A “Uniquely American Problem”: Poor Child Outcomes in the World’s Richest Country

In 2023, three branches of the United States military did not meet their recruiting goals. That’s due, in large measure, to another fact: more than 75% percent of American young people were ruled ineligible for military service for health reasons.

That’s one of many measures of the “social and demographic crisis” in health and well-being that are facing the U.S. and its young people, according to a new opinion piece in the Journal of the American Medical Association.

“What will interrupt these declines and strengthen the nation’s future?” the authors ask.

Their answer is nothing less than a transformation of the youth health care system of the kind laid out in a recent report from the National Academies of Science, Engineering and Medicine.

“What our country’s measures of pediatric health are showing now is the result of decades of underinvestment in child health,” said Kelly Kelleher, MD, lead author of the JAMA opinion piece and an author of the National Academies’ report. “We need to reimagine how we improve child health before children get sick, and how we deliver care to children when they need it.”

Dr. Kelleher, vice president of community health at Nationwide Children’s Hospital, is a member of the Committee on Improving the Health and Well-being of Children and Youth through Health Care System Transformation, formed by the National Academies to create a new vision of pediatric health care. The committee created the recent National Academies report, and members of it wrote the JAMA opinion article to draw attention to its conclusions.

The overall report, called Launching Lifelong Health by Improving Health Care for Children, Youth, and Families, lists five main goals:

• Elevate the importance of child and adolescent health for the nation through continuous public focus on children and youth.
• Finance health care systems for all children, emphasizing prevention and health promotion.
• Strengthen community-level health promotion and disease prevention.
• Ensure co-creation and co-design of programs and structures with youth, family, and community voices and leadership.
• Implement measurement and accountability to ensure equitable achievement of these goals.

Over the course of hundreds of pages, the committee writes of how these goals could be achieved. As one of many examples, the report calls for scaling models like the Healthy Neighborhoods Healthy Families initiative at Nationwide Children’s – which has impacted affordable housing, workforce development and educational opportunity – helps show how a community anchor institution can improve neighborhood health for one community.

“Our only chance for healthy children, families and communities, including a dynamic workforce, lies in designing a child system that aims to produce more ‘health’ and less traditional health care for all children, including revising our legacy financing schemes,” said Dr. Kelleher.