a conceptual framework that illustrates the connection between social inequalities and health http://barhii.org/framework/
I had previously written a diary on the fact that it takes more than just healthcare for people to be healthy. Recently I saw the diary “PSA: The holidays are hard for folks with toxic families” which made me think of the topic of early childhood adversity and toxic stress.
Which then made me think that I should expand on this topic in a new diary, and not only show that we need single-payer healthcare (increased life expectancy and reduced health disparity in Taiwan after 10 years of single-payer) to fix the healthcare part of this complex problem, but also that we need many many more pieces of legislation to repair the damage that has been done by Republicans in the last 40 years. Democrats must stop being coy and playing to the ineffective and paralyzed “moderate” center. Democrats must be bold and creative, just like they were during the New Deal and Great Society. Anything short of that will be throwing away a once-in-a-lifetime opportunity!!!
So let’s look at the different areas of social policy that we need Democrats to work on, in order help create a healthy society, where our focus is making and keeping people healthy, rather than just throwing money at treating sickness. In order to figure that out, we need to figure out what it takes to make and keep people healthy. First let’s look at how to make people healthy, starting at the stage of making people.
Health Starts in the Womb
The health of an individual starts even before they are conceived. Actually, it starts even before that, with the health of the parents (yes even that of the father). Actually, it starts even before that, with the health of grandparents . The effects of toxic stress are passed to future generations through epigenetics and DNA methylation.
So if we want healthy people today, we have to make sure that their parents were healthy as children, or even that their grandparents were healthy when their parents were conceived. That blows the mind! Today’s children are suffering from poor health, because their grandparents suffered from poor health when they were young! If we want today’s children to be healthy, we have to go back in time, and make sure their grandparents were healthy 50-70 years ago! And if we want our citizens to be healthy in the next 50-70 years, we have to make sure today’s children are healthy! Who knew we had to do time travel to fix today’s or tomorrow’s problems?
So when republicans and their little president blame people in poverty, they are ignoring the fact that these people are stuck in multigenerational poverty traps, not only because of the genetic factors that are being passed down to them, but also because of environmental factors. How can they blame people when they are starting at a disadvantage even before their parents were born? Of course the answer to that paradox is that republicans don’t actually care about other people. They are selfish jerks.
If parents and grandparents suffered from poor health and toxic stress, that’s water under the bridge. Or is it? Can the damage be repaired, and can we make today’s adults become healthy again? We will get to that later. But first lets talk about what can we do about the children today. To make the greatest and most long-lasting impact, we need to start as early as possible. The most critical time in a person’s life is the time from birth to the first thousand days.
Advances in neuroscience, molecular biology, and genomics have converged on 3 compelling conclusions: (1) early experiences are built into our bodies; (2) significant adversity can produce physiologic disruptions or biological memories that undermine the development of the body’s stress response systems and affect the developing brain, cardiovascular system, immune system, and metabolic regulatory controls; and (3) these physiologic disruptions can persist far into adulthood and lead to lifelong impairments in both physical and mental health. pediatrics.aappublications.org/...
To put that in another way:
A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life. These early experiences can affect adult health in 2 ways—either by cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods. In both cases, there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of disease. From both basic research and policy perspectives, confronting the origins of disparities in physical and mental health early in life may produce greater effects than attempting to modify health-related behaviors or improve access to health care in adulthood. jamanetwork.com/...
Toxic stress, homelessness, poor health suffered by children, will cause them to suffer from a lifetime of illness and poor health. This means that they will not be able to get better jobs in the future, and they will be trapped in the same poverty that their parents were in. So what would be the best thing for (Democratic) policymakers to do? We know that the return on investment is much better when we invest more on the the first thousand days. So it would make sense to put most of our money and effort into the youngest children, from birth to three years, and beyond.
Investing in disadvantaged young children is a rare public policy initiative that promotes fairness and social justice and at the same time promotes
productivity in the economy and in society at large. Early interventions targeted toward disadvantaged children have much higher returns
than later interventions such as reduced pupil- teacher ratios, public job training, convict reha-bilitation programs, tuition subsidies, or expend-iture on police. At current levels of resources,society overinvests in remedial skill investments at later ages and underinvests in the early years.
www.researchgate.net/…
But we are doing the opposite. We are spending lots and lots of money on prisons and “correction”, rather than investing on our infants and young children.
