Medical Journal Prescribes Fixes for ‘Urgent’ Child Health Priorities

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A child is abused or neglected every 47 seconds and dies from abuse or neglect every seven hours. What surprised leading child health expert Dr. Glenn Flores is the staggering and tragic scope of this problem.

Child poverty, hunger, child abuse and neglect, obesity and a lack of health insurance are among “urgent” priorities for children’s health in the United States, says an analysis published Monday in the journal JAMA Pediatrics.

Gun violence, the soaring number of immigrant children, childhood mental illness, racial and ethnic disparities in health and a lack of investment in child-specific health research round out the priorities identified in the analysis.

The analysis evaluated priorities based on prevalence, impact on children’s health and the potential for federal policy to improve matters.

The two co-authors — Dr. Glenn Flores, a leading child health expert at the University of Texas Southwesternand Children's Medical CenterDallas, and Bruce Lesley, the president of First Focus, a Washington-based child advocacy organization — offered federal policy reform recommendations based on each child health priority.

Researchers have long linked a litany of health problems to childhood poverty, including significantly higher risks of injuries, lower IQs, more admissions to intensive care units and higher death rates in infancy, later in life and as a result of specific conditions.

Youth Today asked Flores, the director of the Division of General Pediatrics and professor of pediatrics, clinical sciences and public, to discuss some of the priorities and why they’re so urgent. Edited excerpts of the email interview follow.

Youth Today: Why are we at such a critical juncture now and what should lawmakers, policymakers and others do to respond to these urgent priorities?

Flores: We are at such a critical juncture because child well-being in America has declined since the most recent recession. Childhood poverty rates are at their highest in 20 years, one in four children lives in a food-insecure household, 7 million children lack health insurance, a child is abused/neglected every 47 seconds, and one in three children is overweight/obese.

Five children are killed daily by firearms, one in five experiences a mental disorder, racial/ethnic disparities continue to be extensive and pervasive, immigrant children are our nation’s fastest-growing group of children but experience suboptimal access to health care. And major National Institutes of Health (NIH) and National Institute of Child Health and Human Development (NICHD) sequester cuts and underfunding of pediatric research have damaged our global leadership in biomedical research and hobbled economic growth and jobs creation.

We believe that the practical, data-driven federal policy solutions which are proposed in the article would successfully address each of these 10 urgent priorities, thereby ensuring a healthy, productive future for American children and our nation.

Priority

Selected policy recommendations

Poverty Set a national target date for the elimination of child poverty.
Extend improvements to the Earned Income Tax Credit and child tax credit.
Hunger Fully fund the National School Lunch Program and implement the program’s nutritional standards.
Lack of insurance  Act this year to avoid cuts to funding for the Children’s Health Insurance Program (CHIP).
Child abuse and neglect Invest in research to improve screening and prevention.
Assess the potential of domestic abuse interventions to reduce the incidence of child abuse.
Obesity Pass the bipartisan FIT Kids Act (Fitness Integrated with Teaching Kids Act).
Gun violence Ensure that criminal background checks are required for all gun sales.
Ban assault weapons.
Mental health Increase Medicaid reimbursement rates for mental health providers.
Reverse funding cuts to federal mental health initiatives.
Racial and ethnic disparities Publicly report disparities data from the local level to the national level.
Improve the diversity of the healthcare workforce.
Immigration Ensure that immigration enforcement actions do not unnecessarily separate children from their parents.
Reform the immigration system to ensure that immigrant children have a path to citizenship.
Ensure that immigration status does not result in the denial of needed healthcare to children.
Lack of investment in child-specific health research Reverse federal budget in “sequestration” cuts to child-specific medical research.
Increase the share of NIH funding focused on pediatric research from its current level of 12 percent to 24 percent – the share of the nation’s population consisting of children.

Source: JAMA Pediatrics

Youth Today: How did you arrive at the list? What sort of research is behind the priorities?

Flores: Urgent policy priorities were identified using the following criteria: 1) prevalence of the condition or issue; 2) potential for a major impact on reducing morbidity or mortality or advancing child health and health care; and 3) feasibility and potential for amelioration by federal legislation.

Youth Today: Why didn’t you rank the priorities?

Flores: We intentionally avoided ranking because we believe that all of the priorities are urgent and require timely action by federal policymakers.

Youth Today: How did you come up with the specific policy reforms recommended?

Flores: We conducted a policy analysis to identify existing proposed federal legislation that has the potential to effectively address a given priority, based on the evidence from the medical literature. Where there was no relevant pending legislation, the available evidence was synthesized and used to propose common-sense federal policy solutions.

Youth Today: What findings surprised you most and why?

Flores: Children account for 73.5 million Americans (24 percent), but 8 percent of federal expenditures.

Federal spending on children in fiscal year 2014 fell by more than $20 billion (14 percent) since 2010, including declines in four of the past five years; and the federal government will spend more on interest payments than children by 2017. These facts surprised me because children are our nation’s future, but our nation’s financial investment in children at this time does not seem to be consistent with such a commitment.

A child is abused or neglected every 47 seconds and dies from abuse or neglect every seven hours. What surprised me is the staggering and tragic scope of this problem, which strikes me as unacceptable as a father, pediatrician and American.

The 2013 sequester resulted in budget cuts of $1.57 billion to NIH, $75 million to NICHD and $289 million to the Centers for Disease Control and Prevention. In fiscal year 2013, only 12 percent of the NIH budget was devoted to pediatric research, and only 4 percent of the NICHD budget, although children comprise 24 percent of U.S. population. This surprised me because the evidence clearly shows that investments in medical research ensure ongoing cutting-edge medical advances, protection of the public’s health, training future generations of researchers, jobs creation and maintaining America’s standing as the world’s biomedical research leader.

Youth Today: What results do you hope will come from this research?

Flores: The hope is that these dramatic findings will galvanize federal policymakers to tackle each of these urgent priorities and to commit to ensuring the very best health and well-being for U.S. children. Because the needs of our nation’s children have never been greater, there is an extraordinary opportunity for federal policy to profoundly improve the health, well-being and productivity of our current and future generations, an investment strongly supported by Americans across the political spectrum.

Youth Today: Anything you'd like to add?

Flores: There is overwhelming, bipartisan support by American voters for measures which would enhance our nation’s investments in and focus on children’s health and well-being. Two key steps include initiating an annual children’s budget, which details federal spending on children and provides an official accounting of federal investments in children and creating a bipartisan Children’s Commission to recommend solutions to problems facing children.