accessed July 24, 2012.

      Question: No child deserves to live in poverty. What policies would you propose:
      • 1)
        To reduce the number of children living in poverty, and
      • 2)
        For those children who remain in poverty, to reduce poverty's effects on their health and well-being?

      Early Childhood Programs

      Facts: At the start of kindergarten, 48% of poor children meet school readiness standards, compared with 75% of children in middle-income families.

      Isaacs J. Starting school at a disadvantage: the school readiness of poor children: Center on Chilren and Families at Brookings; 2012. Available at: http://www.brookings.edu/∼/media/research/files/papers/2012/3/19%20school%20disadvantage%20isaacs/0319_school_disadvantage_isaacs. Accessed July 24, 2012.

      Question: No child deserves to miss out on the opportunity to achieve his or her greatest potential in life. Considering the importance of the first 5 years of life in childhood development, what plans do you have to ensure that all children have access to responsive caregivers (eg, parents, childcare professionals, teachers) who will help children live, learn, and play?

      K-12 Education

      Facts: 40% of U.S. high school seniors have less than a basic level of achievement on national science exams.

      Child Trends. Science Proficiency. Available at: www.childtrendsdatabank.org/?q=node/257. Published 2011. Updated 2011. Accessed May 8, 2012.

      66% of eighth graders test below proficiency level for math and 68% test below proficiency for reading.

      U.S. Department of Education National Center for Education Statistics. 2011 National Assessment of Educational Progress: The Nation's Report Card. Available at: http://nces.ed.gov/nationsreportcard/. Accessed July 24, 2012.

      Question: No young adult deserves to enter the workforce without a fair opportunity to succeed. What will you do to improve our education system, so that all children can receive a high-quality education?

      Health Care Access and Quality

      Facts: 10% of U.S. children under age 18 and 27% of young adults ages 18 to 24 years are uninsured.

      United States Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2010. Available at: http://www.census.gov/hhes/www/hlthins/. Accessed May 8, 2012.

      A total of 34% of children with special health care needs have inadequate insurance to cover their health care needs, and 22% of these children have families that experience financial problems due to their health care needs.

      Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health Data Set, Data Resource Center for Child and Adolescent Health. Available at: http://www.childhealthdata.org. Accessed May 9, 2012.

      Question: No child deserves to be left out of our health care system. What steps should be taken to ensure that all children have access to high-quality health care for both physical and mental health services?

      Equity for Children and Youth

      Facts: 38% of black children, 32% of Hispanic children, and 17% of white children live in poverty
      • Macartney S.
      Child poverty in the United States 2009 and 2010: Selected race groups and Hispanic origin.
      ; 18% of Hispanic youth, 9% of black youth, and 5% of white youth drop out of high school

      U.S. Department of Education National Cener for Education Statistics. The Condition of Education 2011(NCES 2011-033). 2011:Table A-20-21. Available at: nces.ed.gov/pubs2011/2011033.pdf. Accessed July 24, 2012.

      ; and 14% of Hispanic children, 6% of black children, and 6% of white children are uninsured.

      Bloom B, Cohen R, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2010. Vital Health Stat: National Center for Health Statistics; 2011. Available at: www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf. Accessed July 24, 2012.

      Question: No child deserves to be treated less fairly than any other child. What policies do you propose to narrow the wide gaps among children and youth in education, health, and well-being?

      Positive Youth Development

      Facts: Developing strong bonds with adults and involvement in positive activities promote healthy development among teens that elevates lifelong trajectories

      Catalano RF, Berglund M, Ryan JAM, et al. Positive Youth Development in the United States: Research Findings on Evaluations of Positive Youth Development Programs. Social Development Research Group. Available at: http://aspe.hhs.gov/hsp/PositiveYouthDev99/index.htm#toc Published 1998. Accessed June 27, 2012.

      ; however, 18% of youth ages 12 to 17 years do not participate in any organized activities outside of school, and 22% have not been involved in any type of community service or volunteer work in the past year.

      Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health. Data Resource Center for Child and Adolescent Health. Available at: http://www.childhealthdata.org. Accessed June 27, 2012.