State and local spending on prisons and jails has increased at triple the rate of funding for public education for preschool through grade P-12 education in the last three decades, a new analysis by the U.S. Department of Education found. www.ed.gov/...
Why are states spending more money on jailing young adults, rather that investing on children so they won’t end up having problems that land them in jail? www2.ed.gov/...
We need to spend the most money on the youngest children, when their brains are developing, so they will develop into healthy and smart young adults.
Needless to say, continuing this trend would be idiotic.
What would be the smart thing to do? What kinds of policies do we need to help children in the first 3 years of their lives, so we can get the most benefit to our society?
Investing in young children is the responsible thing to do. All children deserve a chance to grow into healthy, educated, and competent people, no matter where and when they were born. While parents bear most of the responsibility for raising their children, especially in the early years of life, governments also have an important role during this critical time of human capital accumulation. For example, governments can ensure that all expectant mothers and young children have access to quality health services and nutrition. They can support parents and other caregivers in providing a positive and stimulating environment for children from birth on by promoting parenting information programs, investing in direct services such as home-based visits, funding daycare centers and preschools, or providing financial incentives to access good quality programs for infants and children. This Early Childhood Development (ECD) guide presents lessons and experiences that have been useful in informing the policy debate about ECD interventions and the design of such programs across the world.
openknowledge.worldbank.org/...
We need a Framework for Early Childhood Policies and Programs, so that we can focus our attention on the critical areas affecting health throughout the lifetime.
A science-based framework created by the Center on the Developing Child at Harvard University to advance early childhood policies and programs.
The biology of health and development explains how experiences and environmental influences get under the skin and interact with genetic predispositions, which then result in various combinations of physiologic adaptation and disruption that affect lifelong outcomes in learning, behavior, and both physical and mental well-being. These findings call for us to augment adult-focused approaches to health promotion and disease prevention by addressing the early childhood origins of lifelong illness and disability.
The foundations of healthy development refers to 3 domains that establish a context within which the early roots of physical and mental well-being are nourished. These include (1) a stable and responsive environment of relationships, which provides young children with consistent, nurturing, and protective interactions with adults to enhance their learning and help them develop adaptive capacities that promote well-regulated stress-response systems; (2) safe and supportive physical, chemical, and built environments, which provide physical and emotional spaces that are free from toxins and fear, allow active exploration without significant risk of harm, and offer support for families raising young children; and (3) sound and appropriate nutrition, which includes health-promoting food intake and eating habits, beginning with the future mother’s preconception nutritional status.
Caregiver and community capacities to promote health and prevent disease and disability refers to the ability of family members, early childhood program staff, and the social capital provided through neighborhoods, voluntary associations, and the parents’ workplaces to play a major supportive role in strengthening the foundations of child health. These capacities can be grouped into 3 categories: (1) time and commitment; (2) financial, psychological, social, and institutional resources; and (3) skills and knowledge.
Public and private sector policies and programs can strengthen the foundations of health through their ability to enhance the capacities of caregivers and communities in the multiple settings in which children grow up. Relevant policies include both legislative and administrative actions that affect systems responsible for primary health care, public health, child care and early education, child welfare, early intervention, family economic stability (including employment support for parents and cash assistance), community development (including zoning regulations that influence the availability of open spaces and sources of nutritious food), housing, and environmental protection, among others. It is also important to underscore the role that the private sector can play in strengthening the capacities of families to raise healthy and competent children, particularly through supportive workplace policies (such as paid parental leave, support for breastfeeding, and flexible work hours to attend school activities and medical visits). pediatrics.aappublications.org/...
So let’s get to work. The best place to start, as I said before, is to focus on the youngest children, from birth to three years old.
www.zerotothree.org/…
On November 6th, more than 10,000 babies were born in the United States, representing our country’s next generation of workers, thinkers, and leaders. Each of these 10,000 youngsters brings with him or her infinite potential in need of support from the many new faces in Congress, governors’ mansions, and state legislatures across the country.
