Pediatricians, the Pandemic, Politicization and Polarization

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Almost everything about the COVID-19 pandemic has been politicized: mask wearing, school re-opening, vaccination development, social distancing protocols, and many other public health and scientific efforts and recommendations. This politicization undermines public health efforts, science, and public trust. It also creates a polarization that makes dialogue, trust building and any progress forward very challenging. Most critically, this politicization and the ensuing polarization harm the health and well-being of children. While less impacted by morbidity and mortality due to coronavirus, children have borne the brunt of the coronavirus pandemic in a myriad of ways, from watching family members cope with illness, unemployment and other challenges, to social isolation and academic disruption due to school closures. In the spring of 2020, with the coronavirus racing around the globe, most US schools shut down for in-person learning, affecting over 50 million public school students.   

Photo by Deleece Cook on Unsplash

Let’s focus on school reopening. One year later, many communities are still grappling with when and how to send students, teachers and staff safely back to school. What started as two weeks of school closures has evolved into a yearlong debate that has become politicized and polarized. Communities are seeing parents, teachers’ unions, school boards, and school districts plunged into conflict. As spring turns to summer and school districts release plans for the fall, families will need to weigh the risks and benefits of returning to school in-person. And we’re asking families to do it during a time of tremendous conflict and controversy. 

If ever there was a moment for pediatrics, this is it. Pediatrics is part of the solution to politicization and polarization. Our exam rooms and our interactions with families create a space for open dialogue and honest communication. Families face a barrage of information from traditional and social media sources, as well as their friends, family members, and communities. Our exam rooms, our video visits, our phone calls with patients and family members – these are all spaces where we can remove polarization and politicization of issues like return to in-person schooling and apply a family-first focus. Much has been written about what we can do at a policy level, and much controversy remains, but let’s focus on the practice level. 

The conversation with every patient and family about return to in-person school is going to be individual and nuanced. We must provide our patients the space, a safe space, to express their concerns about in-person school and virtual school. We can help families weigh the risks and benefits in their own family, and for each child, of different school options. We can share what we’ve learned about coronavirus and school safety. We can discuss how to best meet each child’s needs, by considering their academics, their nutrition, their physical activity, their socialization. And we can help families figure out what kind of return to school is going to work best for their child – virtual, hybrid, in-person, or even a slow ramp up to an in-person experience. Our visits with patients and families can focus on their unique questions and considerations, not the broader public debate and discord. 

Let’s not let this opportunity pass us by. Families are counting on us to be the safe space focuses on their child, and their family. Let’s make our practices the prescription for politicization and polarization. 

 

Header Photo by Ivan Aleksic on Unsplash

How Health Professionals Can Address COVID-19 Vaccine Misinformation  

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Since the COVID-19 vaccine was authorized for children 12 years of age and older, I have had multiple conversations regarding the COVID-19 vaccine with my patients and their families. 

During one encounter, I asked my adolescent patient and his mother about their willingness to receive the COVID-19 vaccine at his annual check-up. He hesitantly said yes while his mother sternly said no. I attempted to further explore the reasons why, but she preferred not to discuss. In another encounter when I brought up the vaccine, the mother said she was waiting for additional information to be released before she put something unknown into her or her child’s body. Of course, I understand their hesitancy, but it is often rooted in misinformation. I often think – how can we as clinicians do better to curb this lack of confidence? It is not easy, but it can be done.  

I feel triumphant when families agree to receive the COVID-19 vaccine because these conversations are often challenging. Many parents are firmly set in their decision to refuse the vaccine, fueled by a barrage of negative information and perspectives. The rapid spread of ideas, images, and stories via the web, social media, and the news has led to increasing health misinformation and disinformation about the COVID-19 vaccine’s side effects and effectiveness. This is an ongoing battle that we as clinicians face every day. This misinformation lowers vaccine confidence and puts our population’s health at risk. 

