Children and families need a reimagined health care system that holistically addresses their unique needs. This includes considering their physical, behavioral, and relational health, as well as families’ health-related social needs, including housing and food security. It’s important to meet these needs in family-centered, anti-racist ways that honor the family’s dignity and expertise in their own lives. Too often, however, the current system fails children, especially Black, Indigenous, and other children of color, who face additional barriers to health and well-being as a result of structural racism and systemic inequities. Children of color are far likelier to experience poor health outcomes, including higher infant mortality rates and predisposition to chronic diseases, for example.

The National Academies of Science, Engineering, and Medicine (NASEM) recently released a consensus study exploring promising strategies for improving the health and well-being of children, adolescents, and their families. NASEM’s recommendations are comprehensive and include co-designing programs and systems with youth, families and communities; strengthening community-level health promotion; and reforming payment systems to focus on prevention and equity. These reflect the growing momentum to prioritize child and adolescent health. For the past four years, the Center for Health Care Strategies (CHCS), with support from the Robert Wood Johnson Foundation, has explored key strategies to transform child health care system, and what can be done to accelerate the pace of transformation. We’ve partnered with thought leaders from across the country — including pediatricians, family engagement leaders, Medicaid policy experts, and community partners — to understand the landscape and help push child health transformation forward. 

This blog post shares insights from conversations we’ve had with two advisors to CHCS’ Accelerating Child Health Transformation initiative, Renée D. Boynton-Jarrett, MD, ScD, Associate Professor of Pediatrics, Boston University School of Medicine, and Benjamin Danielson, MD, Clinical Professor, Department of Pediatrics, University of Washington School of Medicine, on why child health transformation is needed now more than ever, and what a transformed system might look like.

Why Is Transformation Needed Now More Than Ever?

R. Boynton-Jarrett: When we think about why there is such an urgency for child health transformation, we have to consider that for the first time in recorded history, we have a generation of children on track to have poorer health outcomes, life chances, and life expectancy than the generations that came before them. We must do things differently to address that. The health care system is just one component to support health and well-being — it is not the only system. But transforming the child health system opens us up to think about how the health care system should synergistically interact with other systems to support lifelong health and well-being.

B. Danielson: We are not doing everything we can to help support the development, health, and thriving of young people across our communities. To do that, we need a continuous, iterative learning process that takes dedication and willingness to continue to be self-reflective and want to grow. Providers have the opportunity to influence the system. We just need to roll up our sleeves and do it. The child health realm doesn’t give itself enough credit for the amount of potential influence that we can have on the rest of the health care system, to be a guiding light for change in health care systems across the lifespan, and for addressing systematic problems.

What does a reimagined child health care system look like?

The Accelerating Child Health Transformation initiative explores key strategies focused on adopting anti-racist practices and policies; co-creating equitable partnerships between patients, families, and providers; and identifying family and community strengths as well as addressing health-related social needs. Below, Dr. Boynton-Jarrett and Dr. Danielson share practical opportunities to embrace those strategies when reimagining a child health care system.

• Share power and hold leaders accountable.
  
  R. Boynton-Jarrett: Providers and health care leaders hold a lot of privilege and power — and they have the ability to share that power, decision-making, and governance with the families and communities we serve. To support power sharing and more accountability, we need to create clear communications lines, feedback loops, and measures co-created with families to track how well we are honoring the dignity and personal agency of families.

• Foster equitable relationships and opportunities for co-creation with families and communities.
  
  B. Danielson: Child health transformation is deeply vested in our ability to have meaningful relationships with the families and communities we serve. Authentic relationships require us to listen to those families and communities — listen to what they tell us they need and be real partners in helping to make that happen.

• Focus on strengths and dignity.
  
  R. Boynton-Jarrett: It’s important to understand families’ strengths, extended social network, community assets, and the institutions that they’re connected with to ensure that health care providers can have a holistic healing-centered plan that’s co-created with and works for the family. We need to embrace a dignity framework where we can appreciate, acknowledge, and recognize families’ strengths to appreciate their full humanity. No one wants to be defined by the worst thing that’s happened to them or their greatest challenges.

• Support extended care teams.
  
  B. Danielson: Health care teams are trying so hard to do their best work and transform how they deliver care under circumstances and systems that don’t always support their best work — they’re exhausted. When health care teams have the chance to share ideas and experiences, decompress, share grievances and anguish, and celebrate together as a workgroup, they work together better and are more productive. People with lived experiences and family engagement leaders who are integral to transformation efforts also need to be supported as valued and equitable members of health care teams and compensated adequately.

• Integrate reflective and anti-racist practices.
  
  B. Danielson: We need to reflect on how we spend time engaging those most impacted by racism, bias, oppression, and inequities to understand their perspective. This can show us not only where our greatest influence can be had and what kind of work needs to be happening, but also to be our reflectors of whether or not we’re making progress, really allowing the communities most impacted to co-design solutions, be partners in the work, and be the judges of the progress we hope to be making. Is this policy, practice, or decision adequately informed by those who’ve been most impacted by racism? Are there unintended consequences to consider or be measured against? These questions can help anti-racism become the norm and be put into practice.
  
  R. Boynton-Jarrett: To truly integrate anti-racist policies and practices into child health care, we have to be committed to measuring and evaluating the strength of these policies and impacts to gauge systemic, institutional, and interpersonal racism in the same way we measure and value things like billing and other measures. We need to integrate policies in a way where there is tremendous curiosity about what the experience of racism looks like in medical care and how it shows up. Those who experience the brunt of those experiences can best describe what reinforces racist actions and outcomes, and what uplifts equity and dignity.

• Reimagine a new child health care system.
  
  R. Boynton-Jarrett: To me, transformation means being brave enough to reimagine a fundamentally different health care system that centers on the needs and well-being of children. We desperately need imagination to think of something truly different. Our current health care system was built in a context of structural racism. If we can acknowledge that history and how it exists in our contemporary reality right now, it becomes essential for us to fundamentally reimagine what equity would look like. Transformation means building a new system designed by those who are being served by it.
  
  B. Danielson: There are two fundamental components to reimagining a new child health care system. We need to deconstruct the systems that have been historically racist so we can advance child health for those across a spectrum of demographics, lived experiences, and socioeconomic status. But we also need to construct and imagine something new with those at the center for transformation to really be effective.
  
  We can ask ourselves things like, what does it look like to experience the kind of health care transformation that promotes joy, wellness and self-care; that is intentionally built to holistically support parents, caregivers, and families; that takes the experiences and perspectives of children and youth deeply into account; and that celebrates the individual needs, lived experiences, and the varied cultural norms and practices that connect across generations?

Looking Ahead

Child health care transformation efforts are underway in many pockets across the U.S., with dedicated providers and health care systems, family engagement leaders, organizations, agencies, and communities working towards that each day. With recommendations in hand, it will take concerted efforts as well as support from implementation partners to help foster co-creation and co-design with families and communities and to drive policy improvements and spread innovations that can yield sustained investments, greater shared accountability, and more equitable systems. To learn more about efforts in the field, including practical steps to get started and to sustain transformative work, check out the Child Health Transformation Resource Center, an online compendium that contains curated articles, implementation tools, briefs, and other products developed by experts across sectors.