The social determinants of health
have been proven to place specific
populations at risk or in peril of disease and disadvantage.
Climate change is an immediate
threat to children in the United
States and around the world, making the recent decision of the administration to withdraw from the
Paris climate agreement a dangerous step backward
to protecting public health. This action signifies a
detrimental reversal in our country’s commitment to
addressing global climate change. Our children, who
are disproportionately vulnerable to the changing climate, will carry the weight of its consequences. This is
one example of a policy that can have serious negative
implications for the health of children: a new policy
determinant of health.
The fiscal year 2018 budget released by the White
House disproportionately harms children. The cuts
included in this budget to programs like Medicaid, the
Supplemental Nutrition Assistance Program and tax
credits for low-income families are so wide-reaching
and extreme that the programs would be unable to
function as safety nets at all, leaving millions of individuals, including children, without any option for
vital services like health care and nutrition.
After years of systematic federal budget cuts to children’s programs (by both Democratic and Republican
administrations), this budget further erodes key investments in programs that we know work for children
such as anti-poverty programs, pediatric research initiatives, key nutrition programs, pediatric environmental
health initiatives, health care for the neediest children
and assistance for children with severe disabilities. The
budget also recommends the elimination of programs
that have had resounding bipartisan support for decades
and made a real difference in children’s lives. This is
another series of policy determinants of health that will
have negative consequences for real lives of real people.
The Academy rejects any proposal that would roll
back progress for children and leave vulnerable families
worse off, and that’s exactly what the proposed fiscal
year 2018 budget would do. When it comes to feder-
al spending decisions, the Academy’s message to the
White House and Congress is clear: Put children first.
If health is treated as a commodity that is marketed,
produces profits and is governed by market forces,
there will be winners and losers. Both providers and
consumers are engaged in competition for access, quality and price of their health care coverage. Employers
and individuals are also engaged in the quest for better
quality, better access and better price. Our health is
not exactly a good or service that makes comparison
realistic. We can compare, for example, different cans
of corn at the supermarket. Individuals have one health
to maintain or lose depending if one makes the correct
or incorrect decision of provider. Not exactly an object
for which it is easy to shop.
When I think about the most vulnerable groups in
our society who must rely on the collective responsibility of government through their state and federal
legislators, I conclude that new policies are about to
determine the future of their health. As they witnessed
the ideological wars of hyperpartisan rhetoric rage in
the legislative houses to squeeze money out of one
program to pay for another or to decrease taxes to one
group and not pay for the care of their disease, their
pain and their suffering become real and they are made
to pay the consequences of this war.
For poor families who work but are underemployed,
the elderly and the physically and/or mentally challenged, better quality, better access and better care
have become like the weather. They simply do not
know what is going to happen. Their health is falling
victim to the prevailing political winds. Many in this
population are enduring health problems that are the
result of social determinants of health. The uncertainty
of where and how they will access any health care
becomes a matter of policy determining their health.
Social or policy determinants of health?
Fernando Stein, M.D., FAAP
President, American Academy of Pediatrics
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