Despite efforts to prevent the spread of health misinformation, COVID-19 cases are increasing especially in those populations with lower vaccination coverage.1 Fifty percent of the US population has not been fully vaccinated. Within the first 2 weeks of August, there have been 1.5 million new COVID cases reported, and 7,648 deaths due to COVID-19.2, 3 Pediatric COVID-19 cases are also substantially increasing, during the week of August 5th there were 121,427 new reported cases, accounting for approximately 1 in 5 of the total reported cases that week.4 

As health professionals and trusted members of the community, it’s our duty to proactively engage families, understand their point of view, correct misinformation, and serve as subject matter experts on the COVID-19 vaccine. These one-on-one conversations with families are critical but certainly are not enough. With the overwhelming amount of misinformation on social media and websites about the COVID-19 vaccine, more needs to be done to combat vaccine hesitancy. It takes efforts from multiple fronts to help address health misinformation and vaccine hesitancy. Below are recommendations to further strengthen our approach. 

Image by Jack Vessels on Unsplash

Implement statewide strategies to partner with community organizations to provide appropriate resources to inform families about the benefits and known side effects of vaccinations. 

Utilize postal mail, text messages, and telephone calls to communicate with families about the vaccine 

Ensure these messages are linguistically and are culturally appropriate. 

Create opportunities for community members to share their stories and experiences with the vaccine. 

Partner with school systems to provide vaccine education materials to families. 

Create vaccine clinics at schools to allow teachers, staff, students, and families to get vaccinated prior to or after the school day. 

Continue to maintain walk-up vaccination sites throughout the year that remain open during the weekday and weekends. 

Work with local institutions such as churches, barbershops, gyms, and community centers to meet people where they are. 

Hold focus groups and listening sessions with communities to understand what approach would be most effective to reach families. 

Ensure systems are in place to record most effective practices to tackle vaccine hesitancy. 

Continuously monitor and evaluate vaccine confidence after the above practices have been implemented. 

Continue utilizing The Vaccine Adverse Event Reporting System (VAERS), providing up to date, transparent data to the public. 

With the above recommendations in place, the hope is to build vaccine confidence to prevent further cases, hospitalizations, and deaths caused by COVID-19.

References

1. CDC COVID Data Tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#vaccinations-cases-trends. Accessed August 16, 2021.

2. CDC COVID Data Tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#trends_totalcases_totalcasesper100k. Accessed August 16, 2021.

3. CDC COVID Data Tracker. Centers for Disease Control and Prevention. https://covid.cdc.gov/covid-data-tracker/#trends_totaldeaths_totalcasesper100k. Accessed August 16, 2021.

4. Children and covid-19: State-level data report. American Academy of Pediatrics. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/. Published August 16, 2021. Accessed August 17, 2021.

 

Header photo from Adobe

Welcome to the Child Health Advocacy Institute (CHAI) Blog!

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Hello, I am Tonya Vidal Kinlow – the Vice President of Community Engagement, Advocacy & Government Affairs at Children’s National Hospital. I welcome you to our CHAI blog and hope that you come back often to learn about the important work we do to help improve the lives of children in DC, our region, and the country. We – me, my staff, colleagues, partners and collaborators – will share our views on matters that impact the health and well-being of children. The views we express are our own and not necessarily that of Children’s National Hospital. In this post, I’ll share my thoughts on what health equity means to me and how the CHAI works to elevate equity for all children and families.

Most Americans are taught and believe the idealized version of our country’s commitment to equality – “that all men (and women) are created equal.” A close review of public policies related to determinants critical to a high-quality life – health care, education, housing, income, employment – sheds light on the structural impediments to equality and equity in our country. The current COVID-19 pandemic aggressively aggravated how a crisis can impact people who have been systemically marginalized. These inequities are built on centuries of policies and established cultural norms, within government and business, that were designed to deprive this country’s people of color of the opportunity for a high-quality life. Achieving equity through policy and systems change must be our top priority if we are ever to achieve the true potential of the American ideal. 

Household income is one of the social determinants that affects many other quality- of-f life factors. Like a snowball rolling downhill, low income often results in lower quality housing, education and health. According to a Pew Research report, the Black-White income gap in the United States has persisted over time. The difference in median household incomes between White and Black Americans has grown from about $23,800 in 1970 to roughly $33,000 in 2018. 1 Making real change in this one area could have a tremendous impact on the lives of so many Americans. One possible policy solution to the income gap is to provide a living wage.  Yet, Congress just rejected a proposal to establish a $15 per hour minimum wage.  

