In the Literature
SUCCESSES AND MISSED OPPORTUNITIES IN PROTECTING OUR CHILDREN’S HEALTH: CRITICAL JUNCTURES IN THE HISTORY OF CHILDREN’S HEALTH POLICY IN THE UNITED STATES
Howard Markel, M.D., Ph.D. Are the health needs of poor children a government to grant $1.25 million annually to Janet Golden, Ph.D. medical problem or a social welfare issue, and states for child health and prenatal centers,
are such needs the responsibility of the states instructional home visits by nurses, and distri- Pediatrics or the federal government? These questions bution of educational materials. April 2005 115(4):1129–33 have sparked much debate among policy- makers, physicians, and children’s advocates. While most pediatricians supported the law, An abstract is available at: It is the failure to resolve these issues, say the it angered many in the medical establishment, http://pediatrics.aappublications. authors of this article in Pediatrics, that has led including the American Medical Association. org/cgi/content/abstract/115/4/ S1/1129 to the current failure in providing optimal Some opponents felt it had Communist under- health care to every child in the United tones, while others thought it would harm the States. public and intrude on states’ rights. Although For more information about the law had some positive effects, including this study, contact: In “Successes and Missed Opportunities in making pediatrician checkups for infants a rou- Howard Markel, M.D., Ph.D. Protecting Our Children’s Health: Critical tine practice, the bill was not renewed. “In its Director, Center for the Junctures in the History of Children’s Health absence,” say the authors, “a system emerged History of Medicine Policy in the United States,” (Pediatrics, April that decidedly separated the provision of medi- University of Michigan Medical School 2005), Howard Markel, M.D., Ph.D., direc- cal care for needy children from children 734-647-6914 tor of the Center for the History of Medicine whose parents were working or had financial [email protected] at University of Michigan, and Janet Golden, resources.” or Ph.D., of Rutgers University, revisit several
Mary Mahon turning points in the history of child health In 1935, Title V of the Social Security Act Senior Public Information Officer policy. They conclude that while much (SSA) more firmly established the division be- The Commonwealth Fund changed over the course of the 20th century, tween medical care and social welfare. While 212-606-3853 [email protected] “many child health needs still are systemati- SSA created improvements in the health and cally neglected.” In particular, the authors welfare for elderly Americans, it did not lead find a wide divide between underfunded, to similar gains for children, who remain “a needs-based maternal and child health pro- social group without political muscle,” say the
grams, like Medicaid, and general entitlement authors. Because programs for children, like programs administered at the federal level, welfare and Medicaid, are needs-based and not like Medicare and Social Security. guaranteed to all children, they are politically This summary was prepared by unpopular and often threatened. Deborah Lorber. When the practice of pediatrics was first Commonwealth Fund Pub. #999 established in the late 19th and early 20th Despite additional programs designed to aid January 2007 centuries, child health was linked with social children, like the Special Supplemental Nutri-
In the Literature presents brief issues like poverty and child labor. Goals tion Program for Woman, Infants, and Chil- summaries of Commonwealth Fund– were similarly aligned: increasing wages, pro- dren and the State Children’s Health Insurance supported research recently pub- viding aid for widows, improving tenement Program, children remain vulnerable, with 12 lished in professional journals. housing. In particular, the high infant mortal- percent under age 19 uninsured in 2002. Im- THE COMMONWEALTH FUND ity rate united public health officials, philan- proving access to care for a specific age group, ONE EAST 75TH STREET NEW YORK, NY 10021-2692 thropists, health care professionals, and social is possible—as evidenced by the efforts on TEL 212.606.3800 workers. These efforts led to the signing of behalf of the elderly—but will require the FAX 212.606.3500 E-MAIL [email protected] the Sheppard-Towner Maternity and Infancy political resolve of pediatricians and other child http://www.cmwf.org Act in 1921. The act authorized the federal advocates.