Closing Gaps in Literacy, Equity, and Access

More than 1.5 billion students worldwide have experienced school closures because of the pandemic, including at least tens of millions in the U.S. These interruptions have caused irreversible consequences for school-age children, particularly in Black, Latinx, and Indigenous communities. The pandemic has also shone a harsh spotlight on how systemic inequities compound educational inequity. 


The pandemic is deepening the educational divide, jeopardizing the ability of children to learn, grow, and access equal opportunities in education. Immigrant families and families of color in under-resourced communities with children 0-5 years of age will bear the brunt of the pandemic's toll on educational opportunities and learning. When coupled with inequitable access to health care, income inequality, high unemployment rates, food insecurity, and homelessness, the loss of educational opportunities puts these children at a significant disadvantage as they start kindergarten. 

Emerging evidence shows how the pandemic negatively affects the academic growth of many students of color, widening pre-existing disparities. According to the Annie E. Casey Foundation, children who are not reading proficiently by the end of third grade are four times more likely to drop out or fail to graduate from high school. 


Focusing on literacy in children's earliest years is essential. Literacy is a developmental process that begins in infancy. Early literacy can positively shape a child's trajectory, improving school outcomes and long-term economic stability, health, housing, and social opportunities. Still, literacy is easily overlooked as a necessary intervention when working with underserved communities dealing with more immediate health-related social needs like food and housing.   

Pediatricians and other staff in the primary care practice can be effective partners with families in developing proficient literacy skills and supporting children in becoming lifelong learners. The American Academy of Pediatrics (AAP) recommends literacy promotion in primary care beginning as soon as possible after birth, stressing the central role of the pediatric provider in school readiness. The AAP also recommends 14 well-child visits by a child's 5th birthday. During these visits, pediatric providers can introduce children and their caregivers to the benefits of participating in an emergent literacy program that might be integrated into the practice or available through trusted partner organizations in the community. Pediatric providers can educate caregivers about the impact reading has on their child's future success in language development, reading ability, writing, and overall learning. Pediatric providers can also model positive engagement between caregivers and children, providing examples of how parents can support infant learning by listening to voices, watching facial expressions, using sounds and patterns, as well as reading, talking, and singing to children. 

When caregivers are introduced to the idea that literacy begins at birth, they can learn ways to engage their infants and seek out emergent literacy programming. When pediatric primary care practices engage caregivers, reading, language comprehension, and word recognition become part of routine practice between well-care visits. Through these early experiences, both pediatricians and caregivers can help prepare children for lifelong learning and success. 


Not every pediatric practice has the strategies and tools needed to integrate an evidence-based literacy model as an essential component of care for children ages 0-5 years. A targeted focus on practices within community-based health clinics in neighborhoods with high rates of families experiencing homelessness, underserved immigrant families, and low or inadequate literacy rates is vital. But it takes time and effort to identify and incorporate strategies that are proven to have positive long-term effects on the lives of children.

We need a collaborative approach to promote innovative thinking about embedding emergent literacy programs in pediatric practices. This will enable them to strategize, develop, and learn how to implement an early childhood literacy intervention to encourage young children's literacy development and reading readiness. We also need to identify and nurture pediatric literacy champions who can carry these programs forward and sustain them.

For this reason, the United Hospital Fund is launching a new project to tackle this important issue. Our goal is to promote pediatric literacy in primary care, quality improvement plans, and systems improvement, and to advance intentional policies and practices that enhance the integration of literacy as one of the frequently overlooked social determinants of health. 

There is a lot of work to do to enhance early literacy in under-resourced communities. This cannot be achieved unless we increase awareness and access among pediatricians. 

Let's also challenge ourselves to consistently apply a racial equity focus to ensure that all children have an opportunity to reach their fullest potential. We cannot allow our children to fall further behind in literacy. 

Denise Arzola, LCSW, is the director of Clinical-Community Partnerships at UHF. 

United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. Today’s commentary from UHF’s Denise Arzola looks at how pediatric providers can help improve children's literacy. – UHF President Tony Shih

March 24, 2022
Focus Area
Clinical-Community Partnerships
Children's Health Initiative