Posted on | August 4, 2009 | No Comments
The United Nations Children’s Fund issued a Health Report Card in 2007.1 It reviewed six dimensions of health including material well-being, health and safety, educational well-being, peer and family relationships, behaviors and risk, and subjective well-being. Where did the US fall in the rankings? In 5 of the 6 dimensions, the US was in the bottom third of all nations studied. This startling result reflects the absence of a national children’s agenda in this country. We lack both a consistent commitment nationwide to quality medical care in children and a similar commitment that is consistent for quality early childhood education.
The absence of enlightened programming is unwise on many levels including financial. Nobel economist James Heckman showed that investment in early childhood pays off richly. His work clearly pointed out that America does not make good decisions when applying resources for children. We over-invest in “remedial skill programs” at later ages and under-invest in the early years of development. The young have a long time horizon, and “learning begets learning”. Heckman demonstrated that returns on human capital investments in the very young increase markedly the earlier the intervention. Just one intervention – preschool program investment – has a benefit to cost ratio of 8 to 1.2
If a nation is to invest wisely in their youngest, children must have access to health care. The SCHIP Reauthorization Act of 2009 was an important step in the right direction. 13 million children, 17% of all US children, live below the poverty level. For these children, health care plus early childhood education, carefully interwoven with family and community based support, has been shown to be successful. But leadership is critical.3
A good place to begin is to critically review two Institute of Medicine reports. The first, published in 2003, is titled “Unequal Treatment”, and defines the special challenges we face with childhood disparities. Not the least of these is a lack of research. Only 5 of the 103 studies analyzed in the paper dealt with children.4 The second, published in 2004, with the National Research Council, is titled “Children’s Health and The Nation’s Wealth”, and addresses early childhood programs with an eye toward wise long term investment.5
A truly Preventive Health Care System must focus on life course strategic planning and early investment. Existing research has demonstrated that early childhood intervention significantly lowers the incidence of chronic disease burden from cardiovascular disease, type II diabetes, hypertension and mental health.6 As significant as is the avoidance of chronic disease, investment in effective, efficient and integrated education and health care from age zero to five, has a much greater promise, that being the realization of full human potential and productivity in our least fortunate citizens.
For Health Commentary, I’m Mike Magee.
1. UNICEF. Child Poverty in Perspective. An Over-View of Child Well-Being in Rich Countries, Innocenti Report Card 7. Florence, Italy: UNICEF Innocenti Research Centre; 2007.
2. Heckman JJ. Skill formation and the economics of investing in disadvantaged children. Science 2006;312 (5782); 1900-1902.
3. Cheng TL and Jenkins RR. Health Disparities Across The Lifespan. JAMA. June 17, 2009;301:23 (2491-2492)
4. Institute of Medicine. Unequal Treatment. Washington, DC. National Academy Press. 2003. http://www.nap.edu/openbook.php?isbn=030908265X
5. National Research Council; Institute of Medicine; Committee On Evaluation Of Children’s Health, Youth and Families, Division of Behavior and Social Sciences and Education. Children’s Health, The Nation’s Wealth: Accessing and Improving Child Health. Washington, DC: National Academy Press: 2004. http://books.nap.edu/html/child_health/reportbrief.pdf
6. Kuh D and Ben-Schlomo Y, eds. A Life Course Approach To Chronic Disease Epidemiology. New York, NY: Oxford University Press; 1997.