Key Child Health Issues

How are children affected?

We continue to learn more every day about how the coronavirus global health pandemic impacts children. Though children, especially younger children, may not experience or transmit COVID as severely as adults, they suffer consequences in other ways. From its impact on their daily activities, such as going to school or playing with friends, to larger scale implications on their ability to access health care or food, the effects of COVID-19 on children are complex and wide-ranging – even beyond the direct effects on their physical and mental health and well-being.

The Academy’s advocacy priorities are wide-ranging and evolving to meet children and families’ shifting needs as the pandemic continues to spread. From urging that children safely return to school in person when possible to ensuring pediatricians can provide children with the health care and services they need throughout the pandemic to supporting federal nutrition programs to feed families who don’t have enough to eat, the Academy has been working with Congress and the Administration to provide support for pediatricians, children and families.

Health Equity Impact: Black, Indigenous, Latinx and other communities of color have suffered disproportionately from the COVID-19 pandemic, both in disease burden and economic impact. Due to the effects of systemic racism, COVID-19 disease and mortality rates are higher in these communities. The accompanying economic downturn has also exacerbated long-standing economic inequities.

Children are uniquely vulnerable to the effects of prolonged, elevated stress, including the stress of economic hardship, sickness or death in the family, and educational disruptions, which can affect their development and life course trajectory in profound ways. In this time of crisis, children and families struggling under the combined weight of systemic racism and a global pandemic need a more robust safety net to prevent existing disparities from growing even more entrenched.

What can elected leaders do?

All elected leaders must advance policies that prioritize the health of children and families as our country continues to face this global health pandemic. It is essential that pediatricians have access to immediate financial relief that enables them to continue providing care to children. The AAP is calling for stronger federal leadership and enhanced financial support in Medicaid, resources for schools, telehealth, vaccines, testing, and other core components of pediatric care.

Additional resources and action are needed to address skyrocketing rates of food insecurity in households with children. More must be done at all levels of government to ensure the COVID-19 response accounts for children's special needs, including justice-involved youth, children from low-income families, children in the child welfare system, and children in immigrant families.

Key AAP resources

• Critical updates on COVID-19 from AAP
• Advocacy information and resources on COVID-19

Potential questions for candidates

• If elected, what concrete steps will you take to address the needs of children as the pandemic continues? Areas include continued access to health care and Medicaid coverage, resources for schools, nutrition assistance, and many more.
• As we someday exit this public health emergency and life hopefully returns to normal post-pandemic, how will you ensure children's needs – especially in under-resourced communities – are identified and met?
• If elected, how will you work to dismantle the systemic inequities that led to the disproportionate toll the virus took on communities of color? What lessons have we learned?
  
  

How are children affected?

Racism harms children’s health, starting from before they are born. AAP condemns racism of all forms, and notes that even vicarious racism – witnessed through social media, conversations with friends or family, or media images – harms children’s health.

The impact of racism has been linked to birth disparities as well as both mental and physical health problems in children and adolescents. Racism is a toxic stressor impacting multiple aspects of health (e.g., physical, mental and behavioral health) throughout their lives. These outcomes manifest as preterm births and low birthweights in newborns to subsequent development of heart disease, diabetes and depression as children become adults.

Health Equity Impact: As stated in its 2019 policy statement on racism and child/adolescent health, “Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families.” Whether operating interpersonally, systemically, or even within an individual, racism assigns higher worth to some groups on the basis of skin color, while devaluing others, leading to profound inequities in the distribution of opportunities and resources that elevate risk for poorer health, educational and economic outcomes in children of color. 

What can elected leaders do?

We must dismantle racism at every level, from individual to institutional to systemic. Elected leaders at all levels of government must advance policies that reduce disparities and advance social justice. Policymakers need to evaluate current policies through a racial equity lens, eliminate racist policies and create anti-racist policies.

This includes advocacy for improvements in the quality of education in racially segregated urban, suburban, and rural communities, policies that support implicit-bias training in schools and robust training of educators in culturally competent classroom management. It also involves advocacy for alternative strategies to incarceration. Policymakers must develop alternatives for the management of nonviolent youth behavior. In order to impact children of color, this approach cannot be limited to nonviolent youth; mass incarceration impacts families and communities where kids live, learn and play. It must also include advocacy for fair housing practices, including access to housing loans and rentals that prohibit the persistence of historic “redlining”, as well as addressing environmental inequities.

Racism is a public health crisis and our elected leaders must stand ready to recognize it as such and advance policies that address racism through a public health lens.

