Launching Lifelong Health by Improving Health Care for Children Youth, and Families

Ensuring that every child is on an optimal trajectory to a healthy and productive adulthood is imperative for the nation’s future.

Investments in children and families improve child and adolescent health - but also population health, health equity, education outcomes, workforce productivity, and cost-effectiveness in public spending. Despite recent advances in the science of early childhood and in other scientific and technological innovations from early detection to new treatments, children face increasing rates of chronic diseases, obesity, and mental health challenges. The U.S. currently ranks at the bottom among wealthy nations on the mental wellbeing, physical health, and academic and social skills of children.

Improving Health and Wellbeing

Launching lifelong health for the country’s children has never been more important. It is past time to reverse troubling trends in the health and wellbeing of child, adolescent, and young adult populations. Health care systems in the future will need to exist in broader, cross-sector collaborations with aims to build on community strengths and address family and community health needs. With the proper infrastructure and financing, many recent well-evidenced advances in health care can continue to support change and the progress needed in the next 10 years.

Societal Gains from Investing in Child Health

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Key Opportunities

The United States has not taken full advantage of substantial evidence, scientific advances, and innovations in health care delivery that support pediatric health care reforms, leaving many children, parents, and communities disadvantaged across the life course. Moving toward a stronger nation and health equity requires a shift in emphasis to early prevention for long term outcomes with intentional focus on historically marginalized families and communities.

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Life Course Perspective

Scientific and Technological Advances

Community-Centered Care

Health Equity

Innovations in Health Care Delivery

Alternative Payment Models

Public Health Investment and Collaboration

School-Based Health Care

New Approaches to Measurement and Accountability

Achieving the Vision for Improved Healthcare

GOAL ONEElevate Child and Adolescent Health
Focus and Integration: Ensure a sustained emphasis on child and adolescent health at all governmental levels to enhance overall health outcomes.

Recommendations:
- Create a cross-sector expert panel to integrate health programs across various systems.
- Implement legislation scoring to assess impacts on child health.
- Fund a comprehensive public awareness campaign raising the importance of children and adolescent health for the nation’s future.
- Continue and accelerate investment in research on whole child and family health, including mothers, children, adolescents, and families.
Learn more in Chapter 10 and Chapter 1
GOAL TWOFinance Health Systems for Prevention and Promotion

Medicaid/CHIP Reform: Update Medicaid and CHIP to ensure comprehensive coverage for all children and their parents.

Payment Incentives: Shift from fee-for-service models to those that emphasize prevention, health promotion, and equity.

School-based Health: Promote equitable payment for services provided in school-based health centers.

Learn more in Chapter 6 and Chapter 8
GOAL THREEStrengthen Community-Level Health Promotion

Public Health Investment: Increase funding for community health promotion and disease prevention.

Address Inequities: Reduce disparities in public health resources and improve support programs for children.

Collaborative Investment: Partner with communities and organizations to enhance school-based health initiatives.

Community Engagement: State legislatures should mandate investment in community
health from for-profit health care providers and managed care organizations.

Learn more in Chapter 7 and Chapter 8
GOAL FOUREngage Families and Communities

Collaborative Design: Partner with marginalized communities to co-design child-centered health care systems.

Compensation for Participation: Remove barriers to compensating families for their involvement in service improvement.

Training and Competence: Ensure training that supports a health care workforce that is diverse, team-oriented, anti-racist, and able to promote relational health.

Recognize Achievements: Assess and acknowledge efforts related to patient and family experiences and equitable outcomes.

Learn more in Chapter 3
GOAL FIVEImplement Measurement and Accountability

Accountability Systems: Develop and support new measurement systems that focus on equity and meaningful outcomes.

Data and Research: Advance research to enhance accountability measurement for better child health outcomes.

Cross-Agency Coordination: Monitor system performance and eliminate barriers to shared accountability.

