The Urgency of Childhood
I’ve raised four children, including a son who died in an accident—and I’ve loved every moment shared with our seven grandchildren, though the oldest of them endured and is recovering from a brain tumor. My son’s death was an unspeakably tragic accident, my grandson’s illness a terrifying encounter with an unavoidable disease.
But, unlike so many of the families I’ve seen in my career, I’ve never had a child or grandchild who will not be able to live a full and successful life because of barriers related to the income of his or her parents, the color of his or her skin, the gross inadequacy of his or her school, the inaccessibility of decent health care, or the consequences of heartless, shortsighted, or stupid government policies and spending priorities. These perspectives mark the core of my personal mission, based not on making every child “equal” but on the struggle to create equitable opportunity for all children to attain and sustain well-being.
Several of my grandchildren, including eight-year-old Naomi and fourteen-year-old Mia, asked me why I was writing this book about children, secretly hoping, I suspect, that they would be the central characters. They aren’t, though it would be fair to say that my children and grandchildren—and yours—collectively have an enormous stake in the central questions this book explores and the challenges that need our urgent attention.
It boils down to this: Too many children in America (and around the world) live under conditions that threaten their abilities to achieve successful and fulfilling lives. This is an indisputable reality and a problem that, if left unresolved, reflects a moral failure to value and respect the aspirations of children and families. It also suggests a terrible misunderstanding of what it takes for any nation to remain economically viable and internationally influential.
During the 1970s, early in my career as a pediatrician and social justice advocate, America seemed deeply preoccupied with the overriding issues of the day, from the war in Vietnam to the toxic political environment of the Nixon administration. It never occurred to me that certain obvious truths about our basic values, like eliminating disparities and erasing all remnants of racism, would be such a hard sell in our nation—not here, where we still saw ourselves as the leading world power and the principal global purveyor of democracy, human rights, innovation, and economic strength.
Prior to the utter failure of America’s military intervention in Southeast Asia and the big reveal about what was actually being perpetrated by Nixon and his administration, perhaps we allowed ourselves an inordinate level of national hubris that, looking back, seems, at the very least, naïve. We were struggling to understand, through a dense cloud of tragically misunderstood geopolitical realities and deliberate purveying of misinformation, what we were actually doing in Vietnam. We still bore the social wreckage of two centuries of American human and civil rights atrocities, and we still actively grieved the unbearable assassinations of John Kennedy, Robert Kennedy, and Martin Luther King, Jr.
But what has eluded me then and now—a half-century later—is why we still seem unable to understand what children need and how they perceive their own futures, and still seem incapable of making sure that every child has a reasonable pathway to a successful life.
Creating pathways for children to realize their dreams requires a clear understanding that every step of the process is fragile. On some level, this general understanding applies to every child, regardless of socioeconomic standing. It’s just far less problematic when children are raised in environments of adequate resources, appropriate and timely access to needed services, and positive parenting strategies. It’s not as dire even for children raised in poverty who happen to be inherently resilient, especially when internal resiliency is reinforced by a parent or other adult who can serve as a buffer against adversities that otherwise surround them.
But for all children, the laws of development are timely and essentially inviolate. From the moment of conception through adolescence, a varying combination of physical, biochemical, genetic, emotional, and stimulatory conditions affect the growth and development of a person’s brain. The conditions at any given moment along the complex course of human development ultimately influence a person’s capacity to think, function, process information, learn, and stay physically and psychologically healthy.
Once conceived, as the progression from embryo to fetus to viable infant unfolds over a typical 280-day course of pregnancy, the brain and nervous system, along with other body systems, organs, and physical dimensions begin to take shape as an array of controller genes mediates the precise order and pace of development.
