US Children’s Health Has Declined Over 17 Years: Report

The health of US children has worsened steadily from 2007 to 2023 with higher mortality, and more chronic physical, developmental, and mental health conditions, warned a report released in JAMA.

Researchers, led by Christopher B. Forrest, MD, PhD, with Children’s Hospital of Philadelphia in Philadelphia, analyzed data using mortality statistics from the US and 18 comparator high-income nations from the Organization for Economic Co-operation and Development (OECD18), five national surveys, and electronic health records from 10 pediatric health systems (PEDSnet).

They found that from 2007 to 2022, “infants born in the US were 78% more likely to die when compared with their counterparts in other high-income countries.”

Among key findings of the analysis are:

• As of 2022, mortality rates for US infants and 1- to 19-year-olds were 1.78 and 1.8 times greater, respectively, than for those in other OECD countries.
• The two causes of death for infants 12 months or younger in the US with the largest increased risk over OECD countries were prematurity (relative risk [RR], 2.22) and sudden unexpected infant death (RR, 2.39).
• The two causes of death for 1- to 19-year-olds with the largest increased risk over OECD countries were firearm-related incidents (RR, 15.34) and motor vehicle crashes (RR, 2.45).
• A child in the US in 2023 was 15%-20% more likely to have a chronic condition than a child in the US in 2011.
• Obesity rates for 2- to 19-year-olds in the US increased from 5.2% in 1971-1974 to 19.3% by 2017-2018.
• Depressive symptoms (feeling sad or hopeless) increased from 26.1% prevalence in 9th- to 12th-graders in 2009 to 39.7% in 2023.
• Loneliness feelings among US 12- to 18-year-olds rose significantly from 20.2% in 2007 to 30.8% in 2021.

“Without decisive action to change the trajectory, the US health disadvantage is likely to worsen,” wrote Editorialist Elizabeth R. Wolf, MD, MPH, with the Department of Pediatrics, Virginia Commonwealth University in Richmond, Virginia, and colleagues. “Policymakers who are invested in enhancing children’s health must intervene.”

The editorialists noted that it has been well-documented that US residents have lower life expectancy and worse health outcomes than those in other high-income countries, despite spending nearly twice as much relative to gross domestic product than average spending by OECD countries.

Gap Seen in Adult Health Has Spread to Children

Now, they wrote, “Evidence is mounting that the US health disadvantage, a phenomenon that had been restricted to adults, has now spread to the pediatric population.”

Among the root causes of challenges to children’s health noted by the Institute of Medicine and National Research Council is poverty and the US has some of the highest child poverty rates and income inequality in the OECD, the editorialists noted.

“Poverty leads families to prioritize inexpensive calorie-dense foods that contribute to obesity and to drive older vehicles with fewer safety features, increasing crash injuries,” Wolf and colleagues wrote.

5% of Children Uninsured

Additionally, the editorial stated, about 5% of US children do not have insurance, and the 40% of US children with public insurance have limited access to primary and specialist care because of poor reimbursement rates and poor investment in primary care.

Interventions could include investing in child tax credits, broadening health insurance coverage, investing in primary care, and passing firearm safety laws, they wrote.

The editorialists wrote that while the government’s Make America Healthy Again movement draws important attention to chronic diseases and the dietary threats of ultra-processed foods, other policies “will work against the health interests of children.”

For example, in addition to proposed cuts in Medicaid in the current domestic policy bill signed into law last week, they wrote, “Budget cuts to the Department of Health and Human Services have led to the elimination of injury prevention and maternal and child health programs. The tiny investment in the Safe to Sleep campaign that addresses the primary preventable cause of SUID [Sudden Unexpected Infant Death] was canceled.”

Leslie Sude, MD, associate professor of pediatrics at Yale School of Medicine in New Haven, Connecticut, who was not involved with the report, told Medscape Medical News the decline in children’s health won’t change “until transformative, high-level changes are made to social and health policies affecting family well-being.”

Pediatricians will continue to guide families on healthy habits, she said, “but will struggle against grim realities which result from dwindling supports for low-income families, failed gun laws, and under resourced early childhood education.”

Health systems could support broader services “to colocate health promoting services within primary care centers, such as behavioral health, lactation, nutrition, and health-related social needs navigation to reduce access barriers. Health systems must advocate for policies at the highest levels for robust investment in improving the US ecosystem for family well-being,” she added.

Not Enough Services for Kids in Crisis

US children also struggle to get the mental health help they need, noted Yann Poncin, MD, associate professor and vice chair of clinical affairs in the Child Study Center at Yale, who also was not part of the study. “Data show that kids who access mental health when they need it do better. Instead, there are often wait lists.”

But there are positive developments, he added, such as states implementing crisis support services, he noted. “In addition, we as other states do, have [Pediatric Mental Health Care Access Programs], a service whereby a pediatrician can call to get help with referrals or to speak with a child psychiatrist for guidance on medications.”

He added that there are several evidence-based interventions for schools.

“Even just brief groups at the start of high school that deliver information about stressors at school and life in general can reduce signs and symptoms of anxiety, depression, substance use, suicidality,” he said.

This study was supported by institutional funds managed by the Applied Clinical Research Center at the Children’s Hospital of Philadelphia. Forrest is a codeveloper of the Johns Hopkins Adjusted Clinical Groups System, which was used in this study. The copyright for this software is owned by Johns Hopkins University. He reported receiving royalties in accordance with the university’s technology transfer policy. No other disclosures were reported. The editorialists and Sude and Poncin reported no relevant financial relationships.