For newly elected officials, or those that have been re-elected, there is a proven way to build a healthy future for their communities: investing in their youngest constituents. By championing policies and programs that promote good health, strong families, and positive learning experiences for infants and toddlers, policymakers at all levels of government can make an important investment in the families they serve today, as well as our country’s future.
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We can’t predict what the 10,000 babies born on Election Day will grow up to be. They will be passionate for music, the environment, law, art, and medicine. But no matter where their passions lie, their future success depends on the groundwork that our policymakers create now, including:
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Investments to ensure all families can access quality, affordable child care, with a major effort to improve the quality of infant-toddler care.
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A national paid family leave policy to ensure new parents, both dads and moms, get critical time to bond and spend with their newborns.
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Extension of Early Head Start’s two-generation approach to ensure that more families can benefit from its comprehensive services.
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Expanding infant and early childhood mental health grants that support children’s healthy emotional development from the start, preventing a wide range of problems.
Let’s look at legislation that has been offered before, and where Democrats can focus in the future, if not in the Senate, then at least in the House, so people will know the Democrats have their backs.
Afordable child care: usa.childcareaware.org/…
Paid family leave: www.congress.gov/…
Early Head Start: www.acf.hhs.gov/…
Early childhood mental health: www.dds.ca.gov/…
What other specific policy changes can we make to ensure the best future health for the 10,000 babies born on election day, and on every day since, and thereafter?
To ensure all children a head start, we must build a high-quality continuum of early childhood opportunities for every child, including:
- Paid Family Leave so families welcoming a new child into their homes can bond with and support that child’s development before they have to return to work.
- Voluntary Home Visiting so new parents can understand the supports and resources available to them.
- Quality, Affordable Child Care so children’s development can be nurtured while their parents are at work.
- Early Head Start and Head Start for the poorest children and families so that their early needs can be met in a comprehensive way.
- Quality Preschool so children enter school ready to learn.
- Full-Day Kindergarten so children do not miss the critical step between preschool and first grade.
home visiting: mchb.hrsa.gov/…
Full-Day Kindergarten:
NEA recognizes that full-day kindergarten programs close achievement gaps between young children from minority and low-income families and their peers. By providing a solid foundation of learning to children from all backgrounds, full-day kindergarten programs ensure all students' academic, social, and emotional success.
www.nea.org/...
Promoting health for Teens and Young Adults
After children are grown into adolescents and young adults, we are still not done with them. We need to invest in their continued care and education, to prevent them from falling off the tracks and landing into trouble and get incarcerated. We need to destroy the school-to-jail pipeline!
The ACLU is committed to challenging the “school-to-prison pipeline,” a disturbing national trend wherein children are funneled out of public schools and into the juvenile and criminal justice systems. Many of these children have learning disabilities or histories of poverty, abuse, or neglect {{see above ^^^}}}, and would benefit from additional educational and counseling services. Instead, they are isolated, punished, and pushed out. www.aclu.org/...
- Studies show that children in afterschool programs do better in school, stay in school longer and have greater expectations for the future.
- On school days, the hours between 3 p.m. and 6 p.m. are the peak hours for juvenile crime and experimentation with drugs, alcohol, cigarettes and sex.
- Teens who do not participate in afterschool programs are nearly three times more likely to skip classes than teens who do participate. They are also three times more likely to use marijuana or other drugs, and they are more likely to drink alcohol, smoke cigarettes and engage in sexual activity. lcaturano93.wordpress.com/...
What is our little president doing about this?
President’s Budget: $0 for Afterschool & Summer
Nearly 2 million kids may lose their afterschool and summer programs.
www.afterschoolalliance.org
What can Democrats do to break the school-to-jail pipeline? There is no shortage of ideas:
- 21st Century Community Learning Centers (21st CCLC) initiative. Central to increasing access to programs and building program quality is ensuring that local afterschool and summer learning programs are able to leverage federal funding. 21stCCLC is the primary source of federal afterschool and summer learning funding. For fiscal year 2020, we urge Congress and the Administration to fund 21st CCLC at the $1.3 billion level to ensure almost 2 million children and their families continue to have access to quality programming when school is out.
