In August, New York State convened a “First 1,000 Days” on Medicaid initiative, to generate recommendations to improve health for young children covered by Medicaid – with explicit interest in outcomes that are long-term and cross-sector, extending beyond health and medical issues.
I am helping to lead this effort, which involves dozens of leaders and practitioners across many sectors, including pediatrics, managed care, education, child welfare, child care, and mental health. It is unusual, challenging, and exhilarating to have this wide array of expertise at the same table, focused on shared goals with the understanding that we are talking about the same children— and reaching beyond silos.
Nearly all children – 97.5 percent — in New York State have health insurance coverage, with 59 percent of all children age 3 and under covered by Medicaid. Most young children visit a pediatrician or family doctor several times a year. In the years before a child starts school, this means that the primary care setting is one of the best places to ensure that children and families are connected to what they need for strong and healthy development.
Pediatricians do not have all of the tools needed to ensure a child’s healthy development, but they can play a pivotal role in assessing gaps, connecting families to needed supports and services beyond the medical world, and ensuring that family, parent and caregiver health and well-being are integrated into strategies to improve child outcomes. Among the strategies being considered by the workgroup are ways to strengthen and expand the tools and resources available in pediatric primary care.
With clear evidence of the severe detrimental impacts of family poverty, we are attentive to poverty and other social determinants of health and their significant impact on the long-term health of our youngest children. Childhood poverty, economic instability and income inequality lead to numerous negative outcomes for children in all areas of their lives, with effects that can last well into adulthood, and which often build one upon the other.
Children who grow up in poverty are much more likely to suffer from chronic health conditions like asthma and diabetes as adults, as well as lasting changes to parts of the brain that govern learning, memory and emotional functioning. It is also well understood that a child’s socioeconomic status is among the strongest predictors of academic achievement.
The good news is that while childhood poverty and inequality can have devastating impacts on children’s well-being in the short and long term, we have tools to mitigate these impacts. Modest income transfers to low-income families – in the form of subsidized health insurance or child care, tax credits or other income supports – can yield tremendous benefits for children and their families, including improved physical, emotional and behavioral health, higher educational attainment and increased future earnings. High-quality early learning; evidence-informed maternal, infant and early childhood home visiting; and developmental screening and connection to appropriate services are other strategies.
This recognition of the importance of a child’s earliest years has generated significant enthusiasm about forthcoming recommendations in New York’s child advocacy community. We are hopeful that this initiative will stimulate a shared focus on healthy development for all young children and drive policymaker attention and resources to a deeper understanding of how investing in the “First 1,000 Days as a New Yorker” can and should be part of a long-term strategy to strengthen our communities and state.
Kate Breslin is the President & CEO of the Schuyler Center for Analysis and Advocacy.
