Child Health Policies
This article provides an overview of child health policies in the United States, including historical factors and an overview of the Children's Bureau formed in 1912. It discusses the rationale for child health policies and examples of progress in the design process, as well as twenty-first-century practice and impacting legislation and agency interplay. Issues are presented indicating the need for improved approaches to child health policies, as well as outlining policy factors and guidelines and clinical impacts. A conclusion is offered that calls for a systemized child health policy translating policy into practice.
Keywords Child Health Policies; Children's Bureau; Emergency Medical Condition; Fetal and Infant Mortality Review (FIMR); National Institutes of Health; State Children's Health Insurance Program; Title V Programs
Child Health Policies
The Children's Bureau
Muhajarine, Vu, and Labonte (2006) indicate that children's well-being should be an issue that bridges political, cultural, and disciplinary agendas. Historically, "parents, educators, health and social service providers, and child health researchers, community activists, policy-makers, business people and religious leaders have shared a desire to give children the best start in life" (p. 216). In the past, children were the centerpiece of U.S. domestic policy, with the founding of the Children's Bureau in 1912. In 1909, President Theodore Roosevelt called the first White House Conference on Children. The conference brought together 200 experts and made 15 recommendations that became the stimulus for the Children's Bureau (Harvey, 1991).
According to Golden and Markel (2007), the Children's Bureau was "the world's first governmental agency to consider the problems of children, and once served as a model that inspired the creation of similar agencies in other countries" (p. 446). Given the combined efforts of grassroots women's organizations, as well as Progressive social reformers, "momentum to establish the new agency in the United States grew in the first decade of the twentieth century. Support from the General Federation of Women's Clubs and the National Congress of Mothers and the endorsement at the 1909 White House Conference on the Care of Dependent Children led to legislative initiatives. These initiatives succeeded in 1912, overcoming opposition from those who feared that the Children's Bureau would focus its work on child labor protection" as opposed to improving infant mortality, maternal health, and other areas (Golden & Markel, 2007, p. 446).
The premier achievement of the Children's Bureau was the Sheppard-Towner Infancy and Maternity Protection Act of 1921, which became responsible for directing federal funds to the states. As a result as the legislation, "infant mortality rates fell from 95.7 per 1,000 live births in 1915–1919 to 53.2 in 1935–1939." Through these state programs, "more than four million infants and preschool children and approximately 700,000 pregnant women were served (Golden & Markel, 2007, p. 447).
However, despite advancing many compromises, conducting aggressive public relations campaigns, and garnering wide-ranging community support, the Children's Bureau and particularly the Sheppard-Towner Act provoked opposition from the American Medical Association. In 1929, funds ceased, and the bureau was "excluded from the planning of the 1930 White House Conference on Child Health and Protection, and subsequent New Deal programs moved away from the 'whole child' approach once advocated by the bureau's founders and leaders" (Golden & Markel, 2007, p. 447). Due to these circumstances, mother and infant programs received only limited amounts of funding (Golden & Markel, 2007). From a research perspective, it would be interesting to better understand the effects of the economy of the Great Depression and their impact on policies affecting children.
The Franklin Roosevelt Administration's first and only New Deal program for young children was the Child Health Recovery Program. It was managed together by the Federal Emergency Relief Administration and the Children's Bureau. "It provided emergency medical care and food to needy children, and directed resources from public and private health care and relief organizations in each state, with physician consultants and part-time health nurses were paid by the Civil Works Administration for performing their work" (Markel & Golden, 2005, p. 1132). The Social Security Administration included several methods of funding for children. According to Markel and Golden (2005),
Title IV provided funds to states for the Aid to Dependent Children program. Title V echoed the programs of the Sheppard-Towner Act, giving federal funds to states that passed enabling legislation for maternal and infant health care or services to "crippled" children and to expand existing child health programs. Although the Social Security Administration (SSA) was the first step in a rapid growth of programs for the elderly, eventually leading to the Medicare legislation of 1965, similar gains were not made for children, although the Social Security Board, the body charged with implementing the SSA, noted as early as the 1930s that the number of economically disadvantaged children was as much as sevenfold that of the elderly… Children were, and remain, a social group without political muscle (p. 1132).
In the twenty-first century, attention is once again being given to the plight of policies affecting children. "The creation of the National Center on Minority Health and Health Disparities is one sign of renewed interest. Congressional recognition of child health problems and their need for remediation, as evidenced by the funding of the National Children's Health Act, the monitoring of National Institutes of Health (NIH) funding in pediatric health, and funding for the State Children's Health Insurance Program (SCHIP)" further indicates a revitalized interest in children (Golden & Markel, 2007, p. 447). Moreover, the problem of
… racial and income disparities in health care, which is the result of both epidemiological investigations and a growing concern to evaluate the outcomes of federally supported programs once again suggests the need to view health status as a social indicator … The critical question, then, is whether or not there exists the political, social, and economic motivation needed to persuade a plurality of voters and their representatives to legislate a plan that would enable the United States to fully embrace the idea it developed nearly a century ago, a federal agency devoted to children (Golden & Markel, 2007, p. 447).
Reasons for Child Health Policies
Twenty-first-century research has contributed to a new focus on children's health and development. "Population health" focuses attention on early childhood experiences, beginning during gestation, as contributing factors to health that continue decades later (Muhajarine, Vu, & Labonte, 2006, p. 206). Arguments for investing in early childhood take several forms. One of the most common arguments is that children are the future. "If we want to have a healthy, prosperous society in years to come, we must give our children the best possible start in life" (Muhajarine, Vu, and Labonte, 2006, p. 206). The argument can be made that children also have an inherent right to health-promoting conditions, and their health status can be seen both as an investment in long-term societal health as well as "a reflection of its current functioning" (p. 206).
Globally, infant mortality and low birth weight (LBW) rates have closely paralleled race and class divisions within society. Babies born to mothers of minority and socially disadvantaged groups "have consistently lagged behind the predominant or wealthier groups." Statistically, the low birth weight rate remained nearly twice as high among African American children as white children between 1990 and 2011 (Federal Interagency Forum on Child and Family Statistics, 2013), despite advances in access to prenatal care and high-risk health behaviors such as smoking. Researchers suggest that complicated birth outcomes in the United States indicate pervasive and ongoing social disparities "between women of different classes and ethno-cultural identities rather than a lack of access to quality healthcare or high-risk health behaviors" (Muhajarine, Vu, & Labonte, 2006, p. 207). Deprivation at individual and family levels, combined with difficulties at the community level, seems to interact, resulting in health inequalities, which is an observation producing increased international research attention. Conclusively, "any meaningful effort to enhance children's health must go beyond a focus on biomedical and behavioral influences and seek to understand the economic conditions and social milieu in which families live and raise their children" (Muhajarine, Vu, & Labonte, 2006, p. 207).
Another reason for creating a child health policy is the impact of poverty. Regular, long-term income assistance is more beneficial to a child's health than is irregular, intermittent income assistance. This is...
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