Pursuing a Cross-Sector Approach to Advance Child Health Equity

Corley, Alexandra M.S.; Henize, Adrienne W.; Klein, Melissa; Beck, Andrew F.

doi:10.1016/j.pcl.2023.03.008

Cited by 2 publications

(2 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are limitations to the data quality and the ability to infer causality. However, the findings are consistent with prior literature and directly inform how primary care can better support children and families for kindergarten readiness …”

Section: Discussionsupporting

confidence: 87%

Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data

Copeland,

Porter,

Gorecki

et al. 2024

JAMA Pediatr

View full text Add to dashboard Cite

ImportanceMany known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness.ObjectiveTo identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021.Design, Setting, and ParticipantsThis was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP.ExposuresExposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages &amp; Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms.Main Outcomes and MeasuresKRA score (continuous), with a possible range of 0 to 300 (passing score = 270).ResultsA total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child’s KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (−6.7; 95% CI, −7.7 to −5.6), Medicaid insured (−5.7; 95% CI, −9.0 to −2.3), Hispanic ethnicity (−3.8; 95% CI, −6.9 to −0.6), requires interpreter (−3.6; 95% CI, −7.1 to −0.1), 2021 year (−3.5; 95% CI, −4.7 to −2.3), male sex (−2.7; 95% CI, −3.7 to −1.8), ever rarely read to (−1.5; 95% CI, −2.6 to −0.4), and food insecurity (−1.2; 95% CI, −2.4 to −0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model.Conclusions and RelevanceFindings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.

show abstract

Section: Discussionsupporting

confidence: 87%

Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data

Copeland,

Porter,

Gorecki

et al. 2024

JAMA Pediatr

View full text Add to dashboard Cite

show abstract

“…I refer to this approach as 'multisector collaboration' because it emphasizes the need for different sectors in society to work together to tackle the health harms created by adverse social circumstances ('cross-sector collaboration' and 'intersectoral collaboration' are analogous terms). [6][7][8][9][10][11] A simplified depiction of the relationship among fundamental causes, superficial causes, and health is shown. Because any individual superficial cause is only one of several pathways between fundamental causes and poor health, addressing a specific superficial cause may not improve health outcomes, as the connection between fundamental causes and health can shift to other mechanisms.…”

mentioning

confidence: 99%

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

BERKOWITZ

2023

Milbank Quarterly

View full text Add to dashboard Cite

Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax‐and‐transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.

show abstract

Pursuing a Cross-Sector Approach to Advance Child Health Equity

Cited by 2 publications

References 43 publications

Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data

Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

Contact Info

Product

Resources

About