America’s Children: The Big Disconnect

A recent key federal report on the health and well-being of America’s children leaves much to be desired. But you wouldn’t know it by reading the mainstream media coverage.

“America’s Children: Key National Indicators of Well-Being, 2007” is the U.S. government’s annual report that monitors the well-being of the our country’s children. According to ChildStats.gov, the official web site of the authoring Federal Interagency Forum on Child and Family Statistics (a conglomerate of 22 federal agencies), the report is a “compendium of the most recently released federal statistics on the nation’s children… It presents a comprehensive look at critical areas of child well-being. These encompass family and social environment, economic circumstances, health care, physical environment and safety, behavior, education, and health.” In this report, it is noted that nearly 25% of this country’s population is under 18 years old and therefore qualifies as a “child” for the purposes of this discussion.

The Associated Press report, “Positive Trends Recorded in U.S. Data on Teenagers,” was picked up widely a few weeks ago, including in the New York Times, where I first saw it. Hooray, great news! You would think, based on the headline and the article’s highlights, that the well-being of our country’s youth was improving. The story’s lead? “Fewer high school students were having sex and more were using condoms in 2005, according to the latest government report on the well-being of the nation’s children.” You’ve got to be kidding. That’s the best you’ve got?

It actually gets worse. The statistics glowingly quoted include a mixture of the mundane and the misleading. Yes, the teen birthrate was down. “This is very good news,” notes Mr. Edward J. Sondik, director of the National Center for Health Statistics. He continues, “Young teen mothers and their babies are at a greater risk of both immediate and long-term difficulties.” While that is true, it is “truer” that the percentage of low birthweight infants increased, a more important risk factor for infant and childhood morbidity. In fact, the percentage of infants with low birthweight has increased slowly but steadily since 1984. And what about health disparity indicators? As noted in the Forum’s official press release, “There are substantial racial and ethnic disparities among the birth rates for adolescents ages 15–17. In 2005, the birth rate per 1,000 females for this age group was 8 for Asians/Pacific Islanders, 12 for White, non-Hispanics, 31 for American Indians/Alaska Natives, 35 for Black, non-Hispanics, and 48 for Hispanics.” This type of health injustice is intolerable and is no cause for celebration. It is, typically, buried in the details of various media reports, if mentioned at all.

Want a clearer picture on the “well-being” of our country’s youth, our future?

On the rise:

– % of children served by community water systems that did not meet all applicable standards for healthy drinking water

– % of children living in physically inadequate or crowded housing or housing that cost more than 30 percent of household income

– % of children living in counties in which concentrations of one or more air pollutants rose above allowable levels

– % of children had one or more housing problems

– % of children with behavioral disorders, asthma and obesity

Though not specifically cited in this report, the following health conditions are also on the rise – allergies, autism and ADHD, diabetes, and cancer. For a full list with statistics, see this post from June. Think they might be connected?

Falling:

– % of children with health insurance coverage at some point during the year

– % of children covered by private vs. public health insurance

Why are these last two findings important? Children with health insurance have greater access to health care. According to the report, children who were uninsured were nearly 16 times as likely as those with private insurance to have no usual source of health care; in fact, even children with public insurance were more likely to have no usual source of care than were children with private insurance. A “usual source of health care” is consistent with the medical home concept I have written about previously; it is one key to enhancing health and well-being for children and is philosophically aligned with integrative medicine. An estimated 11% of the country’s youth have no health insurance and a whopping 18 percent of children live in poverty. Many of these kids will only receive regular health care once they are enrolled in public insurance programs such as Medicaid or the State Children’s Health Insurance Program (SCHIP). Created 10 years ago, the SCHIP program has been the safety-net, if you will, for those families not quite poor enough for Medicaid but not able to afford private insurance. As a recent AAP statement details, because of SCHIP, “Access to health care has been vastly improved… Family satisfaction and quality of care have also improved significantly, (and) income and racial//ethnic gaps in health insurance coverage and access to care have also narrowed.” This last point is crucial, as economic disparities inevitably lead to health care disparities and, put simply, poor children are sicker than the rest. We can argue (and Congress continues to do so, as SCHIP re-funding is being hotly debated) about who qualifies for public health care assistance; states currently set the bar as a percent of the Federal Poverty Limit (FPL). Should it be set at 200% of the FPL, as the federal CMS suggests as a minimum? Or 350% as New Jersey does? That is up for debate. What should not be is that it is our responsibility to see that each and every child, regardless of income, race, or ethnicity, is afforded the right to high quality, comprehensive, primary health care.