As pandemic affects children's health, programs that work are still underused

The coronavirus (COVID-19) pandemic has caused widespread harm to the health and well-being of already vulnerable children and adolescents in the U.S., particularly those in low-income households and children of color. Nevertheless, evidence-based programs known to reverse the negative effects of poverty are being widely neglected, according to a new report in Health Affairs. Such programs include basic income supports, other family supports, and universal health care structured to meet family needs. A combination of these interventions could substantially reduce the risks children face from poverty and early adversity, say the authors.

"America's children are already less healthy than children in every other industrialized nation, and poverty is one of the most important factors that impact their health and well-being," says James M. Perrin, MD, investigator at MassGeneral Hospital for Children and a professor of pediatrics at Harvard Medical School. Perrin was the lead author of the report, which he prepared with pediatric health experts from several other institutions.

This report builds upon the work described in four earlier studies developed by the National Academies of Sciences, Engineering, and Medicine (NASEM) to identify interventions that strengthen child and adolescent health and well-being. Those reports, published in 2019, each reviewed an aspect of this question: poverty; mental, emotional and behavioral health; adolescence; and young family health and education.

Thanks to that and other work, experts now agree that early experiences profoundly affect children's physical, mental and emotional development with lasting consequences. Researchers have also established that child and adolescent health in the U.S. lags well behind that in almost all other advanced economies in terms of most indicators of well-being. The effects of these factors can last into adulthood, putting vulnerable children at life-long risk of disadvantage and keeping them from participating fully in the workforce.

Taken together, the four NASEM reports provide strong, evidence-based guidance to end persistent disadvantage among disadvantaged children and youth, say Perrin and his colleagues. Further, they looked at how effective specific strategies were.

One key study looked for strategies that could cut poverty in half over a ten-year period, noting that the estimated cost of ignoring child poverty is about $1 trillion per year. It found that none of the 20 program and policy ideas developed by the NASEM committee could do so alone, but that certain combinations—such as providing key family tax credits, expanding nutritional assistance programs, and ensuring families had housing—could. A combination with similar promise included tax credits, along with a child allowance and child support, an increase in the minimum wage, and eliminating restrictions on the eligibility of immigrants for programs.

The reports stress the key role of parents and other caregivers in the outcomes for children—and the need to assure the health and well-being of parents. They call for transformation of maternal and child health care to team care, addressing social drivers of health through stronger community linkages, and integrating mental and behavioral health. Now, the researchers say, there is an urgent need for policy makers and local governments to implement these interventions.

"Adolescents and children can overcome adversity," says Perrin. "But we need to address the long-lasting causes of poor health and give them their best opportunity by supporting children's social, mental and emotional development. The health and well-being of children and youth should be our top priority."