Starting to Solve Societal Inequities

Inequity solutions are quite easy. They are the opposite from what is going on in the United States.

It is clear that our national designs shape even better for those few doing well and worse for most Americans. Middle class income and wealth is dissolving. Higher productivity is not resulting in more income. Individuals and groups have even less standing while corporations have increased standing. 

Solutions start with the youngest humans in their earliest months and years of life – the optimal timing for multiple improvements across education, behavior, economics, jobs, and more. The United States is dead last in child well being - a wealthy nation with more than enough to invest that chooses not to invest in children. The US spends multiple times its Gross Domestic Product less for age 0 - 6 compared to other nations with best child and societal outcomes.

We must have a real war on poverty. Instead we have wars against child development, basic nutrition, basic public health, basic health services, social security, and just about every source of spending where 40% of Americans are segmented off by income, education, geographic location, school district, school funding, property value, access to decent housing…

Federal and state cuts and sequestration have adversely impacted populations furthest behind as they are more dependent upon the economics and jobs derived from government local investments.

Child development is a most worthwhile investment for the impact upon children as well as the local spending and economic impact. Other nations have a real infrastructure for child development led by professionals trained in the best child development and supported by government funding - such that universal neighborhood child development is the rule.

We invest little in care directors or personnel and there are high rates of turnover. The intensity is weak -  passive day care rather than a focus on child development. Many attempting to care for children are themselves trying to escape poverty and sometimes doing child care drags them down rather than helping them work their way out. 

We have such high costs of day care that families with two working parents cannot get ahead and single parents are really in trouble. 

Also the early childhood development sites have to spend half of their time and energy getting grants from various sources rather than spending time delivering services to children and helping to improve their parents. The entire design is not specific to the services and interactions that children need - there are too many distractions because of the design much like designs for health care delivery.

The American focus is certainly not the individual needs of the children. We do not have that design or understand this emphasis. We fail to understand that it costs not to have a parent directly involved one on one with a child. From parent time off in the first months of life until age 8 when the velocity of learning slows, America is a land of missed child development opportunities.

Many love to blast Headstart as a waste of spending. The problem is a lack of specific investment, not waste. Headstart is a failure because only 30 – 50% of the children who need a head start can go to Headstart. Those who understand education understand that the weaker children hold back class progress. When only half get a better start and they mix with the children prevented from Headstart, kids and teachers and neighborhoods have to start over at the lowest level.

What Can Be Done

Here is what the Institutes of Medicine just reported

Strategies for Scaling Effective Family-Focused Preventive Interventions  The Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health

The Cost of Inaction for Young Children Globally - Workshop Summary The Forum on Investing in Young Children Globally, which has now launched, went through a yearlong planning process with initial planning grants by the Bernard Van Leer Foundation and the Doris Duke Charitable Foundation. The first planning meeting took place in March 2013 and the second one in June…

Consider the Perry Early Childhood intervention, or

Meaningful Differences in the Everyday Experience of Young American Children


This study of ordinary families and how they talk to their very young children is no ordinary study at all. Betty Hart and Todd Risley wanted to know why, despite best efforts in preschool programs to equalize opportunity, children from low-income homes remain well behind their more economically…

The World Bank indicates 7 dollars saved for every 1 dollar invested with regard to early childhood development. 

The Rand Corporation indicated a multiplier of 1.26 to 17 with both high cost and low cost per child programs demonstrating benefits. Cognitive/Achievement, Behavioral/Emotional, Education, Home Safety, Health, and other dimensions can be addressed and a number of different interventions are available.

There are a few interventions that have demonstrated little benefit, but the overwhelming spectrum indicates multiplier effects with improvements in outcomes. Also not all of the improvements are measured. For example few studies consider the local job, income, or economic impacts. Often a focus on improved intelligence testing has prevented consideration of other improvements such as less crime, less violent crime, and better jobs. Numerous improvements could also result in better health outcomes, health literacy, and better health decisions but this is too far separated from the early interventions.

Investing time and resources in a child is what separates advantaged and disadvantaged children.

Investments can result in improvement. Cuts and lack of investment can lead to stagnation or worse - by design. 

As far as health care, health personnel arise from lower and middle income children. Better health care may be about better health personnel and this begins with better children and better patients who also had better beginnings. 

Family Medicine Needs a New Beginning

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Declines in Health Care Delivery Despite Increases in Health Spending

Perverse Health Payment Dividing US

How To Resolve Health Access for 40 States Behind By Design

Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...


Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

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