A Generational Opportunity to Invest in Our Children

We identified exemplary practices to help foster the nurturing, stable environments that children need from birth through adolescence to thrive.

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The United States has the most advanced medical care system in the world and spends the most per capita on healthcare. Yet we lag behind other developed nations on important health indicators, including infant mortality, child wellbeing, adult disability, and overall life expectancy. The status quo is failing our kids, denying them a healthier and brighter future. More kids than ever face the prospect of growing up less healthy and living shorter lives than their parents. Children are more likely than any other age group to be poor and live in medically underserved and socially vulnerable communities. Unless we collectively take significant steps to improve our children’s health and development, we will face adverse consequences for years to come.

There is growing evidence on how to improve children’s wellbeing. With support from the Robert Wood Johnson Foundation, the Integrated Care for Kids-InCK Marks Initiative spent the last six years bringing together pediatric practitioners, health administrators, policy experts, and advocates. InCK Marks’ advisors assessed pediatric healthcare practices and innovations, metrics, finances, and culture to identify tangible solutions that advance a culture of health for kids.

This work continually pointed us to—and eventually rooted us in—the value of early investments in preventive health and health promotion. While the return on investment may not be immediate, the dividends are lifelong, with ripple effects into all facets of life. The needed investments encompass more than just medical treatment; health systems must respond more proactively to the determinants that play a lasting role in children’s health, including economic (housing, food, and basic income) and social (relational supports and opportunities) factors.

This work continually pointed us to—and eventually rooted us in—the value of early investments in preventive health and health promotion. While the return on investment may not be immediate, the dividends are lifelong, with ripple effects into all facets of life. The needed investments encompass more than just medical treatment; health systems must respond more proactively to the determinants that play a lasting role in children’s health, including economic (housing, food, and basic income) and social (relational supports and opportunities) factors.

InCK Marks’ research shows that what matters most for children is the context in which they are born and develop. To thrive, they need safe, stable, and nurturing environments from the start. While there remains much to learn, InCK Marks’ work identified exemplary programs and practices that are advancing a new standard of integrated, primary healthcare for children, with impressive results. We synthesized our findings into three overarching recommendations: (1) Prioritize children, (2) Build on what works, and (3) Invest in value.

Prioritize Children

The U.S. health system can play a key role in advancing racial equity and improving population health. Yet too often, health transformation efforts do not adequately include children. While children represent one-quarter of the U.S. population and half of people on Medicaid, they account for less than one-tenth of overall medical expenditures and only one-fifth of Medicaid program costs. Policymakers and health systems have focused much of their attention on health transformations that aim to cut healthcare costs and improve outcomes.

Children are the country’s most diverse age group and their healthy development is most affected by their home and community environments. That alone is reason to prioritize them. But children also are developing personalities, habits, and behaviors that have lifelong implications for their health. Establishing positive health trajectories during childhood has, by far, the greatest overall returns on investment.

The Robert Wood Johnson Foundation’s focus on health transformation and building a Culture of Health recognizes that health is more than the absence of disease or infirmity and that responding to social determinants can improve well-being. While focusing on adults and those with disabilities is where immediate cost containment opportunities are greatest, we need to recognize that a focus on children is key to advancing population health and rectifying longstanding racial inequities.

Build on What Works

A broad, compelling body of research shows the efficacy of primary healthcare transformation for children. InCK Marks identified and worked with champions and child health practitioners who are using innovative strategies to reach children and families to recognize research-based models to build upon (DULCE, Help Me Grow, HealthySteps, Medical Legal Partnerships, etc.) and systemic approaches to developing integrated, community-based responses. InCK Marks synthesized the research examining these programs and identified the practice elements and approaches they shared.

There is now knowledge and a leadership base to move to a much broader standard of child healthcare that supports families in providing safe, stable, and nurturing home environments for their children. This is consistent with the pediatric field’s own guidelines for well-child care and family-centered medical homes. It is particularly important for practices serving socially vulnerable and medically underserved communities, where relational and community health workers can provide key supports. For example, the Center for Health Care Strategies is working with pediatric practices that understand that comprehensive care involves screening for the needs of the whole family. This includes connecting families to supports in respectful and culturally relevant ways, including play groups, library time, fatherhood initiatives, economic stability efforts, and peer-to-peer parent support groups.

Invest in value. Current financing for children’s healthcare is, at best, sufficient to provide basic medical care–immunizations, treating disease and illness, and identifying and responding to medical conditions affecting physical health. This addresses only a small share of factors affecting health.

Going beyond such medical care will require additional resources. While the research clearly illustrates the value of providing enriched primary healthcare for children and expanding the community health workforce, the U.S. model for pediatric care falls short. Given that it covers two in five children and a much greater proportion of those who are most vulnerable, Medicaid must be leveraged to develop a value-based financing system that reimburses at higher levels for enriched child healthcare. This will require an investment approach that does not demand immediate medical health offsets, and additional investments measured in long-term improvements in health and in social, educational, and economic wellbeing.

InCK Marks and a host of leaders in the field recognize the key to advancing the health transformations the country needs will require new public policies and investments, with much greater attention to child health and frontline primary care that truly engages families. The COVID-19 pandemic heightened awareness of the critical need for essential workers in the health and caregiving professions. The challenges and opportunities ahead are to prioritize children and ensure sufficient investments to meet this moment.

InCK Marks and the experts it gathered are committed to identifying and advocating for practical solutions that ensure the nation’s healthcare system prioritizes children’s health, wellbeing, and development.

Visit InCKMarks.org for more information and to learn about how practice, policy, and mindset shifts can advance child health care transformation.

About the Authors

Martha Davis, senior program officer, seeks to address violence through her work in strengthening families to create nurturing, healthy environments that promote children’s positive development.

Charles Bruner is recognized for synthesizing research and using the best available information to develop policy aimed at improving child opportunity and health through collaborations with researchers, policymakers, advocates, and children and families.