… PRESIDENT THEODORE Roosevelt, in 1909, called a national conference to review the “circumstances and prospects” for the nation's children. His message to Congress stated: “The interests of the nation are involved in the welfare of this army of children no less than in our great material affairs.” The report of his conference reinforced this view by stating: “… it is sound public policy that the State through its duly authorized representative should inspect the work of all agencies which care for dependent children, whether by institutional or by home-finding methods and whether supported by public or private funds … .”
Public responsibility for the welfare of children was not easily established. Senators railed against “… long haired men and short haired women …” snooping around the mills–the owners did not like it… .
Since 1915 a Children's Bureau has been established and recently disestablished, and each 10 years since 1909 a White House Conference has affirmed but not generally improved upon Theodore Roosevelt's declaration of government's responsibility for the care of children. Herbert Hoover's conference in 1930 raised the sights a little higher with adoption of a Children's Charter of Rights. Government's responsibility was affirmed to obtain and protect those rights on behalf of the nation's children.
The Social Security Act of 1935 and its subsequent amendments took giant steps toward fulfillment of the Children's Charter developed by President Hoover's Conference. The mission was by no means completed. Categorical emphasis under Social Security and uneven implementation through state government deprived many children of the full benefits that might have guaranteed their health and well-being… .
Concerns about long haired men and short haired women have been resurrected along with ancient rhetoric that extols home and family without helping either of them. Home and family indeed are nearly sacred; they are the best devices we know for raising children, but they are in jeopardy not from public infringement but from public neglect… .
The issue here is not a Children's Bureau, or a Child Advocacy Agency, or the Office of Maternal and Child Health; no single agency ever held the key to good health for all children. The issue is, “Are children important to our national interest?” If the answer be “yes,” then we should be alarmed that nearly every focus we know for public responsibility on behalf of children has been downgraded and diffused so that it exists everywhere and nowhere. Nearly every day brings further evidence that government has abrogated its responsibility to protect children… .
How are children faring? What are their circumstances and prospects? Medical care is by no means the greatest determinant of children's health, but it dominates national thinking in matters of health. Abundant data are available concerning medical care and for that reason it is a useful place to begin… .
… [T]he poor suffer most. American children who are disadvantaged by poverty or racism or by geographic, cultural, or ethnic isolation receive very inadequate medical care, indeed. Popular supposition to the contrary, there has been no concerted national effort to bring medical relief to disadvantaged people. Small samples of these people have sometimes been involved in projects to demonstrate new patterns of medical care. Many of the demonstrations have been most promising, but the promises have not been extended to reach everyone who would benefit.
What is the record? Who gets medical care?
Children from high income families were 4-1/2 times more likely than those from low income families to visit a pediatrician;
In New York City a well-baby check-up in the first 2 months of life was given to 80 per cent of white non-Spanish babies, but only to 56 per cent of the babies of Spanish origin. By 1 year of age, only 0.5 per cent of white non-Spanish babies had received no check-up at all; 7.6 per cent of Spanish origin babies had no check-up;
Thirty-five per cent of inner city children had not received protective immunizations. Protective immunizations had been given to 74 per cent of white children, but to only 61 per cent of nonwhite children … .
What are the needs for medical care? …
Disability due to illness or accident is 50 per cent higher for the poor than for the nonpoor. Within the lowest income groups “some are poor because they are sick and others are sick because they are poor”;
Some diseases are so prevalent among the poor that they are termed “diseases of poverty.” Examples are: tuberculosis, untreated middle ear infections (often leading to deafness and other complications), iron deficiency anemia (about 50 per cent of poor children under 5 years are affected), lead poisoning, malnutrition with attendant increased susceptibility to gastroenteritis, tuberculosis, and respiratory infections and with resultant stunting of growth which in girls perpetuates a cycle of poor pregnancy outcome; …
If medical care to all pregnant women in New York City met standards of adequacy, it is estimated that infant mortality could be reduced by 33 per cent; …
Infant mortality for nonwhites is double that for whites. Maternal death among nonwhites is 4 times that for whites; …
Infant deaths among Indians and Alaskan natives are nearly twice that for other races;
Indian children are 3 times more likely to be damaged by accident than other children… .