The facts on disparities in health care, education, housing and employment are no different than the income indicator and are often linked.  People living in poverty or in lower income groups often have poor health, poor housing and poor education. Programs to address system inequities are great, but most only offer temporary solutions.   

Confronting these inequities takes a commitment to change.  Children’s National Hospital made that commitment when it created the Child Health Advocacy Institute (CHAI). More than 30 years ago, Children’s National was the first hospital in the nation to establish a center to champion policies that build better lives for children.   The CHAI achieves its mission through four core operational areas – community engagement, public policy advocacy, data and research, and education.  

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We are starting with the children. They are our priority. The health care system can be complicated and difficult to navigate.  Our community engagement team works strategically with our Children’s National clinical staff and partners in other organizations to improve health literacy. The CHAI team helped to create new systems and processes that improve the coordination of care, making it easier for families to get the quality health care they need. These efforts ensure fundamental health literacy supports, such as making sure families get patient discharge instructions in a language they understand. Additional systems changes establish more high- touch care coordination follow-up, such as, provider to patient calls to address any concerns that the patient might have complying with home care instructions.  

We are focused on eliminating health disparities. Our Data Lab helps us to identify community health needs.  The data drives where we focus our efforts to make change. And, the community consistently ranks mental health care at one of its top needs.  Due to a growing level of socioeconomic inequality among races, African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care). 

Children’s National supported the development of a new system of mental health care.  One that relies on a trusted health care provider – pediatricians.  Child and Adolescent Psychiatry Access Programs (CPAPs) or Pediatric Mental Health Care Access Programs (MAPs) are a recent innovation designed to address the dire child psychiatry workforce shortage by supporting pediatricians and other primary care providers (PCPs) to address their patients’ mental health concerns within the primary care setting. When mental health services are available, families face serious barriers in accessing care, including difficulties with transportation or attending regular appointments and overcoming the stigma often associated with seeking mental health support. In this context, PCPs are often asked to care for children with complex mental health needs without adequate support. MAPs are regional or state-level programs that allow PCPs to access a centralized team of professionals who they can consult about their patients’ mental health needs. MAPs promote health equity by ensuring all children, including those who live in communities with limited resources, have access to high quality mental health care. The CHAI government affairs team advocated for a national expansion of MAPs. President Biden’s COVID supplemental appropriations, the American Rescue Plan, includes $80 million to expand MAPs. 

We are advocating for health equity.  According to the Center’s for Disease Control (CDC), infant mortality is the death of an infant before his or her first birthday.  CDC’s data shows that Black children are more than twice as likely to die before their first birthday than White children (10.8 deaths per 1000 live births for Black infants and 4.6 for White). Birth defects is one of the leading causes of infant mortality and early detection is a way to save an infant’s life.  The Children’s National Government Affairs team was an early leader in efforts to require birthing hospitals to conduct newborn screening that would detect birth defects. This life saving public policy is now law in all 50 states. There is also a federal law that defines the birth defects that all American infants must be screened for.  While newborn screening is only one strategy used to reduce infant mortality, it creates equitable access for all children regardless of race and ability to pay. 

We are training the next generation of pediatric health care providers to care for the whole child. The CHAI team understands that excellent clinical care is only a small part of what it takes to keep a child healthy.  We want our young doctors to also understand this.  Social factors, such as housing, education and access to quality food, also make a difference in health outcomes for children.  The CHAI advocacy education team developed a national model for socially accountable, interprofessional advocacy education, that will result in a skilled workforce driven to advocate for child health equity and systemic change. Trainees learn about food insecurity during a day long interactive session at the Capital Area Food Bank.  Their experiential learning also includes strategies for helping families resolve this need. 

Eliminating inequity across all social systems will take determination to untangle systemic bias in public policy that have been entrenched for centuries.  At Children’s National, the focus is squarely on making a difference in the lives of children.  We are guided by our community; use data and research to focus our efforts; and advocate for public policy and systems change. Children are only a small part of the U.S. population, but they are our future.  The Child Health Advocacy Institute, through policy and systems change, will champion polices that improve the quality of life and create equity for all children. 

Header photo by Ponsaksitphotos on Canva

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