The statistics are grimly familiar: A child born in Roxbury has a life expectancy almost 30 years lower than a child born in Back Bay. Infant mortality rates are more than twice as high in Black families compared with white families in the United States. As leaders who have worked in the health care field for decades, we believe the racial disparities that lead to such heartbreaking inequities in health outcomes for children must be addressed immediately.
Many years of evidence confirm that the most effective way to turn the tide of heath inequity is to start early, with support that begins in childhood and creates a foundation for improved outcomes throughout life. That means the country has to do a much better job of addressing the social determinants of health.
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The Child Opportunity Index measures and maps the quality of resources and conditions that enable healthy childhoods across the 100 largest US metropolitan areas. It’s clear that children who live in neighborhoods with quality early-childhood education and schools, safe housing, access to healthy food, parks and playgrounds, and clean air are more likely to grow into healthy adults than children who don’t.
Three elements stand out as essential to building a solid foundation for a healthy life: maternal and child health, early-childhood support, and behavioral health and wellness. We see a pressing urgency to act on all three:
▪ Maternal and child health: Healthy moms generally have better pregnancy and birth outcomes. Promoting women’s health — starting in adolescence — to support better screening and management of hypertension, nutritional deficiencies, and reproductive health helps to drive healthy pregnancies, more sustained adoption of breast-feeding, lower infant mortality, and better child health.
▪ Early-childhood support: Optimal supports for children ages birth to 5 include high-quality child care and early-education programs as well as efforts to foster parent engagement and develop parent leadership in supporting their peers. For example, a parent-to-parent support network could focus on how to navigate the behavioral health needs of their children.
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▪ Behavioral health and wellness: Behavioral health, which encompasses the promotion of social and emotional well-being, is critical to success in education, recreation, work, and family life. Opportunities to foster social-emotional wellness, expand and diversify the behavioral health workforce, and improve screening for behavioral health should be promoted.
There is legislation pending on Beacon Hill that will provide much-needed support in all three of these areas. In addition, coalitions in the health care, government and business communities are actively working to turn the tide.
Access and participation in programs supporting these three areas are far from equal. Beyond investing in programs and services, society must build the infrastructure and quality-improvement approaches at the neighborhood level that will assure we are making progress, distributing resources equitably, and closing the profound access and outcomes gaps. These efforts will depend on enhanced data collection on race, ethnicity, language, and other disparities, and will also require an investment in workforce diversity initiatives including ongoing professional development.
Currently, there is not a common and coordinated approach to sharing information to help support those neighborhoods most impacted by disparities in the social determinants of health. The way information is shared among the health, public health, education, and human services sectors must be improved so that there is a better understanding where the disparities are most pervasive and pronounced and so stakeholders can work collaboratively to eliminate them.
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Investing in children returns tremendous long-term benefits. We must make the investments, provide the resources, and address the key social determinants of health in a way that will ensure that the future is as strong and healthy as it can be for all our children.
Dr. Kevin B. Churchwell is the president and chief executive officer of Boston Children’s Hospital. Michelle A. Williams is the dean of the faculty at Harvard T.H. Chan School of Public Health.
