Healthy child development that results in educational and social success similarly involves the same set of points, particularly when social institutions are defined to include schools and their educational components. These points provide the basis for that common etiology to achieving both good child health and healthy child development.
In the United States, the first two points on this list generally are considered to be subject to influence by the health care system through the primary pediatric practitioner. The last four points generally are considered to be primarily influenced by the child’s family and community and their network of supports, with some role from public health on environmental health conditions, a role for schools for educational development, and a role for law enforcement for public safety.5
This paper argues that such distinctions and segmentations of responsibility can miss opportunities for addressing child health disparities by race and ethnicity. In fact, child health practitioners6 and their institutions can play a contributing role in supporting child health and healthy child development across all these points. As an example, Figure 3-2 shows that when the pediatric practitioner’s role is broadly defined and practiced, the set of healthy child development outcomes that should be at least partially addressed through well-child care for young children involves identifying potential concerns on all these points and at least beginning to address them.7
Defining child health and the responsibilities of the health care community broadly is particularly important in distressed or vulnerable neighborhoods, where child health outcomes are poorest and where children of color disproportionately live.8 While there is a limited clinical research base regarding the effectiveness of more holistic pediatric approaches to healthy child development, there is also little within current research to indicate an inability to develop such pediatric practice.9 Further, there are promising programs with evidence of success in improving health outcomes and reducing disparities that deserve attention and support, particularly as they connect children and families to other community-building activities. Two such programs—Help Me Grow in Connecticut and the Eastside Partnership for Families in Richmond, Virginia—are described as examples of exemplary efforts to combine clinical practices with community-building ones. Linking clinical practice with community-building efforts offers promise in both improving child health and children’s healthy development, but requires explicit attention to the role that child health practitioners should play in supporting other organizations in leading community-building efforts. Expanding the knowledge and practice base on effective strategies that combine clinical and community-building strategies also requires evaluation approaches that extend beyond traditional clinical trials as ways to attribute causality and measure impact.