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In My Opinion


Invest in children to aid U.S. health care

By Fannie Flono
Associate Editor
Jack Betts
Fannie Flono writes on news, politics and life in The Carolinas. Her column appears on the Editorial pages of The Charlotte Observer.

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  • Recommendations

    • Invest in physical and mental well-being of youngest children

    • Create communities that foster health-promoting behaviors

    • Broaden health care to promote health outside of the medical system


    Source: Robert Wood Johnson report (

The Robert Wood Johnson Foundation weighed in this week on health care with a welcome twist. Its panel of experts focused not on the Affordable Care Act – Obamacare to some – and problems with its roll out and health care exchanges. Instead, the foundation’s Commission to Build a Healthier America called for a “seismic shift” in this country’s approach to health care by laying a foundation for better health outcomes early in life to reduce costs and sicknesses later on.

Titled “Time to Act: Investing in the Health of Our Children and Communities,” a 120-page report calls for “a revolution in the mindset of individuals, community planners and leaders, and health professionals” by expanding the U.S. focus on “how to stay healthy in the first place.”

The commission, which included medical professionals, economists, academics and community advocates from diverse backgrounds, spent many months assessing data and programs and reached the vital conclusion that “improving America’s health must reach beyond medical care.” Indeed, they conclude that this country cannot get health care costs under control or significantly improve the health outcomes of most Americans without addressing socioeconomic and other factors that play a key role in those matters.

The report bluntly takes note of this country’s poor and dropping health care status worldwide. In 1980, the U.S. ranked 15th among affluent countries in life expectancy. In 2009, it stood at 27th, below places like Slovenia, Chile and Korea – and just above places like the Czech Republic, Poland and Mexico. Thirty countries have infant mortality rates lower than ours.

And that health care status comes in no small part because too many Americans grow up in environments and have childhood experiences that are detrimental to their health. Said Dr. David Williams, a professor at Harvard’s School of Public Health and a staff director for the commission, to the PBS Newshour this week: “What we know is that the foundations of health in adulthood are laid in childhood. And the opportunities and the experiences that children have even before they go to school shape their risk of chronic disease 30, 40 years later, so that everything that we can do to prepare those children and give them the optimal health and optimal developmental opportunities in the preschool area, then they’re ready for school, and they have high levels of education, and they will have better health for the rest of their life.”

With that perspective, it’s no surprise that the first of three strategies the commission recommended for improving the health care of Americans focuses squarely on the young. The report notes that “research clearly tells us that children have a greater chance of achieving good health throughout life if they are raised in families that provide a well-regulated and responsive home environment, benefit from early supports that build resilience by mitigating the effects of significant adversity (such as chronic poverty, violence and neglect), and participate in high-quality early childhood programs.”

Critics who deride the value of prekindergarten programs might want to take a moment to absorb these findings. Though the evidence is mixed on test score gains associated with preschool programs, there is strong evidence from studies that preschool yields more important and long-lasting benefits – self-sufficiency, higher education, home ownership, more stable marriages and staying out of trouble with the law. Now this report says preschool and other investments early in a child’s life are “key to lifelong physical and mental health.” With the health cost savings associated with that, it should be a powerful incentive for policymakers to make that investment in the well-being of young children – especially children growing up in chronic poverty.

With growing numbers of N.C. children living in poverty (26 percent do), Laila Bell, head of Action for Children North Carolina (which recently merged with Covenant with NC's Children to become NC Child) took note last month of poverty’s impact: “Poverty impairs cognitive development, making it difficult for children to start school ready to learn.”

Enhanced learning environments and preventative health care can overcome those deficits, she said.

Many others are recognizing those benefits as well. President Obama has proposed a plan to support universal prekindergarten, and late last year a bipartisan group of House and Senate members offered similar legislation to create federal-state partnerships to expand voluntary pre-K programs for 4-year-olds near or at the poverty line.

Still, the U.S. now ranks 25th out of 29 industrialized countries in public investments in early childhood education. Notes the Robert Wood Johnson commission: “We must change our spending priorities to ensure that America’s youngest children, from birth to age 5, get the best foundation for a healthy and productive life.”

Unfortunately, N.C. policymakers and officials are on the wrong path to achieve that goal. Their refusal to expand Medicaid, reducing eligibility for preschool programs, and long delays in providing food stamps have created more hardships for the poor and potential harm to the state’s most vulnerable children.

This report should provide incentive to change course. The Charlotte education advocacy group MeckED has made one of its two policy goals for 2014 pushing the N.C. legislature to fully fund the NC Pre-K program so all at-risk children have the opportunity to access high-quality early learning curricula and not show up in kindergarten already behind their peers.

That’s a goal we in North Carolina should embrace. The value is documented as the Robert Wood Johnson commission shows. But this report also makes a strong case for other investments in the well-being of young children, especially those living in poverty. And it makes a good case for revitalizing neighborhoods to foster healthy behaviors and for incentivizing more health care focus on safe housing, job opportunities, access to healthy foods and other factors that contribute to health ills and higher costs.

Some communities are already embracing these investments and showing results, the commission notes. The rest of us should join them.

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