Although many policies affect children’s health, most are developed and implemented without formal consideration of their effect on children. It is beyond the scope of this report to provide a comprehensive review of all policies that have had an impact—or could have an impact—on children’s health. Instead, we illustrate the importance of policy with discussions of fluoridated water, children’s health insurance, and welfare reform.

Fluoridated Water

Fluoridation of drinking water has contributed to reductions in dental caries in both children and adults (National Research Council, 1993), and the Centers for Disease Control and Prevention (CDC) has highlighted water fluoridation as a significant public health achievement (Centers for Disease Control and Prevention, 1999b). Cross-sectional studies conducted in the mid-1900s showed water fluoridation to have an effect on dental caries and prompted policies to fluoridate water in many cities throughout the United States. A review of studies on the effectiveness of water fluoridation conducted in the United States between 1979 and 1989 found that caries were reduced between 8 and 37 percent among adolescents (Newbrun, 1989). There is some evidence that water fluoridation has been particularly beneficial for communities of low socioeconomic status (National Research Council, 1993; Riley, Lennon, and Ellwood, 1999), perhaps attributable to their disproportionate burden and lower access to dental care. Evidence of the effectiveness of water fluoridation in reducing dental caries has led to other approaches to introduce fluoride, including the addition of fluoride in toothpastes and topical fluoride treatment by dental professionals.

There has been some debate about whether water fluoridation increases the risk of a range of other health conditions, including cancer, osteoporosis, and Down syndrome. A review by the National Research Council (NRC) in 1993 concluded that there was no credible evidence to support these claims. The NRC is currently conducting a study to review the evidence since 1993 and advise EPA on the adequacy of its current water fluoride standards in the context of the variety of fluoride sources now available.

Health Insurance

The role of health insurance for health care access and service use2 has been a focal point of health policy and specifically children’s health policy over several


Policies focused on improving the quality of health services available to children in the United States are equally important. Because there is an extensive literature on the importance of appropriate health care treatments to improve health in the face of disease, we do not review that here, but underscore the importance of access to care based on the information that health can be enhanced through health care.

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