- Child Care Development Block Grant (CCDBG) School-age children are supported through CCDBG. As the 2014 CCDBG reauthorization is implemented an opportunity exists to strengthen school-age program quality and access.
- Every Student Succeeds Act (ESSA) In addition to 21st CCLC (Title IV part B), Title I, Title IV Part A, and Title IV Part F funds of the Every Student Succeeds Act (ESSA) can support local afterschool programs.
- Perkins Career and Technical Education (CTE) Act reauthorized in July 208 is an opportunity to build career pathways and include afterschool and summer learning programs as partners in the effort to provide students with activities and experiences such as competency based learning, hands-on STEM, mentorships, site-visits and apprenticeships.
- Science, technology, engineering, and mathematics (STEM) - increasing access to quality science, technology, engineering, and mathematics (STEM) afterschool. Learn how to make the case for afterschool STEM with talking points and other resources from The Afterschool STEM Hub.
- Child Nutrition and Physical Activity Streamlining federal child nutrition programs like the afterschool meal and summer feeding programs, and increasing physical education and activity nutrition education and access to nutritious food in out of school time programs.
- Social and Emotional Learning. Increasing access to social and emotional learning in afterschool and summer learning programs.
- Higher Education Act (HEA) - provides many opportunities for collaboration between afterschoola and summer programs and institutions of higher education including college preparation, teacher training and pathways, and child care for college going students. www.afterschoolalliance.org/...
Health of Young Parents and Their Children
One of the most important policy areas that can impact the health of young families is paid parental leave. The USA is shamefully lagging behind the rest of the world, even behind those that the little president had the most contempt for.
How do we know that paid maternity leave matters and can make a difference in the health of young families? Here is the evidence:
Birth. 2016 Sep;43(3):233-9. doi: 10.1111/birt.12230. Epub 2016 Mar 17.
Paid Maternity Leave and Breastfeeding Outcomes.
Employed women who received 12 or more weeks of paid maternity leave were more likely to initiate breastfeeding and be breastfeeding their child at 6 months than those without paid leave.
Paid Maternity Leave in the United States: Associations with Maternal and Infant Health.
Women who took paid maternity leave experienced a 47% decrease in the odds of re-hospitalizing their infants (95% CI 0.3, 1.0) and a 51% decrease in the odds of being re-hospitalized themselves (95% CI 0.3, 0.9) at 21 months postpartum, compared to women taking unpaid or no leave. They also had 1.8 times the odds of doing well with exercise (95% CI 1.1, 3.0) and stress management (95% CI 1.1, 2.8), compared to women taking only unpaid leave. Conclusions for Practice Paid maternity leave significantly predicts lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management. Policies aimed at expanding access to paid maternity and family leave may contribute toward reducing socio-demographic disparities in paid leave use and its associated health benefits.
Child Health in Elementary School Following California’s Paid Family Leave Program.
Using the Early Childhood Longitudinal Studies (ECLS) within a difference-in-differences framework, our results suggest improvements in health outcomes among California elementary school children following PFL’s introduction. Furthermore, the improvements are driven by children from less advantaged backgrounds, which is consistent with the notion that California’s PFL had the greatest effect on leave-taking duration after childbirth mostly for less advantaged mothers who previously could not afford to take unpaid leave.
House Democrats, get to work, pass paid family leave of at least 12 weeks for all American families!!!