The process continues in an orderly timeline, including in the first few years of life when brain growth is rapid and critical. Language absorption is key—and it must happen at a certain point in development if children are to be optimally ready for social interaction, reading, and comprehension at the appropriate times. It is clear now that the number of words spoken to infants and toddlers of families living in extreme poverty are millions fewer than those typically heard through conversation and reading to babies and young children in more affluent households. This disparity makes a difference in learning readiness in early elementary grades. Healthy emotional and social development is also on the line. At certain moments of brain and neurological development, young children learn to “self-regulate” emotional responses and reactions to external and internal stimuli.
Once in preschool and through the early years of elementary education, the progression continues. Ideally, children are taught new skills at developmentally relevant points of readiness. There is an ideal window for learning to read, for instance, when the brain’s readiness is at an optimal state. The same goes for developing computational skills.
It is worth remembering, too, that new skills build on those already acquired. Hearing words, lots of them and repeatedly, is a precursor to learning to read most efficiently. One step follows the next.
Nobody gets to be a paleontologist or a marine biologist without getting through middle school. People can’t function in college if they don’t reach an acceptable level of language and math skills via a successful high school experience. Peeling back a few layers, if children aren’t prepared for kindergarten, they are likely not to be reading at grade level when they reach third grade. And that is an early indicator that graduating from high school on time is potentially unlikely.
No matter how poor and marginalized they may be, children dream and aspire. Our job, whether as parents, teachers, doctors, policy makers, or, I would say, voters, is to make aspirations realizable for every child. That’s sometimes a very tough assignment in the inner cities or in the myriad of other communities in America’s urban and rural “opportunity deserts.”
This book is about why this is so and why failing to recognize and secure the aspirations and well-being of children may have irreversible consequences for America and the planet.
Yes, I know and fully appreciate that there are other, dire challenges facing our future. Drastic action to slow climate change, for instance, is for many people the first and foremost priority for every government on the planet. I don’t argue with that. The hard truth is that securing a productive, safe, and peaceful future for the planet demands the capacity to deal with more than one challenge at a time.
Persistent racism, extraordinary poverty, epidemics of preventable disease, outbreaks of genocide, threats to planetary biodiversity, unfulfilled rights of women and members of the LGBTQ community, an unjust criminal justice system, the rise of violent terrorism, and a host of other challenges confront many other nations on the planet, from the most to the least developed. Each of these issues deserves intense focus and attention.
But what should be well understood is that the failure to secure the future of children, the inability to make sure they maximize their full potential, and a blasé unwillingness to do whatever it takes to provide a clear trajectory for every child to express and fulfill his or her aspirations will spell trouble for America by the middle of this century. This is because each child who does not reach his or her potential must live with serious challenges that could have been prevented or mitigated. These conditions lead to the need for remediation and, far too often, involvement in the criminal justice system. In many cases, there can be a measurable impact on lifelong productivity and aspirational fulfillment of adults who have had avoidable struggles from infancy though adolescence.
The statistics speak for themselves. For a child born today, the probability of a white male’s ending up incarcerated is one in seventeen. But for a Hispanic male child, the chances are one in six, and, particularly disconcerting, a male African American infant born today has a one in three chance of ending up in prison.1 And, as I discuss further later in the book, while high school graduation rates are generally improving and stand at more than 83 percent of all students in 2015, only 70 percent of black children graduate on time.2
There’s another point worth mentioning. In order to get beyond slogans, political pandering, and clichés like “Children are our most valuable resource” or, my personal favorite inane fluffery, “Children are our future,” we have to assume a far more specific strategic posture. Those who aspire to advance the prospects for children and family issues must leverage politics, public opinion, and resources with the persistence and urgency we regularly see on behalf of big pharma, the real estate industry, hospitals, and the like.
The work to ensure the health and well-being of children is serious, grown-up business. We need heartstrings to be tugged by the folks who work on the front lines of caring for children in need. We certainly need calls for compassion and charity. But we also need the hard-core, take-no-prisoners types who demand that those empowered to determine priorities and allocate resources understand and respond to the needs of children.
