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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health
From a policy perspective, it is important to ascertain to what extent policies directed at families or adult family members, even if not explicitly targeted on child well-being, in fact alter children’s chances of healthy development. We illustrate this kind of policy analysis with the welfare reform law (the Personal Responsibility and Work Opportunity Reconciliation Act of 1996), which was directed first and foremost at increasing the employment and reducing the welfare dependence of mothers.
Evidence on the likely effects of welfare reforms comes both from random-assignment experiments and from longitudinal survey studies (National Research Council and Institute of Medicine, 2003). A key finding from the experiments is that effects on the achievement and behavior of younger children were consistently more positive in programs that provided financial and in-kind supports (earnings supplements) for work than in those that did not. The packages of work supports were quite diverse, ranging from generous earnings supplements provided alone to more comprehensive packages of earnings supplements, child care assistance, health insurance, and even temporary community service jobs. At the same time, these experiments produced evidence of negative effects on adolescent achievement across all types of programs, although a prominent nonexperimental study did not replicate the negative adolescent results (Chase-Lansdale et al., 2003). Systematic approaches to evaluate the effect of policies on children of this sort are the exception, rather than the rule, and few other systematic attempts can be identified.
This chapter provides a discussion of evidence concerning the influence of various types of characteristics on the health of children. Although imperfectly understood, the important role of interactions of these influences, which may differ in kind and amount at different ages and stages of development, is amply supported by the evidence. Notably absent from most of the discussion, however, is the relative importance of the various types of influences on children’s health at different ages. For the most part, evidence for the influences comes from studies of the relative risk imposed by them. However, exposure to influences differs in frequency from one influence to another. Influences that have a high relative risk may be of only minor importance to the health of the population of children if they are relatively uncommon. In order to understand the effect of these factors on the health of children, such information is critical (see Goodman et al., 2003).