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.  

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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