By Sean Miskell
“The earliest years of our lives set us on paths leading toward – or away from – good health.”
— RWJF Commission to Build a Healthier America
Evidence increasingly shows that the experiences children have when they are young have a lasting impact on their lifelong health and well-being. A new issue brief from the Robert Wood Johnson Foundation (RWJF) highlights the intergenerational determinants of health for both children and their parents. While this brief mainly focuses on educational programs, public health programs such as the Children’s Health Insurance Program (CHIP) and Medicaid also play a key role in ensuring that children – and their parents – have access to care and resources that have long-lasting effects throughout their lives.
The RWJF brief paints a picture in which health and social disadvantage are both intertwined and intergenerational. That is, a lack of opportunities and resources early in life not only sets children on a path to poor health but toward other negative outcomes in areas such as educational attainment that lead to yet more social disadvantage. In this regard, the brief calls for a “two-generation” approach to shaping early childhood experiences that emphasizes the need to assist both disadvantaged children and their parents, as “social disadvantage in childhood” leads to “health disadvantages in adulthood.” For example, the brief documents research showing that children’s nutrition correlates with parents’ income, and draws on research from Harvard University and other sources that establish a link between a child’s development and their family’s socioeconomic circumstances.
RWJF’s brief cites a number of specific factors that can help children and their families transcend their disadvantages and lead to better health and educational outcomes, including very specific factors such as qualified teachers as well as more general programs such as Head Start and Pre-K programs in states such as Georgia and Oklahoma. But while these programs are indeed important, public health programs such as Medicaid and the Children’s Health Insurance Program (CHIP) play key roles in in providing children and their families with access to health care that has a lasting influence on their health throughout their lives.
Medicaid and CHIP are unique in efforts to invest in young children’s experiences because their reach is so broad. As we noted in our new issue brief on the role of Medicaid and CHIP in improving early childhood outcomes, 45 percent of children under six are covered by public programs. This coverage is crucial to providing children with care – especially preventive care – that facilitates good health later in life. Without Medicaid coverage, low-income children and their parents would be less likely to have a usual source of health care as well as less likely to obtain necessary health care services, according to the Urban Institute and the Kaiser Family Foundation. For example, 88 percent of children under six that are covered by Medicaid receive preventive medical visits, compared with 63 percent of uninsured children in the same age group, according to a recent MACPAC report. Young children with Medicaid coverage have access to the program’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefits package. These benefits make it more likely that health problems will be discovered and treated early to prevent them from becoming worse later in a child’s life, according to the National Health Policy Forum.
In addition to, and consistent with RWJF’s ‘two-generation’ approach, we’ve also pointed to how important Medicaid coverage is for parents as well as their children. When parents lack health coverage and cannot access needed care, they are less able to support their families and care for their children.
RWJF’s recent brief on the importance of investing in early childhood experiences is an important reminder that children’s health is inextricably linked with not only their long-term health but also with their ability to obtain additional social advantages such as education which all have long-lasting implications for their economic prospects later in life. Public health coverage programs such as Medicaid and CHIP are crucial elements to any effort to provide low-income children and their families with access to resources that will help improve outcomes across generations of families.