C. Arden Miller.
Source. Courtesy of Dr. Thomas M. Miller.
What does all this mean? It means that health care is rendered most abundantly to population groups whose health is least in jeopardy; and people who are at greatest risk from poor health have the most difficulty in gaining access to health care. Preventive services which should be routine for everyone are maintained at marginal levels at best, and at grossly unsatisfactory levels for disadvantaged people. Deficient immunizations, inadequate prenatal care, and missing well-baby health checks are conspicuous examples of neglect.
If a person in this country is poor, black, poorly educated, employed in a hazardous occupation, part of a large family, or lives in a disadvantaged area his chance of a disability is exceedingly great and his chance of getting help for it is exceedingly small. If a preschool child is black, Chicano, poor, migrant, or living in a rural or urban slum the likelihood of malnutrition and growth failure with all their attendant disabilities is exceedingly great; the likelihood that health can be restored in later years under even the most favorable medical circumstances is quite remote… .
America's children require a National Health Service for Mothers and Children. Such a program would operate not as a token or demonstration health service; it would not depend on local organizational initiatives; and it would extend appropriate health services to every child and expectant mother in America. Such a program would guarantee not just payment for medical services some of which may not even be available, but direct provision of services themselves, by government agencies as necessary, on behalf of all children… .
Government need not be seen as an alien force interfering with our lives. Government is ourselves organized, and it must be made to respond positively for guarantee of those services which cannot be assured in individual ways… .
A National Health Service for Mothers and Children will be an economical measure. It will save our society, not only the anguish of raising damaged children, but the enormous private and public financial burden of caring for diseased, defective, apathetic, and stunted children who become inadequate and unfulfilled adults.
When Americans speak of health they speak first of medical care. This is a distorted priority, reflective of our national eagerness to solve social problems by technological means rather than by more painful and difficult social reforms. Good medical care for children carries abundant justifications and they should not be minimized. But the substantial benefits of improved medical care can be realized only in a population that enjoys certain other benefits. The health of children and youth is overwhelmingly jeopardized, not from deficient medical care, but from social pathology.
One of the important indicators is malnutrition. Government must implement a national program to feed children. It must be administered by agencies that have, as a first priority, the interests of children and not those of agri-business. How long can we pretend that we do not know how to do it? We feed armies, we can feed children. The Special Supplemental Food Program for Pregnant, Lactating Women, and Infants and Children 0–59 months-known as WIC–affirms that government acknowledges its responsibilities to improve nutrition of children. Initiation of this program only after court order raises doubt that it will be implemented with the full administrative enthusiasm it deserves. The court order suggests to us, however, that government can be helped to do its duty… .
One school of thought advises that the public should be better instructed on what to eat. This is not a sufficient response. Many people already know what they should feed their children, only they cannot do it. One of the strongest correlates of inadequate diet in one survey was inadequate housing. A mother living without stove, refrigerator, or indoor running water will be hard pressed to provide her children an adequate diet no matter how much she knows about nutrition… .
About 40 per cent of all preschool children have parents both of whom work outside the home. Who cares for the children?–not very often the extended family of grandmother or elderly aunts. Our mobile society has nearly eliminated that important and valuable family support. Most mothers who work outside the home do so because of economic necessity, and their children are cared for in a horror of makeshift random ways that range from sterile, impersonal commercialism to quiet and hidden neglect in the crowded quarters of neighbors' homes. America's families need help to care for their children. That help need not be disruptive of family life–it can be supportive… .
A national program of community support for families, including day care, could be a family and life-saving mechanism for improved nutrition, for health education, and for medical care and health maintenance of many kinds. The country came close to such an enactment in 1971; renewed efforts should be made. Failure to do so will bring further deterioration of the American home and family as the best ways we know for rearing children… .
An effort to supplement American families gives important recognition to a new revolution in the world of children. The revolution has to do with change in the role of women. The world is full of evidence that children, far from being deprived by this revolution, will be stimulated and enriched by it… .
These … endeavors all require public money and public administrative authority. Some will say we cannot afford them. The response is “poppycock.” We cannot afford the awful cost of a nation of neglected children… .
No matter whether our mechanisms for protecting children be public or private, and they surely must be both, they need to function with the forceful mandate that children are important to us. Let us take up that cause.