|
PROLOGUEChildren’s Health And Health CareFollowing the lead of Massachusetts and Illinois, many states are now debating extending universal health insurance coverage to their children or all of their residents. The papers in the opening section of this thematic issue on children’s health go well beyond that contentious debate. Can we take the next crucial step from providing coverage to all children to actually building a system that nourishes and sustains a child’s good health and well-being over the course of a lifetime? How do we build it, and how do we measure it — but, most of all, why is it crucial to start with childhood? One can think of these papers as asking a pair of simple but profound questions: Why do kids count, and how do we count them? What is unique about children’s health and well-being that we need to account for them in new, evidence-based ways? Neal Halfon, director of the Center for Healthier Children, Families, and Communities at the University of California, Los Angeles (UCLA), and his UCLA colleagues, Helen DuPlessis and Moira Inkelas, lay out a critique of our current system characterized by fragmentation, shot through with holes in its safety net, and designed to meet twentieth-century needs of infectious disease. Halfon and colleagues then take readers on a ride toward the envisioned future. They start the discussion of transformation: How do we move to a twenty-first-century design based on the emerging science of health, one that can align multiple service sectors and funding streams? One of the key concepts used in a new understanding of how health, childhood, and environment interact is the measure of social determinants of health. Janet Currie, an economist at Columbia University, and Wanchuan Lin, a colleague of Currie’s previously at UCLA, revisit one of the vexing issues of how we measure these determinants. Why do poor children do worse even when income is accounted for? Scholars have yet to comprehensively measure how limiting ill health, and poor mental health in particular, is for all children—especially low-income children—as they try to become productive members of society. Daniel Eisenberg and Gary Freed of the University of Michigan take another tack at how poorly we value children. As a society, we badly underestimate how highly we value children’s potential good health and lifespans by the way we measure cost-effectiveness. They look at an issue of particular interest in children’s health care: the costs of vaccination. To get at the true measure of good health, we need to rethink how we measure its costs and potential. All of the papers, in their unique ways, demonstrate that we have the science and the knowledge to do better by our children and our country’s health care. What they all ultimately ask is, Do we have the will?
| ||||||||||||||||||||
