What is health equity?

Health equity is the goal of ensuring that all people are given the opportunity to attain their highest level of health. Because early childhood experiences provide the foundation for health as an adult, health equity in early childhood is particularly important to address. Innovative and concrete steps that actively promote optimal health and development for young families, improve access to essential health care and social resources for babies, and reduce toxic stress for families can make a meaningful difference. 

What do we know about children’s health disparities in New York State?   

While there has been progress on some children’s health issues in recent years, the gains have not been shared equally across New York’s families. Data on how well our system works to give each child a healthy start in life show that communities of concentrated poverty and, in particular, communities of color often fare worse on health and developmental outcomes. These disparities are caused by factors like barriers to accessing health care and early education, racism and discrimination, inadequate maternal health care, poor nutrition, substandard housing quality and housing instability, and community violence. These gaps hamper our ability to reach the highest potential for all New York children. Although good data on child health disparities are often lacking, below is a snapshot of four commonly cited statistics on children’s health disparities in New York. 

 
PEDS Learning Network
Low Birthweight and Infant Mortality
Variation by Race

In New York City, low-birthweight babies are born to Black mothers at twice the rate of white mothers (12.6% vs. 6.3%). Despite low overall infant mortality rates in NYC, the rate for Black infants is three times as high as the rate for white infants. For Hispanic infants, the rate is one-and-a-half times as high.

Source on Birthweight and Mortality Statistics
Asthma ED Visits for 0- to 4-Year Olds
Variation by Neighborhood

The asthma-related emergency department visit rate in Bronx County for 2012–14 was three times the rate for the entire state overall. (670.6 per 10,000 vs. the New York State rate of 218.1.)

Source on New York Asthma Statistics
Child Poverty
Concentration of Poverty

While the rate of children living in poverty in New York City declined by nearly 20% since 2010, the rate went up by more than 25% in two counties, Rockland and Delaware, during the same period.

Source on Child Poverty Statistics
Adverse Childhood Experiences (ACEs)
Concentration of ACEs

Nearly 60% of New York State adults reported experiencing at least one adverse childhood experience; 13% reported experiencing 4 or more ACEs.

Source on Adverse Childhood Experience Data

What can a clinician do?

While health inequities are caused by many forces deeply rooted in society’s structures—and there is no single solution for achieving health equity—child health providers have an important role to play. Clinicians are on the frontlines interacting with young children and families daily. At an organizational level, many clinicians hold—or could influence—decision-making power related to how programs and services are structured. As trusted professionals, child health providers can also participate in broader structural change by informing policies that address root causes of disparities. 

The following list presents New York and national briefs on how clinicians can work toward health equity and promote early childhood development. 

 

Making the case for change 

This list presents New York and national policy statements and research papers that help make the case for enhancing pediatric primary care’s role in promoting early childhood development and the role of pediatricians in reducing health inequities. 

 
Building Blocks for Change
An Online Resource Center for Equity and Change

For pediatric practices looking to expand equitable practices at their facility, the PEDS Learning Network has gathered a range of online resources, arranged by foundational topic: social needs of young children and families, behavioral health screening, ways to support and partner with parents, workforce training in equity, and more. These pages include practical tips and annotated lists of resources and readings.

Sources

For more data on children’s health and the impact of social determinants of health on child outcomes, see these resources: 

  • Citizen’s Committee for Children: Keeping Track Online data portal includes the latest available measures of child well-being in NYC by community, borough, or for the entire city.
  • DiversityDataKids and its Child Opportunity Index 2.0 data sets are part of a comprehensive research program to monitor the state of well-being, diversity, opportunity, and equity of U.S. children. The data sets include socioeconomic and policy indicators on a wide range of topics. 
  • Health Data NY is New York State Department of Health’s official data inventory and houses over 40 data sets related to children’s health. Topics covered among data sets include performance on key child and adolescent health measures across managed care plans; enrollment in Medicaid and Child Health Plus; availability of Women, Infant, and Children (WIC) services; and health care utilization.  
  • Kids Count, a project of the Annie E. Casey Foundation, provides data on the health and wellbeing of children. It has national and state-by-state data sets. 
  • Public Health on Call Podcast (Episode 98): The Impact of Racism on Child and Adolescent Health. Dr. Mary Trent, lead author of AAP’s policy statement on racism and child health, in conversation with Dr. Josh Sharfstein on the ways racism undermines health over a lifetime, and how to give providers and parents alike the tools needed to address racism’s impact on the health, safety, and well-being of children.
 
"Health equity is the principle underlying a commitment to reduce—and, ultimately, eliminate—disparities in health and in its determinants, including social determinants. Pursuing health equity means striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions."
Paula Braveman, "What Are Health Disparities and Health Equity? We Need to Be Clear"
Public Health Reports 129 (Suppl. 2): 5-8, 2014.