ABSTRACT | Children’s development of cognitive, affective, and behavioral capacities is best promoted when the contexts that surround them are strong and healthy. Children are embedded in families, who are, in turn, embedded in communities. Policies or programs that strengthen families and communities by addressing the social determinants of health also promote children’s healthy development, and ultimately national prosperity. We provide examples of housing, education, and income policies that address the social determinants of health. We suggest that their potency is augmented when they also strengthen the collective efficacy of families and communities, thus laying the foundation for children’s long-term, healthy development. We urge a concerted focus on these broad social policies as a key component of any children’s health policy.
Introduction
Federal and state policies that invest in families and strengthen communities create the enabling conditions for child development and, by extension, our nation’s prosperity. These policies can directly target children (for example, the Children’s Health Insurance Program [CHIP] and the Early and Periodic Screening, Diagnosis, and Treatment benefits under Medicaid), or they can indirectly support families and communities (for example, through income support programs or housing policies). Child-focused policies such as CHIP raised the standard for children’s health care coverage, and consequently 95 percent of children nationally now have public or private health insurance [1]. Yet, critical as these policies are, we argue in this paper that children’s development of cognitive, affective, and behavioral capacities requires more than investment in programs directly targeting children’s health.
Children’s development is best promoted when, in addition to these direct investments, policies and programs that strengthen families and communities are supported. Children are embedded in families, who are, in turn, embedded in neighborhoods and communities. Consequently, policies or programs that strengthen the ecologies of children—i.e., their families and their communities—also promote children’s healthy development. Policies and programs investing in family and community are often more cost-effective than services provided only to children, because they affect a broader population of children and the adults in their lives, and are more likely to have longer-term effects. Strengthened family and community contexts increase the capacity for community cohesiveness, thus activating a sense of meaning and purpose. This process, called collective efficacy, can be a lens through which to assess the contributions of federal and state policy investments, even when those policies do not directly target children. We use this lens to review major federal and state policies targeting social determinants of health, and the evidence regarding their effect, and describe how these policies and programs can strengthen family and community agency or purpose, and therefore can influence children’s development.
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