Key AAP resources

• AAP policy statement on racism and children's health
• AAP press release condemning racism and how to talk to children
• A press release on an AAP-endorsed Senate resolution declaring racism as a public health issue

Potential questions for candidates

• Do you consider racism a public health crisis? How do you plan to dismantle systemic racism within systems that impact children?
• Do you support federal or state protections from evictions to protect families from losing their homes in the middle of a pandemic?
  
  

How are children affected?

All children, adolescents, and young adults from birth to the age of 26 years who reside within our borders, regardless of income, family composition, or immigration status, should be covered by an affordable, quality health insurance plan that allows access to comprehensive essential care. 

Children rely on health care coverage to grow up healthy and thrive. When children have health insurance, they are more likely to access the medical care they need. Additionally, we know that parents who are enrolled in coverage are more likely to have children enrolled in coverage, and parents with coverage are also more likely to maintain their children’s coverage over time.

Children make up the single largest group of people who rely on Medicaid, including children with special health care needs and those from low-income families. Medicaid guarantees specific benefits designed especially for children. Children in Medicaid are more likely to get check-ups, miss less school, graduate, and enter the workforce than their uninsured peers.

The U.S. Census Bureau issued a report showing that roughly 5.7% of children were uninsured in 2019. Since the historic low in 2016, the number of uninsured children has grown each year, with 726,000 more children becoming uninsured even before the pandemic and associated recession.

Health Equity Impact: Large disparities in health insurance coverage and access to health services have long persisted in the U.S. health care system. Despite significant coverage improvements since the passage of the Affordable Care Act, many Americans remain uninsured. In particular, Hispanic children have higher rates of uninsurance. The health of children’s parents, family and community impacts their own health. Children are also more likely to be insured themselves when their parents are insured. Black, Hispanic and Indigenous adults are more likely to be uninsured. Increased access through expansion of Medicaid has been shown to reduce mortality, access to care and self-reported health for adults.

What can elected leaders do?

Elected leaders must support policies that keep programs like Medicaid and the Children's Health Insurance Program (CHIP) strong for the children and families who rely on them, in addition to promoting policies that expand coverage for parents. Any legislation or policy efforts should aim to improve coverage and access to health care for children, not do the opposite. At a time when children's uninsured numbers are increasing, we need elected leaders that prioritize affordable, comprehensive health insurance coverage for children and families.

Key AAP resources

• An interactive data hub from the Georgetown University Center for Children and Families showing the state-by-state breakdown of children's uninsurance
• Principles from AAP and leading children's health groups on protecting and improving health coverage for all children
• State-by-state fact sheets on health care coverage

Potential question for candidates

• If elected, what steps will you take to protect and enhance children's access to care, particularly through the Medicaid and CHIP programs?
  
  

How are children affected?

Only when all children can reach their fullest potential can we reach ours as a nation. As pediatricians, we support the health and well-being of all children – no matter where they or their parents are born.

Family separation and detention have serious consequences on the health of immigrant children. AAP has long been speaking out about how separating a child from a parent causes serious stress – called toxic stress – which can harm the developing brain and impact a child’s health long-term. We also know that no amount of time in detention is safe for a child, and detention can have lifelong consequences on their health and development. Alternatives to detention exist and should be pursued instead of putting families in detention.

Many immigrant children and families arrive at our border fleeing violence and adversity to seek refuge in our country. They deserve to be cared for and treated with compassion.

Inequitable policies affecting the health of immigrant children and families extend beyond the border and impact all of our communities. Policies that create barriers to accessing health care, nutrition and housing assistance, such as the public charge regulation, have harmful effects on immigrant health. The chilling effect alone of this regulation has led to fear among immigrant families, causing them to avoid or disenroll from vital services.

Health Equity Impact: At the root of anti-immigrant policy is racism. When racist policy restricts access to basic human rights like food, health care, housing, and even the care and protection of parents, children suffer profoundly, both in risks to short term survival and long-term health. Communities across the country are offered a network of resources that help them build economic security – such as programs and policies that support things such as meaningful employment and homeownership. Historically, communities of color have been cut off from this network of support, which impedes their opportunity to prosper. In order for everyone to live to their full potential, we must ensure all communities have fair access to resources, which will require work to repair existing structures and distribution of resources.

What can elected leaders do?

Immigrant families cannot control the circumstances they are fleeing, but we can control how we treat them when they come here. The Academy continues to urge elected leaders at all levels of government to advance policies to support the health and basic rights of immigrant children and families.

