Children’s Health and Welfare: Rhetoric vs Reality

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Image courtesy of the Barbara Bates Center for the Study of the History of Nursing

By Cynthia Connolly, PhD, RN, PNP, FAAN

Much has changed for American children during the past half century, a great deal of it for the better.  Vaccines, for example, reduced morbidity and mortality from infectious diseases such as whooping-cough, diphtheria that once felled entire communities of children.

Milk pasteurization helped eliminate the tuberculosis that crippled and killed thousands of children a year.  Improved sanitation and other public health measures minimized many other threats to children’s health.  Moreover, a veritable blizzard of medical, surgical, nursing, and pharmaceutical innovations redefined childhood as a time period in which parents expected their children to not just survive, but to thrive.  And when children did become ill, society expected that health care providers could do something about it.

Yet many of the problems children face that stymied our predecessors through the early and middle decades of the twentieth century endure.  For example, despite the fact that major federal programs such as Medicaid, Supplemental Social Security, and the Children’s Health Insurance Program were designed, at least in part, to make sure that all children could benefit from new scientific knowledge and technological advances, many still do not.  According to the United States’ Census Bureau, 8.9% (6.6 million) of children lack health insurance.

Another “old” problem that has never been satisfactorily addressed is the fear that a public investment in children undermines the American family and parental authority. The founding of the first federal agency dedicated to children, the Children’s Bureau in 1912, was mired in fears that the end result might be governmental intrusion in family life and the weakening of the parent child bond.

Excerpt from first annual report of the Children's Bureau  which pledges desire not to intrude on the lives of citizens.

Excerpt from first annual report of the Children’s Bureau which pledges desire not to intrude on the lives of citizens.

Twenty years later, the 1930 White House Conference created a Bill of Rights known as the “Children’s Charter.”  But in an effort to avoid controversy, the details for whose responsibility it was to fulfill the Charter’s “Rights of Citizenship” for children (Parents? Government? Some combination of the two?) was left unclear.  As a result, the United States was set firmly on a fragmentary path in which children and their needs were viewed through the prism of social class.  Policymakers assumed that middle and upper class children’s needs would be met by their parents and that only poor children and families should have governmental involvement in their health and well-being.

Again in the early 1970s, the Comprehensive Child Development Bill (CCDB), designed to draw together initiatives interspersed throughout the health care, education, and social welfare sectors for all children, not just those who were poor, failed. As then President Nixon argued, the legislation was a “radical”….”leap into the dark” that “commit[ed] the vast moral authority of the National Government to the side of communal approaches to child rearing over against the family-centered approach.”

Most recently, these fears resurfaced again in the context of President Obama’s call for universal preschool for all four-year olds, entitled “Preschool for All.”  Obama’s ideas were met with deep suspicion by those who believed that more governmental investments in children was not necessary because most families that could afford to do so, did not favor such a plan. Framed this way, universal preschool is not an evidence-based intervention grounded in the latest brain science as the President argued; it is an anti-family measure for all but the very indigent.

What is the right approach?  And who should decide?  Nursing, the United States’ largest group of health professionals, needs to be engaged in these debates.  And when we do, consider that this “new” idea in 2014 of preschool for all American children reflects a contemporary political and social context shaped by history.


About the Author: Cynthia Connolly, PhD, RN, PNP, FAAN is an associate professor of nursing at the University of Pennsylvania School of Nursing and a leading scholar on the history of pediatric nursing and healthcare. She holds a secondary appointment in the History and Sociology of Science department and is a Fellow at the Barbara Bates Center for the Study of the History of Nursing, Leonard Davis Institute of Health Economics, and Gender, Sexuality, and Women’s Studies Program and The Alice Paul Center for Research on Gender, Sexuality, and Women. She is Co-Faculty Director for the Field Center for Children’s Policy, Practice, and Research.

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