Dear President Biden:
Your administration will have its hands full: a surging pandemic, growing income inequality, national unrest over racial and ethnic inequities, and more. Despite the pressure to resolve these issues, we urge you to keep sight of the fact that the group most affected by all of them is, has been, and will always be our nation’s 74 million children. Our country has an urgent imperative to make their health and well-being a higher priority.
Investing in our children is the single most powerful lever to create a healthier society and stronger economy. Optimizing health in childhood would greatly reduce chronic conditions that burden individuals, our health care system, and our economy. You have an opportunity to provide national leadership and underscore that the world’s greatest societies invest heavily in their children. These investments will benefit children directly and benefit 100 percent of the next generation of adults.
The pandemic has severely disrupted the lives of children and youth with alarming levels of child poverty, food insecurity, and homelessness, significantly increased need for mental health care, reduced educational opportunities and higher levels of youth unemployment. These issues are compounding an already challenging environment for children’s well-being.
We urge you to establish a national strategy in this area, coordinated by a new White House Office on Children and Youth and federal Children’s Cabinet. The office would be a powerful first step toward improving the nation’s future health and economic potential by ensuring that every child receives coordinated support to achieve lifelong physical, social, emotional and financial well-being, regardless of race, class, ethnicity or gender.
You have boldly proclaimed that elimination of racial inequity in this country will be a priority for your administration. Our nation’s systemic inequities run deep and have huge consequences for children’s quality of life, productivity and lifespan. Nearly one-fifth of children live in poverty. More than 44 million are exposed to violence, crime or abuse. In the past decade, youth mental health has declined, with reported suicide attempts rising 41 percent. During the opioid epidemic, thousands of children have experienced the addiction, incarceration or death of a parent. The pandemic has exacerbated these trends.
Children from Black, Hispanic, Native American and rural communities have worse health outcomes than their peers. In America’s most economically disadvantaged counties, children die at rates up to five times those who live elsewhere in the same state. These children are also three times more likely to lack regular access to healthy food and 14 times more likely to drop out of high school.
America’s health care systems overwhelmingly focus on medical services, which account for only 15 percent of an individual’s health. Long-term health is mostly determined by underlying factors such as education, nutrition, housing, poverty and experiences in childhood — collectively called “social determinants of health.”
UNICEF reports that America’s children have worse health outcomes than their peers in other countries, primarily from demonstrable differences in social determinants of health. The United States ranked 24th in the World Bank’s 2018 Human Capital Index, which measures “the amount of human capital that a child born today can expect to achieve in view of the risks of poor health and poor education currently prevailing in the country where that child lives.”
To reverse these failures, the federal government can engage with state, local, private-sector and nonprofit partners, and families and youth themselves. Currently, programs for child nutrition, schooling and health care are dispersed across agencies without coordination to maximize the impact of our investments. National leadership is sorely needed to align these programs to promote successful, evidence-based solutions.
The payback on an investment in America’s children will continue for decades. The Office could host a multi-sector White House Conference on Children and Youth to inform national goals and strategies. With the Children’s Cabinet, it would create a multi-agency budget and align federal programs and reporting requirements. It would partner with state and local entities to remove barriers to innovative, coordinated investments in children and youth.
Evidence shows that strategic investments early in life yield enormous returns. When children are hungry or homeless, or live amid violence or trauma, their ability to thrive is diminished for a lifetime — yet intervening early can reverse these effects. Adolescence is another critical window when the effects of disparities may be overcome — or intensified. Nearly five million youth in the United States are not in school or the workforce. Research shows clear opportunities to re-engage this group and help them build positive trajectories.
As we emerge from this pandemic and recession, we can also develop healthy children and a strong workforce for the future by prioritizing health and well-being early in life. Establishing this office and cabinet is a critical first step. Prioritizing our children and youth will help us meet our greatest challenges and place our country on a healthy path forward.
R. Lawrence Moss, MD, is president and CEO of Nemours Children’s Health System based in Jacksonville, Fla.
Bruce Lesley is president of First Focus On Children based in Washington, D.C.
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Correction: A previous version of this op-ed misstated R. Lawrence Moss’ name.