A generational opportunity to invest in our children

InCK Marks’ research shows that the most important thing for children is the context in which they are born and develop. To thrive, they need a safe, stable and nurturing environment right from the start. While there is still much to learn, InCK Marks’ work identified exemplary programs and practices that promote a new standard of integrated primary health care for children, with impressive results. We summarized our findings in three overarching recommendations: (1) Prioritize Children, (2) Build on What Works, and (3) Invest in Value.

Prioritize children† The US health system can play a key role in promoting racial equality and improving the health of the population. All too often children are not adequately involved in health transformation efforts. While children represent a quarter of the U.S. population and half of those taking Medicaid, they account for less than a tenth of total medical expenditure and only a fifth of the cost of the Medicaid program. Policy makers and health systems have focused much of their attention on health transformations that aim to reduce healthcare costs and improve outcomes.

Children are the most diverse age group in the country and their healthy development is most influenced by their home and community environments. That alone is reason to prioritize them. But children also develop personalities, habits and behaviors that have lifelong consequences for their health. Establishing positive health trajectories during childhood has by far the greatest total return on investment.

The Robert Wood Johnson Foundation’s focus on health transformation and building a health culture recognizes that health is more than the absence of disease or infirmity and that responding to social determinants can improve well-being. While the focus on adults and people with disabilities is greatest to enable immediate cost containment, we must recognize that a focus on children is key to improving public health and rectifying long-standing racial inequalities.

Build on what works† A broad, compelling body of research demonstrates the effectiveness of transforming primary health care for children. InCK Marks identified and collaborated with champions and child health professionals using innovative strategies to reach children and families to identify research-based models to build on (DULCE, Help Me Grow, HealthySteps, Medical Legal Partnerships, etc.) and systemic approaches to developing integrated, community-based responses. InCK Marks synthesized the research on these programs and identified the elements of practice and approaches they shared.

There is now knowledge and a leadership base to move to a much broader standard of child health care that supports families in providing safe, stable and nurturing home environments for their children. This is in line with the pediatric field’s own guidelines for proper childcare and family-oriented medical homes. It is especially important for practices that serve socially vulnerable and medically disadvantaged communities, where relational and community health professionals can provide important support. For example, the Center for Health Care Strategies partners with pediatric practices who understand that comprehensive care involves screening for the needs of the entire family. This includes connecting families with support in respectful and culturally relevant ways, including playgroups, library time, paternity initiatives, economic stability efforts, and peer-to-peer parent support groups.

Invest in value Current funding for pediatric health care is, at best, sufficient to provide basic medical care: vaccinations, treating diseases and ailments, and identifying and responding to medical conditions that affect physical health. This only addresses a small part of the factors that influence health.

Going beyond such medical care requires additional resources. While the research clearly illustrates the value of providing fortified primary health care for children and expanding the health workforce in the community, the US model for pediatric care falls short. Since it covers two in five children and a much larger proportion of the most vulnerable, Medicaid should be used to develop a value-based financing system that reimburses at higher levels for fortified children’s health care. This requires an investment approach that does not require immediate compensation for medical health, and additional investments measured in long-term improvements in health and in social, educational and economic well-being.

InCK Marks and a host of leaders in the field recognize that the key to advancing the health transformations the country needs will require new government policies and investment, with much greater focus on child health and primary care that truly engages families. The COVID-19 pandemic has raised awareness of the critical need for essential workers in the health and care professions. The challenges and opportunities ahead are to prioritize children and ensure adequate investment to handle this moment.

InCK Marks and the experts it has gathered are committed to identifying and advocating for practical solutions that ensure the national health care system prioritizes children’s health, well-being and development.

Visit InCKMarks.org to learn more and learn how practices, policies, and changes in mindset can drive the transformation of children’s health care.