Here are more ways to help mothers and young families:
APHA recommends that the US Congress, the Executive Branch, federal agencies, state and local governments, and partners—
- Increase federal, state, and local funding and support to implement the CDC recommendations to develop and establish multidisciplinary, independent pregnancy-related mortality review boards in every state;
- Encourage these review boards to use the multiple sources of data and expanded definition of pregnancy-associated maternal deaths recommended by CDC in their identification of cases, and to use standard guidelines and case abstraction forms in their formation and functioning;
- Encourage all states to adopt the US standard birth and death certificates as recommended by CDC, including the 5 recommended checkboxes indicating whether and when the woman had been pregnant at the time of death or at any time during the year preceding death;
- Encourage all state departments of health to create electronic data linkages between death and birth certificates to better identify pregnancy-associated deaths;
- Support funding for programs focused on increasing access to timely and appropriate quality health care for all women, free from economic, legal, psychosocial, and cultural barriers;
- Expand existing efforts to measure, analyze, and report on pregnancy outcomes to include maternal health outcomes, including maternal mortality, near misses, and morbidity; increase research funding that examines a woman’s experience during maternity care; and develop and implement quality indicators to better assess the quality of maternity care;
- Encourage maternity care professionals, facilities, and professional associations to revise standards of practice and practice guidelines on the basis of the best available evidence and the recommendations of independent maternal mortality reviews;
- Increase funding for data collection, research, review, analysis, and education in order to
- identify and reduce clinical, economic, legal, psychosocial, and cultural factors, including violence during and after pregnancy, that contribute to maternal mortality and morbidity, poor maternal care practices, and
- develop, evaluate, and implement effective interventions; and
- Support and pass legislation that would reduce maternal mortality and morbidity and improve maternal health both globally and in the United States, including by
- increasing the prioritization and coordination of maternity care at the Department of Health and Human Services;
- reducing shortages of maternity care providers and facilities;
- improving the quality of care provided by improving provider education;
- increasing data collection, including the implementation of performance measures; and
- ensuring that payment structures include incentives to provide care according to the best evidence (rather than creating perverse incentives). www.apha.org/...
Food Security
Food system policy, public health, and human rights in the United States.
...the present US food system is largely unhealthy, inequitable, environmentally damaging, and insufficiently resilient to endure the impacts of climate change, resource depletion, and population increases, and is therefore unsustainable. Thus, it is imperative that the US embraces policy reforms to transform the food system into one that supports public health and reflects the principles of human rights and agroecology for the benefit of current and future generations.
Policy recommendations: www.annualreviews.org/…
Healthcare for ALL
pdamerica.org/...
It is a moral outrage for a country as wealthy as ours to leave 60 million people with no reliable access to health care and tens of millions more with inadequate or overly expensive coverage. In addition, despite spending nearly twice as much as other developed nations on health care, our system performs poorly, because the private U.S. insurance bureaucracy soaks up as much as one-third of all the money and pharmaceutical interests overburden America by avoiding price competition.
Healthcare Human Rights is part of PDA’s Fund Human Needs/Cut Pentagon Waste platform. We work on the following issue:
- Medicare for All (National)
- State Single Payer
Healthcare Human Rights Statistics
- Americans with no health insurance = 60 million (est)
- Americans with no insurance with full ACA implementation = 30 million (est)
- Almost 1 million Americans declare bankruptcy each year because of medical costs – 75% had health insurance
- 60,000 preventable deaths occur each year for lack of medical care – with ACA the estimate will still be 30,000
Healthcare Facts
- Even with ACA, many won’t be covered
- Medicare doesn’t cover dental or vision
- Mental health care is underfunded
- Copays and deductibles are prohibitive
- No medical control with HMO’s
Legislation Our Team Has Endorsed
- HR 676 (Conyers – D-MI-13) Expanded and Improved Medicare for All
- HR 1200 (McDermott – WA-07) American Health Security Act
- S 1782 (Sanders – VT) American Health Security Act
Transportation
I think there are enough policy ideas to keep the Democrats in the House busy for not just 2 years, but 12 years. If Democrats grow a spine and pass these legislations, the American people will know that Democrats are working for them, not for monied interests like big insurance, big pharma, big agro, big military-industrial complex, big medical-industrial complex, big banks, and big jerks in general. Here is one last area that affects our health, and how democrats can fix it.
A recent study of 4,297 Texans compared their health with the distances they commuted to and from work.It showed that as these distances increased, physical activity and cardiovascular fitness dropped, and blood pressure, body weight, waist circumference and metabolic risks rose. well.blogs.nytimes.com/…
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While there is still a long way to go before the majority of Americans live in communities that foster good health, more urban planners are now doing health-impact assessments and working closely with architects, with the aim of designing healthier communities less dependent on motorized vehicles for transportation.
AMEN!
Let’s revive this policy idea: www.democraticwhip.gov/…
