Healthy Kids are Key to a Healthy Society

By Dr. Maja Castillo, AVP Pediatric Medical Director, Healthfirst

Picture a newborn baby - millions of little synapses are making connections, lighting up neural pathways that will determine this child’s future abilities. It is a time of burgeoning opportunities as well as potential dangers. Mounting evidence tells us that children who experience hardships in early childhood grow into adults who fare much worse in their physical and emotional health, educational attainment, earning potential and overall wellbeing. The best way to create a healthy society is by providing children with appropriate access to family-centric preventative care to impact developmental trajectory and addresses physical, emotional and risks.

Unfortunately, evidence shows that we are still failing our children — especially those who are most vulnerable.

Significant gaps in early well child visits, vaccination rates and developmental support persist across racial, ethnic, and socioeconomic groups in the United States. A recent study of over 17,000 children between the ages of 0 and 18 years revealed that Black and Hispanic children were significantly less likely to adhere to the recommended well child schedule than white counterparts (52.5%, 58% and 67.8% respectively). Insurance status also affected adherence with uninsured children trailing far behind those with public or private insurance (31.1%, 58.7% and 66.3% respectively).

Since most immunizations for children happen at their routine well visits, it is not surprising that studies show disparities in vaccination rates. Only 66.5% of Black children between 19 and 35 months were fully immunized compared to71.5% of white children. In this age range from families below the poverty line 37% of Black infants were less likely to be fully vaccinated.

One of the critical functions of routine childhood care is to provide the opportunity for assessment and diagnosis of developmental delays, emotional and behavioral issues with the child as well as identify family risk factors such as homelessness, food insecurity, caregiver stress, mental illness and substance use that can affect the potential for the child to lead a healthy, stable life. We have seen in studies that children who are Black, Asian, spoke a primary language other than English or had no health insurance are less likely to be diagnosed with developmental delays by preschool or kindergarten. Even if they are diagnosed, Black and Hispanic children are less likely to receive services for those delays.

It is unclear if the inequities in diagnosis and services are due to less preventative visits, less attention to these children, or other factors. The answer is likely multifactorial, but we can only address these disparities through frequent longitudinal screening and monitoring in a high-quality pediatric setting during those formative first years.

At Healthfirst, we are committed to improving the odds of lifelong success for our pediatric members, the majority of whom are in the Medicaid and Child Health Plus (CHP) programs.

When COVID struck New York City in March 2020, we created a system to detect real-time delays in immunizations for our 0 to 3-year-olds and developed a campaign to text and email parents with details of what their child needed and where they could go for care. This led to our “better on the other side” strategy, currently in development, to proactively reach out to parents before their child is due for a visit and alert them if their child is overdue for vaccines.

Additionally, we are promoting health equity in early childhood developmental and behavioral health by working with our hospital partners to create sustainable value-based models for the Advanced Pediatric Primary Care model. This model incorporates evidenced-based dyadic preventative support programs such as Healthy Steps into primary care practice.

We must ensure that all children and families receive this care, on the recommended schedule, and with attention to all the social and environmental risk factors that lead to poor health over a lifetime. Three ways we can do so:

• Federal and state policy makers can help by designating funding for pediatric preventative care in high quality models such as the Advanced Pediatric Care Model that specifically seek to identify and treat families at risk and work with managed care organizations (MCOs) and providers to promote these models.
• States and MCOs could incentivize well child visits and immunizations within a health equity framework, with incentives based on improved access/rates based on racial/ethnic and socio-economic data instead of all child visits.
• Medical facilities and doctors should work to provide equitable access, such as extended evening hours, weekends and telehealth so working parents can keep their kids on schedule.

As a healthcare system, we can do better on preventative care for children to give all kids an equitable start in life. Although the outcomes of improving care for kids are not immediately seen, in the long run we will benefit from a healthier, more productive adult population.