NAVIGATING the Future Through the Past The Enduring Historical Legacy of Federal Children's Health Programs in the United States

Abstract

The United States excels at treating the most complex medical conditions, but our low-ranking health statistics (relative to other countries) do not match our high-end health care spending. One way to understand this paradox is to examine the history of federal children's health programs. In the 1800s, children's health advocates confronted social determinants of health to reduce infant mortality. Over the past 100 years, however, physicians have increasingly focused on individual doctor–patient encounters; public health professionals, meanwhile, have maintained a population health perspective but struggled with the politics of addressing root causes of disease. Political history and historical demography help explain some salient differences with European nations that date to the founding of federal children's health programs in the early 20th century. More recently, federal programs for children with intellectual disability illustrate technical advances in medicine, shifting children's health epidemiology, and the politics of public health policy.

The Future of Maternal and Child Health

“…While science, technology and big data will undoubtedly advance MCH in the coming decade, the biggest gains will still come from improving social conditions for all women, children and families. We should not forget that some of the greatest improvements in MCH over the past 150 years were achieved with better sanitation and hygiene, cleaner water and a safer food supply, enactment of child labor laws and women's suffrage, and overall improvements in educational attainment, economic opportunities, and social status of women and children in our nation and around the world (Brosco 2012).…”

“…While our mission has remained constant for over a century, what we do has changed over time in response to new opportunities and threats. Reports of poor health among World War I recruits and the passage of the nineteenth amendment led to the Sheppard-Towner Act in 1921 (Brosco 2012). The development of polio vaccine in 1954 and phenylalanine assay in 1962 gave rise to large scale children's immunization and newborn screening programs (Brosco 2012).…”

“…Reports of poor health among World War I recruits and the passage of the nineteenth amendment led to the Sheppard-Towner Act in 1921 (Brosco 2012). The development of polio vaccine in 1954 and phenylalanine assay in 1962 gave rise to large scale children's immunization and newborn screening programs (Brosco 2012). In every decade, scientific discoveries, medical breakthroughs, changing epidemiological patterns, political and economic forces, and other societal trends have shaped and reshaped our work in MCH.…”

The Affordable Care Act, Science, and Childhood Adversity

“…3,4 Value is often jeopardized when patients receive treatments that do not help them, when there is a lack of coordination of care, and when the complexity of institutional processes and requirements becomes onerous for frontline caregivers. 8 The Adverse Childhood Experiences (ACE) study found exposure to adversity in childhood was predictive of health in adulthood. Modifiable social determinants are those that can be altered or controlled.…”

The United States Children’s Bureau and Pediatric Medicine: A Retrospective Analysis

“…9 Today it resides within the Department of Health and Human Services, Administration on Children, Youth and Families, and "partners with federal, state, tribal and local agencies to improve the overall health and well-being of our nation' s children and families." 10 The history of USCB reminds us of the remarkable power of a society to act on behalf of its children in an organized fashion, and it also highlights the on-going challenge for child health professionals working with community partners to confront the current challenges of "millennial morbidity, characterized by differences in health outcomes linked to race and class."…”