A recent policy article (JAMA Pediatr 2014; 168: 1155-63 –thanks to Ben Gold for this reference) outlines “10 urgent priorities for the health and health care of US children.” These priorities and some of the action steps are as follows:
- Poverty: “16.1 million children (22%) live in poverty. ” Action steps include enacting measures to improve employment in families and extending child tax credits.
- Food Insufficiency: “>16 million children live in food-insecure homes.” Actions could include investing rather than cutting children’s nutrition programs.
- Lack of health insurance: affects “7 million children (9%)” though two-thirds are eligible for coverage by Medicaid and CHIP. Actions could include fully funding CHOP and Medicaid and abolishing ACA family glitch along with improving outreach to enroll eligible children.
- Child abuse/neglect (maltreatment): “In 2011, 681,000 children experienced maltreatment and 1570 died” as a consequence. Everyday, a child is abused or neglected every 47 seconds. Action steps included focusing on domestic violence and treatment and funding more screening and preventative treatment research.
- Obesity: “32% of children are overweight and 17% are obese.” Actions could include passing FIT kids Act (HR 2178) and maximizing funding for USDA’s Farmers market promotion program and the Fresh fruit and vegetable program.
- Firearms deaths/injuries: 5 children die daily by firearms. Actions could include better background checks, along with regulations to require safer storage and safety classes. Other options include higher taxation on weaponry and ammunition to “better represent societal costs.”
- Racial disparities: Action steps include monitoring and disclosing disparities and working to ensure all children have a medical home.
- Mental Health: up to 20% of children experience a mental health disorder annually. Actions could include increasing the number of qualified mental-health providers (by enhancing reimbursement).
- Immigration: “children living in immigrant families are the fastest growing group of US children.” Action could include obtain health insurance for all children.
- Research: Increase funding for children. Overall NIH pediatric funding is 12% of total budget whereas children represent 24% of US population.
The problems faced by this nation’s children will reverberate for a long time. For example, with childhood poverty, it is “associated with substantially higher mortality rates in adults, regardless of adult socioeconomic status (i.e., even affluent adults who were poor as children have elevated death rates), and this increased mortality risk extends across 2 generations.”
Bottomline: Children receive a disproportionately low share of federal expenditures and this extends to healthcare. In addition, federal spending on children in 2014 has decreased by more than $20 billion (14%) since 2010.
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