Advocacy has been, and always will be, a defining element of pediatrics. We know that so much of what determines a child’s health happens outside the exam room and that the root causes of health – and health disparities – are driven as much by policy and politics than any other cause.

From vaccines to air quality, from seatbelt safety to smoking cessation, public health has been made better (or worse) by legislation, regulations, and policy choices made at the state and federal level. And the American Academy of Pediatrics (AAP) will work with lawmakers from any political party, at any time, to help improve the health of children.

With this framework in mind, the AAP approached its longstanding goal of advancing gun violence prevention legislation after the tragic mass shooting at Robb Elementary School in Uvalde, Texas, in spring 2022. With the testimonies of AAP President Moira Szilagyi, MD, PhD, before the House Appropriations Subcommittee and Senate Judiciary Committee, and those of more than 300 AAP members from 40 states, particularly the moving words of Uvalde pediatrician and AAP member Roy Guerrero, MD, we finally pushed major gun safety legislation across the finish line.

It wasn’t everything we wanted – legislation never is, but it was the most significant gun safety bill passed in decades. We owe a debt of gratitude to generations of pediatricians who brought us to this victory.

I remember after the Sandy Hook Elementary School mass shooting, when AAP President Thomas McInerny, MD, visited the White House and gave then-Vice President Joe Biden a copy of the AAP policy on gun violence prevention. Ten years later, President Biden signed the Bi-Partisan Safer Communities Act into law. We didn’t know it would take a decade, but we knew we would never stop fighting for it.

Those of our more senior AAP members may remember the late Julius Richmond, MD, who was on the editorial board of Pediatrics, served as Surgeon General of the United States, John D. MacArthur Professor of Health Policy at Harvard Medical School, and chaired the AAP Committee on Scientific Meetings and its Sections on Community Pediatrics and Child Development. Dr Richmond taught us that, if we are to make meaningful change, we must balance three elements: knowledge base, political will, and social strategy.

But it’s hard to rally around a knowledge base – or even a shared set of facts – in an angry, polarized political climate, with a splintered media landscape, and amid the seemingly unstoppable manipulation of public perceptions and emotions that damage social stability, reduce rational debate, and question the medicine you practice.

Pediatricians serve as the voice of science and reason and our children’s most influential and trusted protectors. Yet, this comes with a price.

Each year at our Annual Leadership Conference, we discuss, debate, and vote on the leading pediatric issues facing our diverse membership to determine our top 10 resolutions. The number one resolution at our 2022 Conference was a cry for help: a request to support pediatrician advocates experiencing adversity, stress, threats of violence, and public attacks for speaking out for the health and safety of children, the rights of their patients, and the sanctity of the pediatrician/patient relationship.

In response, the AAP will make supporting and protecting the health and well-being of our pediatricians a strategic priority.

To mitigate risks to patients and pediatricians, the AAP has filed briefs in state and federal courts, testified before Congress, and spoken out against these attacks and injustices in media interviews. We’ve joined forces with the American Medical Association and the Children’s Hospital Association to urge Attorney General Merrick Garland and the Department of Justice to investigate the increasing threats against physicians and hospitals, and we’ve called on technology platforms to do more to stop the rhetoric that has led to harassment campaigns and threats of violence across the country.

Advocating can be hard. Sometimes it can be risky. Our members have been spat upon, cyberbullied, and been victims of false, damaging online reviews.

Yet, long before there was a Yelp or Twitter, our early pediatric pioneers and advocates experienced much of the same (and even worse).

Abraham Jacobi, MD, often referred to as the father of pediatrics, was a key figure in the movement to improve child health care and welfare. Yet, his advocacy for children and the poor also brought him into conflict and danger. As a medical student in Germany during the time of the great student, worker, and peasant rebellions, Dr Jacobi was on his way to Berlin to complete his exams when he was arrested for treason. He spent two years in prison, at times in solitary confinement, until one of his captors helped him escape.

Dr Jacobi emigrated to the United States just before the Civil War, when pediatrics was considered part of obstetrics and medical specialties centered on a particular organ or technology. Dr Jacobi insisted that pediatrics should have a broader, more conceptual focus and criticized the growing practice of caring for orphans in large institutions – even condemning his own employer.

They tried to shut him down, but Dr Jacobi would not be silenced and continued to promote a model for this new field of pediatrics that involved disease prevention and social activism for children’s rights.

During this period, children were laboring in factories, mines, and industrial farming. Conditions were harsh and unsafe, and they were subjected to injury, abuse, and economic exploitation – restricting their fundamental rights and threatening their future.

In the early 1900s, after hard work by advocates, Congress passed a law with groundbreaking wage and hour limitations for child labor. But the Supreme Court struck it down. A couple of decades later, advocates succeeded again, and Congress passed another law. The Supreme Court struck down that law, too.

How dispiriting and demoralizing to go through the legislative process over and over only to have your hopes dashed by the Supreme Court.

It wasn’t until 1938 that Congress passed the Fair Labor Standards Act. And that time, the Supreme Court upheld it!

Just imagine having to wait 40 years to stop the suffering and exploitation of children and proclaim their fundamental human dignity and human rights.

Child advocacy has always been a long-run game. Though at times the path to progress can break our hearts or make us cynical, it helps to remember that, over the decades, we have made enormous gains and improvements in child health. We have immunized children against deadly diseases like polio and whooping cough, reduced exposure to lead, decreased deaths from motor vehicle accidents, improved and expanded insurance coverage and access to care, increased the survival of premature infants, and found the cure for many childhood diseases.

The going may get tough, but we’re in it for the long run.

The AAP was built for times like these – founded by pediatricians who navigated America through the 1918 influenza pandemic and cared for children despite the hardships of World War II, the Great Depression, and numerous other tragedies and disasters.

Now, the work rests in our hands. What we do is not for the faint of heart, yet it will have a lasting impact on the health and life trajectory of our nation’s youth for generations to come.

The moral arc of the universe is long, but it does bend toward justice. We must never stop believing in the power of our collective action and the science and humanity of the pediatrics profession to move us to a better future.

Adapted from the 2022 AAP Annual Business Meeting CEO Address


American Academy of Pediatrics