Promoting Health for the Whole Child Through Policy

The vast majority of high-quality research points to the reality that unhealthy children go on to be unhealthy adults. Prioritizing children’s health is crucial to improve the overall health of the entire population. As such, policy to prevent health problems are important investments that need to be deliberately designed with the whole child in mind.

The World Health Organization defines “health” as a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity. Health can be viewed in a broad sense, including both physical and mental health indicators. Furthermore, because many children’s health issues go undiagnosed or take years to appear, conditions that predict poor child health (e.g., low birth weight) and behaviors that affect health (e.g., substance use) should be considered within the definition as well.

Traditionally, child health policy in the United States has been a joint effort at the federal, state and local levels. Some policies specifically target improving child health, while others more indirectly impact the health of children. Some policies are focused on helping low-income children, while others are more universal. Across all legislation, five overlapping themes have emerged within the past several decades:

• 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 tends to disregard prevention and — consequently — 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 tend to face the greatest health risks.

Given the inherently problematic nature of many of these topics, how should policymakers and researchers move forward? And how can we ensure that health and health policy does not focus narrowly on access to health care?

Health policy should devote more resources to preventing, diagnosing, and managing ALL conditions to improve children’s functioning and trajectories. Mental health problems, for instance, have surpassed physical health problems to become the most prevalent and disabling conditions facing children today. For many families, the first point of contact (and the setting for intervention) with mental health conditions is in their children’s schools. Thus, cooperation between children’s health care and education needs to be coordinated through policy.

The fragmented nature of responsibility for child health and health policy has produced a chronic lack of coordination among different actors and levels of government. This systemic disarray makes it more likely that children will fall through the cracks and predisposes us to take a crisis-oriented stance versus a proactive approach to health policy. While businesses would be harshly criticized for not tracking customer data, our government continuously fails to use the data at their disposal to create an integrated portrait of child health or to target policies who have the most to gain from them. Systems that can effectively increase coordination among the home, doctors’ offices, schools, and other institutions that touch children’s lives would tremendously benefit efforts to promote child health.

Invest in evaluation. The government pays remarkably little attention to rigorous evaluation or even to documenting exactly what elements the programs involve. We have too little information to compare different approaches, which makes it difficult to answer the most basic questions facing policymakers. We cannot determine what the most cost-effective ways to promote child health are.

However, there is one caveat: the fact that we can’t compare all policies should not keep us from implementing or expanding those we know to be both effective and cost saving, or from evaluating others that show promise. Many programs do have well-designed evaluations that demonstrate their benefits; these are the programs that should be doubled-down on.

Poor and minority children deserve special attention, especially given the disproportionate burden of ill-health that they face. Evaluating policies through an equity lens is key, as the same policies may have different impacts on different groups. The overall effect of legislation may actually be negative for the most disadvantaged groups, even when it appears to be helping others (e.g., housing subsidies when individuals are not able to navigate the system and obtain the subsidies).

Investments in child health have the potential to repay current expenditures many times over, both by allowing children to grow up to be productive citizens and well as by improving the circumstances of the next generation. Policies in areas such as health care, behavioral health, nutrition, housing, income, and child development all promise to pay dividends.