Policies to Promote Child Health: Introducing the Issue

Abstract

A large volume of high-quality research shows that unhealthy children grow up to be unhealthy adults, that poor health and low income go hand in hand, and that the consequences of both poverty and poor health make large demands on public coffers. Thus promoting children's health is essential for improving the population's health; policies to prevent children's health problems can be wise investments; and policy makers should implement carefully designed policies and programs to promote child health. According to the World Health Organization, health is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity. We view health in this broad sense, encompassing both physical and mental health indicators. And because some children's health problems may go undiagnosed or take years to become apparent, we also consider conditions that predict poor child health (such as low birth weight) and behaviors that affect health (such as substance use). We view policies in a broad sense as well. Because an array of physical and social factors--including unsafe housing, pollution, food insecurity, and maltreatment, all of which are related to poverty--can adversely affect health, many types of policies are important for child health. Thus we consider the effects of policies that don't specifically focus on health (such as cash or in-kind assistance, or parenting education programs) in addition to policies that focus on access to health care or the direct provision of medical services. Relevant policies come in many shapes and sizes, ranging from large federal programs such as Head Start and the Supplemental Nutrition Assistance Program (SNAP) to more modest local public health initiatives. U.S. child health policy is thus a patchwork of efforts at the federal, state, and local levels. Many policies aim specifically to improve child health, while others have different goals but could indirectly affect the health of children. Some health-related policies target children directly, attempting to treat health problems once they occur or to prevent them from occurring, while others target women during or before pregnancy with the goal of improving the health of newborns. Some policies target low-income children, while others are more universal. For this issue of The Future of Children, we commissioned a group of experts to review research on how effectively U.S. policies promote child health. The articles, based on the strongest evidence to date, assess how best to promote child health and, more specifically, what interventions and strategies work best at various stages of children's development. In the lead article, Sara Rosenbaum and Robert Blum paint a portrait of child health in the United States today, setting it in its historical, national, and international context. Maya Rossin-Slater reviews programs to promote child health at birth and in the early childhood years. Craig Gundersen, Ingrid Gould Ellen and Sherry Glied, and Lindsey Leininger and Helen Levy review policies that provide food, housing, and access to health care, respectively, examining how those policies impact child health. Lawrence Berger and Sarah Font consider policies that focus on families, viewed through a child health lens. Alison Cuellar focuses on children's mental health and reviews policies in that important area. Finally, Clare Huntington and Elizabeth Scott provide important context vis-a-vis the legal framework that both shapes and constrains U.S. policies to promote child health. Themes of the Issue Five broad, overlapping themes emerge from this issue: * A wide range of policies are important for promoting child health; * Responsibility for promoting child health is fragmented, with a lack of consensus about government's appropriate role; * We have a "crisis response" mentality that doesn't focus on prevention and often precludes implementing policies in ways that would let us thoughtfully evaluate their efficacy; * Information about cost-effectiveness is severely lacking; and * Poor and minority children typically face the greatest health risks. …