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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health
to contribute to the family’s economic situation and, eventually, to the support of their aging parents. There was little collective commitment to the provision of education or services to improve health and only limited knowledge of the environmental factors that influence healthy development. Modern societies generally have less urgent need for children to enter the workforce, and the technological age demands a longer period of schooling and greater skill level from its workforce.
Awareness of and commitment to protecting the health of children and to their nurturance has increased in recent decades (see Zelier, 1994). Observational and empirical research in the 20th century, led by individuals such as John Watson (behaviorism), Arnold Gesell (maturational stage theory), Sigmund Freud (psychoanalytic theory), Jean Piaget (cognitive development theory), Erik Erickson (psychosocial theory), John Bowlby (attachment theory), Urie Bronfenbrenner (ecological theory), and Arnold Sameroff (transactional theory), created the concepual basis for understanding the cognitive, emotional, and social importance of childhood and the roles played by both family and societal forces.
The social transformation of childhood in modern societies reflects a retreat from the view that parents have full and unlimited jurisdiction over their children to one in which the welfare of children is increasingly understood as a shared social responsibility which requires investments in education, health care, and other institutions. At the same time, there has been a growing body of evidence that children’s development is influenced both by their families and by the social forces and cultural norms that society produces. Thus, children’s health, development, achievements, and social attainments have come to require the interest, guidance, and protection of both families and society—not just for the intrinsic value of children but for society’s collective future. This view of childhood is embedded in the very foundation of such social institutions as schools and the health care system, which play important roles in preparing children for the challenges of modern times and ensuring that, as they grow and develop into adults, they are prepared for life in an increasingly complex world.
From a public policy perspective, this emerging view was crystallized in the major social changes that took place in the 19th and 20th centuries and was manifested in national policies for providing health care to indigent populations, free and compulsory public education, mandatory immunizations that both protect individual children and provide group immunity against widespread epidemics of infectious diseases, policies for protection of the welfare of children, and the creation of the juvenile justice and child welfare systems (Katz, 1997; Cravens, 1993; Levine and Levine, 1992).
In the United States, these policies resulted in the creation of the Children’s Bureau in 1913, which later evolved into the present-day Maternal and Child Health Bureau (Hutchins, 1997); a federal agency to oversee education; later the establishment of the National Institute of Child Health and Human Development; and the creation of subsidized health care benefits for particularly needy