Child Advocacy in Politically Tumultuous Times

In my long career in medicine I have had the privilege of serving the public in numerous capacities.  My latest appointment at the Greenville Health System is within the Department of Pediatrics where I hold an endowed chair in Childhood Neurotherapeutics.  I love being within the Department of Pediatrics and working with children.  I especially cherish the long tradition of advocacy ingrained in the history of pediatrics.

Many people are unaware that the mission of the American Academy of Pediatrics (AAP) is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Pediatricians believe in the inherent worth of all children.  In this regard, Pediatricians share the values of parents, in that children are our most enduring and vulnerable legacy. This idea, that patients come first, although within the bounds of the Hippocratic tradition, was not readily accepted by all of our medical predecessors.

It is probably fair to say that the American society of the 1920’s brought about some of its major achievements as a side-effect of the women’s suffrage movement.  Progressive thinking during the 1920’s bundled together the rights of women with those of children.  This was the era when governmental studies showed that limited access to medical care for pregnant women was linked to increased infant mortality.  Since lack of medical treatment was most apparent for the lower socioeconomic class, there was a strong correlation between poverty and infant mortality.

In 1921, the US Congress passed the Sheppard-Towner Act: the Promotion of the Welfare and Hygiene of Maternity and Infant Act.  The Act created thousands of maternal/child health centers around the nation and gave medical care to millions of children. This bill had strong opposition by the American Medical Association (AMA) who believed it was a socialist approach to medicine and opened the door for the government to regulate the practice of medicine.  The AMA fought the reauthorization of the bill, leading members of the AMA’s pediatric section to break ranks and establish their own organization. The American Academy of Pediatrics (AAP) was thus officially chartered in June 1930. Within a year of its founding the AAP created a committee to advocate at a federal level in favor of the rights of children.

The advocacy role of the AAP has continued until present. Its policy statement in regards to children’s initiatives (e.g., early brain and child development, immunizations, mental health, obesity) are all spelled out in a brochure available online: AAP Agenda for Children 2017-2018. These public policies are updated regularly and published in the AAP society journal Pediatrics. These include the big topics that constitute public health problems at a particular points in time, e.g., adverse childhood experiences, toxic stress.  The policy statements are meant to convey what the AAP believes needs to be done for the health care of children. The statements are non-partisan but unabashedly pro-children.  Ultimately, the policy statements are translated into state and federal government initiatives by the Council on Communications and Media of the AAP.

It should come as no surprise that the AAP strongly opposed the Republican led efforts to deeply cut the Medicaid program and to repeal of the Affordable Health Care Act. Approximately 40% of all of the children in our nation are covered by Medicaid. This program, the historical analogues of the Sheppard-Towner’s Act, covered health related services to keep kids healthy, including choice of doctors, regular check-ups, prescription drugs, eye exams, dentist visits, and hospital care.  When considering the budget allotted to children along with that targeting help to the elderly or the disabled, the total figure accounts for 80% of Medicaid’s budget.  Many of the services for disabled individuals, including autistic, are imperiled by these cuts (Note: AAP has a Council on Children with Disabilities that offers useful information to autistic individuals and their parents).

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In December 12, 2017 Jimmy Kimmel became an outspoken supporter for universal health care.  His own child underwent a second heart surgery and was only saved by the very “bright and talented doctors and nurses” at the Children’s Hospital in Los Angeles.  As Jimmy introduced his son to the audience he joked, “Daddy cries on TV, but Billy doesn’t”.  It was an emotionally charged experience that he shared with his audience. Jimmy went on to decry how millions of children were about to lose the health insurance that would give them the same chance at survival as his son.  Indeed, Medicaid and the additional supplementation by the Affordable Health Care Act gave poor children the opportunity to obtain medical service at the same institution as Jimmy Kimmel’s son.

At present the government extended funding to the Children’s Health Insurance Program (CHIP). This program provides health coverage to children in families that earn too much money to qualify for Medicaid. With present cuts on Medicaid the government has targeted the poor in this nation, those that need help the most.

I admire and support the AAP’s position in favor of children over politics. Health insurance is one of the relevant issues they have tackled during these politically tumultuous times.  For those interested, the AAP has made a public position statement on school violence which goes beyond physician counseling and mental health access. The AAP actively lobbies for stronger gun control laws.  Similarly, the AAP has taken a position against president Trump’s decision to end Deferred Action for Childhood Arrivals (DACA) (Note: AAP’s position on immigrant children makes mention of the special challenges to their health and well-being regardless of immigrant status).  The positions offered by the AAP have invited speculations/criticisms that it has become a political party.  In reality, social activism on behalf of the welfare of children has always been AAP’s mission.  Politics have entered into the realm of AAP’s activities only as a way of establishing and/or safeguarding social reforms to benefit children.

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