Caring for the whole child: A new way to finance initiatives to improve children’s health and well-being

A growing recognition that socioeconomic factors affect health outcomes in significant ways is fueling new community investments and change in health care delivery systems1. Often referred to as “social determinants of health” (SDOH), these factors refer to “the structural conditions in which people are born, grow, live, work and age” that have profound implications for an individual’s overall well-being2. Addressing SDOH needs for children and their families is particularly important in light of the strong evidence that investments in the earliest years can have a potent impact on children’s development and their ability to thrive and grow to be healthier adults. Yet children have largely been left behind with respect to SDOH investments in part because the financing for these initiatives has relied heavily on the potential for a relatively short-term return on investment (ROI) for the health sector. SDOH interventions focused on children will produce health-related financial returns but typically on a longer time horizon, and they often will result in savings outside the health care sector (for example, to the child welfare system), giving rise to what is known as the “wrong pockets” problem. Given the extraordinary impact that the COVID-19 pandemic is having on the well-being of children, and most notably children of color, the urgency to act could not be more apparent.