The Whole Child

The Whole Child

The founder of the Children's Defense Fund calls on the public health community to help realize the dream of health, hope, and prosperity for all of America's children.

These remarks are excerpted from a talk Marian Wright Edelman gave at the University of Michigan earlier this year during the symposium “Public Health Leadership to Improve the Health of Young People,” presented by the School of Public Health Office of Public Health Practice.

For those of you who are working on public health issues out in communities, thank you for your work. Keep working harder. And let’s join together to build the movement which we have to build if we’re going to change the priorities of our nation and invest in all of our children, because children don’t come in pieces. They come in families, families come in communities, communities are affected by the investment priorities and policies of their local governments, state governments, and national governments, and all of us are affected by the values of our culture. And so we need to think about the whole child, and not just our piece of a child.

Let’s go to public health, and to health coverage for every child, which is my chief goal for 2009. All of you know we have a health care crisis in this country. Forty-six million people have no health insurance, including nine million children. The majority of these uninsured children live in 2-parent families. Almost 90 percent have a parent who works, and almost 90 percent are citizens. Almost 28,000 children die each year in the United States before their first birthday, and far too many are born in our country at low birth weight. Almost a quarter of our 2-year-olds are not fully immunized. For minorities the percentages of uninsured children are even higher. And it’s not just an issue of low-income children—nearly half of the growth in uninsured children is in families with incomes between 200 and 400 percent of the federal poverty level, which is between $41,000 and $82,000 for a family of four. We know that there are at least two reasons why we have so many uninsured children—the rising cost of prmiums, and the fact that many workers and parents simply cannot afford dependent coverage, even as their employers drop it.

Now no one disputes that children need a broad range of medical services. They need regular health screenings to identify and treat problems. They need to have checkups for their vision, hearing, blood levels, immunizations, and nutritional needs. They need continual follow-up to make sure that problems don’t get worse. But uninsured children are almost nine times as likely to have a medical need that goes unmet than a child with health coverage. And they’re almost five times as likely as an insured child to go more than two years without seeing a doctor. And when uninsured children do get medical care, they often get less care than an insured child. An uninsured child who goes to the hospital to be treated for injuries is twice as likely to die while in the hospital as a child who is insured. The lack of the most basic health services, like dental care, can have devastating effects on children.

My heart was broken twice in one week last year when 12-year-old Deamonte Driver, a boy from Maryland, had a toothache. His mother went to 26 dentists, couldn’t find one who would take a Medicaid child, and she couldn’t afford the $80 for a tooth extraction. That toothache became a tooth abscess, the abscess infected Deamonte’s brain, and by the time they tried to operate at Children’s Hospital—at a taxpayer cost of $250,000—Deamonte died

A 5-year-old died for the same reason down in Pass Christian, Mississippi—couldn’t find a dentist to take his case, low reimbursement rates, mother couldn’t get out of the county, didn’t have transportation, and he died on his school bus, going to school. These children should not have died, and we have the means to prevent these kinds of child deaths and to make sure that they get what they need.

There are thousands of children with serious mental health needs. For children with serious emotional disturbances, intensive community-based mental health services are the most effective treatment, but they’re in much too short supply. A recent survey of juvenile detention insti-tutions found that nearly 15,000 children and youth were relinquished by their parents into the juvenile-justice system just so they could get mental health services. Among them were children as young as seven years old. It is our goal to make sure that every child and every pregnant woman gets health coverage, and that includes comprehensive health coverage which includes mental health and dental health. That many thousands of pregnant women are uninsured and don’t get prenatal care must change this year, with your voice and our voice. We’re the only rich, industrialized Western country that does not provide prenatal care for all of our mothers, and it’s so much cheaper to do than to keep low-birthweight babies alive with costly neonatal intensive care. And our mortality rates, particularly for children of color, are just unacceptable.

While we think health, we have to recognize that health is a part of a broader set of concerns and a broader set of priorities and a broader set of dynamics that we’ve all got to address. And one of those is the problem of poverty. And I hope that child poverty can be put on this nation’s agenda—poverty generally—and I think that we’re finding an awful lot of people who never thought it could happen to them standing in food stamp lines now, losing their homes, at a time when the gap between rich and poor is at its highest ever. I do hope that we will take this moment of national challenge and downturn as a way of rethinking our need for a national safety net for all.

And if we do not name and change this cradle-to-prison pipeline that is driven by poverty, and by continuing racial disparities in all of our child-serving systems—from health to child welfare to early childhood to our juvenile justice system—we are going to resegregate America. The fact is that black young people and Latino young people arrested for the same drug offenses are at hugely disproportionate rates of going to prison. Incarceration is becoming the new American Apartheid. Unless we confront it, back up, and begin to dismantle these punitive policies, unless we change our paradigm into early prevention and prevention and give our children what they need, from before birth through adulthood, we’re going to see the loss of the progress that so many people sacrificed and died for.

Frederick Douglass said a long time ago that it’s so much cheaper and easier to build a healthy child than to repair a broken man. Our states are spending on average three times more per prisoner than per public school pupil. I can’t think of a dumber investment policy. We know how much money we save if we invest a dollar in immunizations—in immunizing all of our children—rather than trying to treat the diseases from the lack of immunization.

Hope needs meat on its bones. Hope needs health care. Hope needs early childhood that’s of high quality. Hope needs wonderful after-school mentoring programs. Hope needs first-rate education. Hope needs a community that values its children and makes them feel important and empowered, and that is the challenge that we all face.

Let me end with a Sojourner Truth quote. She was heckled one day when it seemed impossible to end slavery. But she never gave up talking against slavery, and she never gave up talking about the second-class treatment of women. And she got heckled one day by an old white man who said he didn’t care any more about her antislavery talk than for an old flea bite. And she snapped back at him and said, “That’s all right. The Lord willing, I’m going to keep you scratching.” And the point is that enough strategic fleas can make the very biggest dogs uncomfortable. We saw that in the Civil Rights movement of the Sixties, we saw it in last year’s election—the extraordinary power of community organizing and of people coming together. We know what to do about health care for children and for others, we know how to build good policies and all these areas I’ve talked about. What we need now is the political and the spiritual will, and that is our challenge, and I know that we’re up to it.

"An uninsured child who goes to the hospital to be treated for injuries is twice as likely to die while in the hospital as a child who is insured."

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