oriented services include those that are provided in clinical encounters and ambulatory care settings (e.g., acute medical care), as well as those that are provided in hospitals (e.g., emergency services). Long-term, home, and community-based care includes community-based rehabilitative services designed to restore function (e.g., physical therapy), as well as habilitative services designed to maintain the development of function (e.g., speech or language therapy for children with language impairments).

Research is warranted to tease out the role that a range of services play in mediating and modifying influences so children can stay healthy, as well as supporting and promoting their optimal health. Improved specification of the effects of services, better targeting and customizing of services for specific populations, and improved monitoring of the effect of specific services on population health measures should be considered important research and analysis priorities.

POLICY

The health of children in the United States is affected by laws, rules, and regulations developed at the national, state, and local levels. These governmental actions determine the availability of publicly supported services and often regulate the provision of privately administered services. They are integral to how communities operate.

Policies directed specifically at health or health care services, such as eligibility for publicly funded insurance (Currie and Gruber, 1996a) or requiring a child to be immunized prior to starting school (Briss et al., 2000), have both intuitive and documented effects on children’s health. But many improvements in children’s health over the past century were also influenced by policies in areas other than health. Prominent examples include improvements in children’s health as a result of the decision to include vitamins in food products (e.g., vitamin D in dairy products and folic acid in cereals and breads) and fluoride in drinking water (Centers for Disease Control and Prevention, 2001); drinking water and food quality standards (Environmental Protection Agency, 1996; Perdue et al., 2003); educational and child care standards and programs (e.g., the Individuals with Disabilities Education Act); and environmental emissions and engineering safety standards (Perdue et al., 2003).

Innumerable serious injuries and deaths have been prevented by traffic safety standards, such as car seats and speed limits (Sleet et al., 2003; Farmer et al., 1999), consumer product safety standards (Sleet et al., 2003), and such building codes as requiring fencing around swimming pools and safety protections on high-voltage electrical equipment (Stevenson et al., 2003).

The policy environment also affects children’s health in less obvious ways. For example, welfare policy decisions play a role in families’ SES and even child achievement (see discussion below), and education policies play a role in the availability and quality of schools in a given community (Chase-Lansdale et al., 2003).



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