      Question: No child deserves to be denied the opportunity to experience a healthy, productive adolescence. What initiatives do you support to promote and ensure community connections for youth?

      Conclusion

      During the last 50 years, we’ve witnessed a transformational shift in the well-being of the elderly in the United States. During the next 50 years, if a similar transformation in the well-being of U.S. children has not occurred, it will not be because the wrong individuals were elected to office, or because the wrong party was in control. It will be because we—the nation's child health professionals, parents, and advocates—did not sufficiently raise the bar on expectations for what we as a country can and should do to promote the well-being of children. This fall, let us begin to do better.

      References

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        • Cohen R.
        • Makuc D.
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        Health insurance coverage trends, 1959-2007. Estimates from the National Health Interview Survey.
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      2. Social Security Online. Address by Theodore Roosevelt in Chicago 1912. Available at: http://www.ssa.gov/history/trspeech.html. Accessed May 8, 2012.

      3. Social Security Online. Historical Background and Development of Social Security. Available at: http://www.ssa.gov/history/briefhistory3.html. Accessed May 8, 2012.

      4. Centers for Medicare & Medicaid Services. History of Medicare and Medicaid. Available at: http://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/History/. Updated March 27, 2012. Accessed May 21, 2012.

      5. Child Trends. Children in Poverty. Available at: www.childtrendsdatabank.org/?q=node/221. Published 2011. Updated September 2011. Accessed May 8, 2012.

      6. Child Trends. Food Insecurity. Available at: www.childtrendsdatabank.org/alphalist?q=node/363. Published 2011. Updated October 2011. Accessed May 8, 2012.

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        The wisdom, the will, and the wallet: leadership on behalf of kids and families.
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      9. Voices for America's Children. Election 2012 Debate Watch Update–Moving America's Children into the Spotlight: The Presidential Election as an Opportunity for Dialgue About America's Future. Available at: http://www.voices.org/category/news/. Published 2012. Accessed April 30, 2012.

      10. Bloom B, Cohen R, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2010. Vital Health Stat: National Center for Health Statistics; 2011. Available at: www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf. Accessed July 24, 2012.

      11. Isaacs J. Starting school at a disadvantage: the school readiness of poor children: Center on Chilren and Families at Brookings; 2012. Available at: http://www.brookings.edu/∼/media/research/files/papers/2012/3/19%20school%20disadvantage%20isaacs/0319_school_disadvantage_isaacs. Accessed July 24, 2012.

      12. Child Trends. Science Proficiency. Available at: www.childtrendsdatabank.org/?q=node/257. Published 2011. Updated 2011. Accessed May 8, 2012.

      13. U.S. Department of Education National Center for Education Statistics. 2011 National Assessment of Educational Progress: The Nation's Report Card. Available at: http://nces.ed.gov/nationsreportcard/. Accessed July 24, 2012.

      14. United States Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2010. Available at: http://www.census.gov/hhes/www/hlthins/. Accessed May 8, 2012.

      15. Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health Data Set, Data Resource Center for Child and Adolescent Health. Available at: http://www.childhealthdata.org. Accessed May 9, 2012.

        • Macartney S.
        Child poverty in the United States 2009 and 2010: Selected race groups and Hispanic origin.
        U.S. Census Bureau, Suitland, Md2011
      16. U.S. Department of Education National Cener for Education Statistics. The Condition of Education 2011(NCES 2011-033). 2011:Table A-20-21. Available at: nces.ed.gov/pubs2011/2011033.pdf. Accessed July 24, 2012.

      17. Catalano RF, Berglund M, Ryan JAM, et al. Positive Youth Development in the United States: Research Findings on Evaluations of Positive Youth Development Programs. Social Development Research Group. Available at: http://aspe.hhs.gov/hsp/PositiveYouthDev99/index.htm#toc Published 1998. Accessed June 27, 2012.

      18. Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health. Data Resource Center for Child and Adolescent Health. Available at: http://www.childhealthdata.org. Accessed June 27, 2012.