This book focuses on a single theme, an overriding societal goal: fulfilling the promises and potential of all children. My own life experiences have been eclectic, at times driven by serendipity and other forces I may or may not fully understand. But I have seen many children in many environments, too many under circumstances that not only threaten their potential development but actually threaten their literal survival.
That is why the work of protecting children involves a wide, some might say overwhelming, range of concerns, from children in poverty without access to decent health care or good education, to children who have been physically or psychologically abused, to children vulnerable during and after a major disaster, to those who end up in the pediatric intensive care units and those who might have needed advanced medical care where none was available.
Throughout the book you will be introduced to many of the children I have met in my work over the past four decades, but especially those I have encountered through the Children’s Health Fund (CHF), the organization that Paul Simon and I, with the invaluable help of Karen Redlener, founded in 1987. CHF provides more than 260,000 health care visits each year, mostly in unique mobile child health clinics serving vulnerable children and families in some of America’s most economically disadvantaged urban and rural communities. I think you’ll understand why I love these children and the futures they envision, but fear the barriers that impede their abilities to achieve their perfectly reasonable dreams.
I should point out that while we will spend time getting to know some extraordinary children who dream big but face obstacles that seem—and, too often, actually are—overwhelming, we will also meet other children who make it through the challenges in spite of growing up with serious adversities.
In addition, this book shares some of my own—let’s just call it like it is—“unusual” personal and professional experiences which, collectively, may shed some light on how I came to a point of chronic frustration about how long it’s taking us to understand how important it is to care for children and their futures, yet still remain optimistic and energized about what can and will be done going forward. I’ll leave it to you to decide if having dinner with Fidel Castro before touring Cuba’s health care system, sitting across the table from Michael Jackson as he ranted about a song he didn’t write, or traveling with presidential candidates on the campaign trail is relevant to the bigger story about children and their prospects for a well-lived life in America.
I do know that the years spent practicing medicine in a poverty-stricken, racially torn Southern county and in the homeless shelters of New York City, and my work with badly abused children and those caught up in terrible natural disasters, have added, one after another, to my personal gestalt—every experience in some way irrevocable and contributing to my particular take on our societal priorities.
One of the biggest challenges in writing this book was figuring how, perhaps why, to include the autobiographical elements found herein. I felt from the outset that understanding something of my own roots would help me understand for myself, if no one else, what made me so driven to deal with inequities, with social justice, with persistence in the face of adversity. So I went back to some very early experiences that ultimately helped define my worldview as I found my way into adulthood. It was, in fact, these accumulated experiences—in childhood, during my training, and throughout my career—that have in many ways shaped me as a physician, but mostly as a human being struggling to find meaning and purpose.
I recently asked my dear friend Dr. Jack Geiger—one of the world’s leading public health activists—if he recalled any instances from his childhood that could have influenced his perspectives as he grew and developed. Just shy of his ninety-first birthday when we spoke about this, Jack responded immediately, recalling an incident that occurred when he was five years old. Walking with his mother on Manhattan’s West Side, he encountered a man selling apples from a pushcart. Jack asked why he was doing that, and his mother gave him a five-year-old’s version of the Great Depression, talking about the many people who had lost their jobs and had to do whatever they could to make sure they had food for their families.
Jack asked his mom to buy some apples; she refused, saying they didn’t need apples. Jack, distraught, said, “We have to do something.” Breaking away from his mother’s hand, Jack ran over to the apple seller, pulled a nickel out his handkerchief, and gave it to the man, explaining that was all he had.
That’s what stayed with Jack for the next eighty-six years: something is not right, I need to fix it. That’s the story of Jack’s life and, as far as I can tell, mine too.
I am determined to leave you feeling optimistic about the future. There is indeed much that can be done by government, parents, and any citizen who wants to understand how investing in children now will increase the chances of securing America’s future resiliency and prosperity. These prescriptions will be described in the final chapters as a reminder to all of us that fighting for children is anything but a lost cause. And nothing could be more important.