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We need to be the voice for children on Election Day and beyond

October 1, 2024
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 “No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time.”

 – Winston Churchill

On Nov. 5, we will have the opportunity to exercise our right to vote in local, state and federal elections. While our system of government may be imperfect, it works pretty well, when it works. And we know it only works when we the people are active and engaged.

In 2023, the McCain Institute issued a Civil Society Declaration of Democratic Principles stating, “All people share an inherent right and irrepressible desire to live in freedom and make decisions about their own lives. As historical and more recent events have shown, denial of this basic truth leads inevitably to injustice, conflict, and suffering.”

As pediatricians, we bear witness every day to the ways in which injustice, conflict and suffering impact the kids, families and communities for whom we care. While threats to freedom and equity impact all of us, we know the burden of those threats is borne disproportionately by minoritized and marginalized communities. Our freedom is threatened by legal incursions into exam rooms that aim to prevent our patients from making decisions about their own lives.

While it has always been important for us to vote, this election feels different. I hope all 67,000 AAP members go to the polls and exercise their civic duty. I also hope each and every one of us is encouraging the families for whom we care and the people in our communities to support policies and candidates from the top of the ballot to the bottom that protect and advance child health and well-being (https://www.aap.org/votekids). We need to be the voice of the 22% of our citizenry who are too young to vote.

The real work, however, begins on Nov. 6. People tend to say nice things about kids and profess support for issues that impact them. Yet, the platitudes and promises often fall away when it comes to economic and policy decisions. I believe this is due less to malice than to a lack of understanding of kids’ unique needs, the unique value proposition of pediatric health care and acquiescence to the power of competing interests.

While policy advocacy often centers on federal policy, the truth is that much of what impacts kids happens at the local and state levels.

For example, a school’s discipline policy, including suspension and expulsion, is determined by the local school board, not the state legislature. Each state administers its Medicaid program, not the federal government, which means coverage in Oregon is completely different than in Texas. These and other decisions affecting child health and well-being are made at tables close to home. This is where we need to be.

Last month, I wrote about the power of our stories. There also is power in our expertise in child health and well-being. About 50% of state spending in 2021 was for programs that uniquely impact kids, including education, health and public welfare, including Medicaid, according to the Urban Institute. How many state and local elected officials understand what children need and that they are not little adults?

Pediatricians have the expertise and credibility to help elected officials navigate the complexities inherent in child policy issues. But how many of you know your state representative or senator or local school board members? Do you know when they hold office hours, town halls or neighborhood coffees to hear from constituents? They need to hear your stories and learn from your expertise. You need to be there.

We are experts in building relationships. My charge to you is to reach out to your state and local elected officials, get to know them, give them your business card and offer to help them do what’s best for kids. Imagine if state legislators knew every pediatrician in their districts and relied on us to help enact policies that were informed by our policy and practice.

We know politics only works if we, the people, vote. It will only work for kids if we, the pediatricians, are active and engaged.

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