Key AAP resources

• AAP policy statement on detention of immigrant children
• AAP policy statement on providing care for immigrant children

Potential questions for candidates

• Over the past several years, children who arrived at our southern border have been separated from their families, detained in squalid conditions, and denied access to medical care. What actions will you take to ensure that children and families who arrive at our border are treated with dignity and respect?
• Inclusive policies support health and wellbeing. For instance, evidence shows the positive health outcomes of DACA recipients and their children as a result of the benefits of DACA, including work authorization and relief from deportation. However, restrictive policies like public charge have the effect of discouraging children in immigrant families from accessing health care, nutrition, and housing. What inclusive policies will you enact so that children in immigrant families are able to grow up healthy and well?
  
  

How are children affected?

Climate change is a public health crisis that threatens children’s health and exacerbates health disparities. Children disproportionately bear the impacts of worsened air and water quality, extreme heat and weather events, food system insecurity, changing patterns of infectious disease, longer and more severe allergy seasons and mental health harms.

In addition, air pollution from burning fossil fuels has many consequences on children's health, such as but not limited to causing and exacerbating chronic lung illness, affecting birth outcomes, including prematurity and low birth weight, and neurodevelopmental toxicity, including IQ loss, deficits in attention, learning disabilities, and sleep disorders.

Health Equity Impact: Historically under-resourced groups including Black, Hispanic/Latinx, and Indigenous communities are disproportionately affected by climate change. In the United States, race is the best predictor of proximity to environmental hazards, and environmental racism is an important determinant of health disparities. Climate justice means centering equity and dismantling systemic racism in the transition to a clean energy economy, which is urgently needed to reduce health disparities and protect child health.

What can elected leaders do?

Now is the time to accelerate our transition to the clean energy economy needed to protect the well-being of all children, today and in the future.

According to the United Nations Intergovernmental Panel on Climate Change, we have only about 10 years to slow the trajectory of climate change and to hold global warming below a threshold that will protect children’s health and preserve the health of our planet. Exceeding this threshold will result in significantly worse health, ecological, and economic harms. The urgency of climate action at this time cannot be overstated.

We must also remember that climate solutions are child health solutions – clean energy, sustainable transportation, vibrant and inclusive urban planning, and sustainable food systems all have immediate child health benefits in the form of cleaner air, safe spaces for kids to walk and play, support for social cohesion and healthier food. These solutions should address the environmental and economic injustices that contribute to health inequities, including, for example, disparities in chronic disease burden and in COVID-19 outcomes.

Key AAP resources

• AAP policy statement and technical report on global climate change and children's health
• An AAP Voices blog post from Aparna Bole, MD, FAAP, chair of the AAP Council on Environmental Health, "​Climate Change: Lessons from the COVID-19 Pandemic"

Potential questions for candidates

• What are your top three priorities to slow the pace of global warming and accelerate the United States' transition to a clean energy economy, which is necessary to ensure a healthy future for our children?
• How will you ensure that those communities most impacted by climate change, especially historically under-resourced groups, are at the table in designing and implementing climate solutions?
  
  

How are children affected?

Every day, 87 children in the United States are killed or injured by guns. Gun violence is a public health crisis that jeopardizes children's health and safety.

Pediatricians regularly treat children injured or killed by firearms: toddlers who find loaded guns in the home; children who experience gun violence in their communities or at school; and adolescents who attempt suicide. While mass shootings capture headlines, it is the daily acts of gun violence—suicide, homicide, unintentional shootings—that injure and kill children at alarming rates.

Just like any other public health crisis affecting children, we need a rigorous scientific approach informed by research that can keep children safe and promote their lifelong health and well-being.

Health Equity Impact: Our nation’s epidemic of gun violence has roots in centuries of violence and trauma perpetrated against historically under-resourced communities and structural racism that leaves communities of color disproportionately harmed by gun violence. Firearms are the leading cause of death for Black youth aged 1 - 19. Black, Hispanic/Latinx, and Indigenous youth are also more likely to die from firearm homicide than their white counterparts. Exposure to gun violence in disproportionately affected communities contributes to toxic stress and other health inequities with lifelong implications. A public health approach to gun violence prevention is urgently needed to address the disproportionate burden of this epidemic on communities of color and promote child health equity.

What can elected leaders do?

Elected leaders must take common-sense steps to address gun violence as a public health issue and keep children, families and communities safe. This includes enacting legislation to protect children from gun violence, such as strengthening background checks, supporting effective extreme risk protection orders, encouraging safe firearm storage, banning assault weapons, and addressing firearm trafficking. Lawmakers can also support $50 million in annual funding allocated evenly between the Centers for Disease Control and Prevention and the National Institutes of Health to continue and expand federally funded gun violence prevention research.

Key AAP resources

• AAP policy statement on firearm safety
• Call to Action on Firearm-Related Injury and Death

Potential question for candidates

• As a pediatrician, I know gun violence is a public health issue and must be addressed that way through evidence-based policies and legislation. What policies will you support to protect children, families and communities from gun violence?