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In November 2022, Children’s National Hospital hosted a virtual Inaugural School-Friendly Health Systems (SFHS)…

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At the intersection of healthcare access and the delivery of equitable care, Dr. Martin Luther King Jr. never understated…

Happy New Year from the CHAI!

The Child Health Advocacy Institute (CHAI) wishes you the very best in 2023. For today’s blog post, we are re-sharing our very first post from Tonya Vidal Kinlow where she provides her perspective on equity and how the CHAI works towards achieving it. One of Tonya Kinlow’s messages can be captured in this simple quote by Martin Luther King, Jr.: 

 The time is always right to do what is right.

We look forward to working with our community and our colleagues to do what’s right for children. Happy New Year! 

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.  

Photo by Ponsaksitphotos on Canva

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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The CHAI Adopts a Land Acknowledgement Statement  

A land acknowledgement statement, also known as Indigenous land acknowledgement, are formal statements used to spread awareness and understanding of the longstanding history of the Indigenous population genocide that occurred on the land that we reside on. They can be verbal or visual: signage, short theater presentations or simple spoken-word greetings before large events such as conferences.  

“When we talk about land, land is part of who we are. It’s a mixture of our blood, our past, our current, and our future. We carry our ancestors in us, and they’re around us. As you all do.” Mary Lyons (Leech Lake Band of Ojibwe) 

Land acknowledgements do not exist in a past tense, or historical context: colonialism is a current ongoing process, and we need to build our mindfulness of our present participation. It is also worth noting that acknowledging the land is Indigenous protocol.  

Why are land acknowledgement statements necessary? 

Land Acknowledgement Statements became popular in countries like Australia, New Zealand and Canada. These countries started these statements for various reasons, for example in 2008, Canada launched a Truth and Reconciliation Commission that included 94 recommended calls to action created by First Nation people to address the historical harm done to their communities.  

Photo by Aaron Burden on Unsplash

Land acknowledgements started in the United States’ from within the arts community due to the direct call to action from the North Dakota Pipeline protests starting in 2016. The US Department of Arts and Culture launched a social media campaign called #HonorNativeLand and provided a resource on Indigenous People’s Day 2017 (October 11): ‘Honor Native Land: A Guide and Call to Acknowledgment.’ Soon after, higher education institutes started providing statements. The first university to provide an official land acknowledgement statement was in 2018 by Northwestern University (NU) read at commencement, printed in programs, and published online. Due to the growing popularity of these statements on college campuses and the spark of the Black Lives Matter movement, this demanded that organizations take a look at their practices and traditions.  

These statements and movements led to the historic name change of the NFL Washington Football Team. Why is that important? It may seem like a small change, but the term “redskin” is considered a slur by Native American activists and has been used since the 18th century. This slang was used by the first colonists settlers and utilized to label Native Americans (or known as “Indians” during that time) as lower than white people. Some historians say that the term “redskin” could be reference to when Native Americans were scalped when they were hunted for bounty in the 1800s. Since the 1960s, activists have tried to encourage the NFL to change the mascot and name of the Washington team. Land acknowledgements and civil rights movements help to bring awareness and hold large corporations like the NFL accountable.   

How to Use Statements 

Email Signatures 

In order to spark awareness, you can have a simple statement at the end of your emails such as this one: 

“In the spirit of healing, I acknowledge and honor the Piscataway and Nacotchtank Tribes, and all of the original Indigenous peoples of the land upon which Children’s National Hospital stands. / Whose land are you on?” 

The link provided shows the historical territories of Native American tribes throughout the United States. Links like this can be provided or another education link regarding land acknowledgements.  

Formal Statements 

In the spirit of healing, CHAI has created a land acknowledgement statement. Children’s National Hospital has not established an official statement yet, but we encourage you all to spread awareness. You may utilize this statement for your own needs during appropriate times before large gatherings or in need of reflection regarding racial equity topics. If you do choose to use this statement, please reach out to Lin Chun-Seeley at to ensure you are using the statement appropriately.  

Our Example: CHAI Land Acknowledgement Statement  

The Child Health Advocacy Institute at Children’s National Hospital acknowledges that Washington, DC is the traditional territory of the Nacotchtank/Anacostan and Piscataway people. This land acknowledgement is read to recognize and honor the Indigenous peoples and the genocide, forceful removal and displacement of their elders whose lands and territories were stolen from them. We acknowledge their legacy and find inspiration in their great stewardship of the region for generations. 

The CHAI recognizes and celebrates the resilience, strength, and enduring presence of Indigenous people in Washington, DC and in all communities around the world. We have a shared responsibility to acknowledge the history and legacy of colonialism in our history as a community, as a nation, and as an institution. We commit to supporting the Indigenous members of our community as we educate ourselves on Indigenous histories, cultures, and issues. 

In the spirit of reconciliation, healing, and collaboration, please join us in a moment of reflection to acknowledge the injustices of our past and present as we work to dismantle the ongoing legacy of colonialism. Land acknowledgement is only one small part of supporting Indigenous communities. We hope our land acknowledgement statement will inspire others to stand with us in solidarity with Native nations.  


Header photo by Stephanie Valencia on Unsplash