Academic journal article The Future of Children

How Healthy Are Our Children?

Academic journal article The Future of Children

How Healthy Are Our Children?

Article excerpt

Summary

The past century has seen vast improvements in our children's health. The infectious diseases that once killed huge numbers of children have largely been conquered. Infant mortality has also fallen markedly, although the United States lags behind other industrialized nations in this and other measures of children's health. Accidents and injuries also kill fewer children than they once did.

Today, write Sara Rosenbaum and Robert Blum, the greatest threats to U.S. children's health are social and environmental conditions, such as stress and exposure to toxic substances, which are associated with noncommunicable illnesses, such as mental health problems and asthma. Unlike the communicable diseases of the past, these are not equal-opportunity hazards. They are far more likely to affect poor children and the children of racial and ethnic minorities. And they have long-lasting effects, both for individuals and for the nation. For example, people who experience unhealthy levels of stress as children grow up to become less healthy, less productive adults.

Rosenbaum and Blum also examine government spending on children's health. Though such spending has increased over time, the largest share of that increased spending has been for health care, while spending on other determinants of child health, which may be as or more important, has not kept pace. Investments in medical care alone can't overcome social and environmental threats to children's health that have their roots in historic levels of poverty and inequality. Rosenbaum and Blum argue that the best way to promote children's health today is to mitigate poverty, invest in education, and make our neighborhoods and communities healthier and safer.

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This article presents an overview of the health of America's children and examines the role and extent of government investments in child health. In brief, we find that despite major gains over the past century, children's health varies widely across population subgroups and lags well behind that of many other industrialized nations. Furthermore, although public health-care expenditures for children have grown steadily, this growth has come from expanded eligibility for publicly financed health insurance and substantial increases in the cost of health care. Rising health expenditures have coincided with the erosion of public investment in education, housing, and social services, all of which are thought to affect health, especially among the poorest children.

U.S. children's health today is best understood in the context of how child health has evolved over the past century. Evidence over time illuminates the social, behavioral, and economic factors that help explain both the nation's accomplishments and its existing and emerging challenges.

Where government investment in child health is concerned, we must explore a broad range of expenditure trends, since virtually all government policies can affect children's health. These include both tax expenditures and direct investments across the areas of income support, education, social services, housing, community development, national infrastructure, public health, and health care. One reason we must view government spending broadly is that direct investment in other populations can have spillover effects on children. For example, spending on the elderly, though frequently contrasted with spending on children, could help children by easing their families' burden of caring for aging parents.

Health Status of Children and Adolescents

To understand how public expenditures affect children's health, we must first understand child health itself.

Measuring Child Health

There are no comprehensive, agreed-upon measures or indices as to what constitutes child health. (1) The National Research Council and Institute of Medicine conceive health across four domains: sociodemographic, psychological, behavioral, and contextual (community). …

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