Transparent Reporting: Create a clear reporting protocol for data submission in health information systems.

Learn more in Chapter 9

	Societal Gains	Findings from Research
	It is a national value and moral imperative to give all children a healthy start in life. The future depends on nurturing young minds and bodies (Gen 2).	Investment in the health and wellbeing of children and families improves health and education outcomes and health equity, and reduces short- and long-term costs. Children are the poorest and most racially and ethnically diverse age group in America, the opportunity and imperative to close these equity gaps are great. Early investment produces the greatest returns in human capital.
	Child health and wellbeing support the nation’s tax base, workforce, economic prosperity, and sustain a high standard of living. The current young adult workforce does not meet national economic and security needs (Gen 2).	From 2000 to 2015 the number of children under 18 years increased by only 1.9%, while the rest of the population grew by 18.5%—nine times faster. Demographic shifts—including aging of the population, the large-scale exit of baby boomers from the workforce, and declines in international migration—threaten the U.S. workforce. Today, 77% of adolescents and young adults are not eligible for military service because of poor physical and mental health and for the first time the U.S. Army, Navy and Air Force all missed their active-duty recruiting goals in FY 2023, with a combined shortfall of more than 20,000 enlistees. Poverty and poor child physical and mental health are associated with reduced work productivity in adulthood. Investment in child health and wellbeing leads to greater adult productivity.
	Children who are sick prevent parents from working, playing, resting and being their full selves. Parent health, happiness, and productivity depend on child health and wellbeing (Gen 0, 1).	Parents cannot work if children are not healthy or not in school. Healthy children and healthy families are linked: child health affects family health and family health affects child health. Chronic illness in children often leads to a parent dropping out of the workforce and can weaken parent health. Interventions for improving child health also protect adults and older populations from illness (e.g., pertussis or RSV vaccines).
	Child health and wellbeing are essential because children are future caretakers of a growing retired population depending on a proportionately shrinking child population (Gen 0, 1). Maximizing the capabilities of a shrinking population of children is a societal need.	By 2030 the ratio of seniors to working age adults will have doubled the 20th-century ratio . A demographic flip is occurring: the 1970 ratio of three children aged 10–14 for every senior aged 65–69 is projected to be one child per senior by 2030. The growing number of retired people will rely on an undersized working-age population.
	Child health is the foundation for adult health. Most adult health problems—including heart disease, diabetes, and mental health conditions—originate in childhood, and the most effective prevention starts early in life (Gen 2).	Research has established clear early antecedents to adult chronic disease and the pace of aging. Poor child health is associated with worse adult physical and mental health. Investment in child health and wellbeing improves health and wellbeing in adulthood and saves money in health care, education, social services, and criminal justice.
	Child health and wellbeing are essential as the next generation of child bearers at a time of declining fertility rates and rising maternal mortality (Gen 3). Healthy reproduction and parenting are essential for the next generation.	Healthy childhood is essential for healthy pregnancies, childbirth, and parenting. Research demonstrates the importance of preconception and prenatal health for healthy babies. There has been a historic decline in U.S. fertility rates, and some states are already feeling the effects in lower school enrollment, threatening future tax revenues. The combination of rising U.S. maternal mortality associated with racial disparities and declining birth rates threatens health and economic outcomes and accentuates the importance of optimal health in every pregnancy and birth.
	Scientific and technological advances (e.g., genomics, prediction by artificial intelligence) point to the promise of earlier identification and prevention of disease to improve societal health (Gen 2). Identification, prevention, and health promotion in the preconception, prenatal, childhood, and adolescent stages pay off.	The genomic revolution offers the promise of prediction, preemption, and precision medicine, enabling disease identification and intervention earlier in the life course. Scientific advancements on several fronts—prediction by artificial intelligence, understanding of social determinants of health, health services research, population health research and interventions, and health care financing—all emphasize the potential of earlier identification, prevention, and health promotion to improve societal health.