Pediatric Vital Signs: An Initiative to Protect the Health of Every Child and Improve the Future

Children’s health is part of current population health and impacts future population health, economic productivity, and national security as children age into adulthood and intergenerationally as they become parents.¹ According to data from the 2022 National Survey of Children’s Health, more than 40% of US children aged 0 to 17 years—representing almost 30 million children—had at least 1 current or lifelong health condition.² If undiagnosed or untreated, these health conditions can result in long-term morbidity and mortality. Recent trends in children’s health suggest cause for concern and the potential value of public health action. In 1999, 10.6% of US high school students were considered to have obesity based on self-report via the Youth Risk Behavior Surveillance System (YRBSS); that percentage increased to 16.3% in 2021.³ Using the same data source, the percentage of US high school students who reported having seriously considered suicide in the past year ranged from a low of 13.8% to a high of 20.5% between the years 1997 and 2019 and was 22.2% in 2021.³ Early health habits and good mental health can facilitate healthier adulthood and, in turn, healthier children and families.¹ 

Estimates that were only recently available from national data collection efforts do not allow for trend analysis but offer a baseline against which to compare future trends. Data from the 2022 National Survey of Children’s Health indicate that fewer than two-thirds of US children aged 3 to 5 years (63.6%) were “Healthy and Ready to Learn” according to the Title V National Outcome Measure for School Readiness.⁴ Data from the YRBSS indicate that in 2021, 30% of high school respondents reported ever having had sexual intercourse, and 13.7% of those adolescents reported that they did not use any method to prevent pregnancy during their last sexual intercourse with an opposite-sex partner.³ These national estimates of children’s health mask differences based on characteristics such as demographic factors (eg, sex, age, race, ethnicity), socioeconomic and family factors (eg, household income, number of parents in the home), neighborhood factors (eg, number and type of available community resources, neighborhood safety), and geographic factors (eg, rurality). Public health partnering with health care⁵ has potential to unpack these characteristics and focus interventions on populations most at risk.

The 6 initiatives documented in this supplement not only reflect health topic–specific interventions but also may be an example of an emergent Accountable Community for Health (ACH), specifically focused on children’s health.⁶ Little empirical evidence exists to understand the critical components of an effective ACH. In a 2016 simulation study, Homer et al⁷ estimated the effects of combined investments to deliver higher-value health care, reinvest savings and expand global payment, enable healthier behaviors, and expand socioeconomic opportunities by a regional health system–driven collaboration with public health, communities, and private entities. The results estimated a 20% reduction in severe chronic illness, 14% lower health care costs, and 9% improvement in economic productivity over a 25-year period from 2000 to 2025. The study authors questioned whether there are US regions where a critical mass of organizations is committed to make such investments together. The 6 initiatives documented in this supplement suggest that Columbus, Ohio’s Pediatric Vital Signs (PVS) initiative may be an example of that commitment.

Comparing the Ohio PVS initiatives with components examined in Homer et al,⁷ all 6 initiatives include evidence-based policies and programs to either enable healthier behaviors⁸ or expand socioeconomic opportunities,⁹ or both.^10–13 All 6 included community engagement¹⁴ and included partnering with health care and/or activities to deliver higher-value health care. More specifically, most included efforts to deliver higher-value health care through provider training related to evidence-based guidelines and practices, with some also addressing quality of care through activities beyond the primary health care providers, such as videos that can be shared with families and community health workers to connect families with services,¹⁰ kindergarten readiness coordinators,¹¹ and text messages.⁸ Initiatives also sought to improve quality of care through components involving care coordination and patient/family-centered care practices.^8,12,13 

The fourth component in Homer et al⁷—reinvesting a negotiated fraction of health care cost savings and move to global payment—was not apparent in these articles, although the articles do mention braiding funding from public, private, and nonprofit sources. Efforts to address the long-term stability aspects of accountability measurement systems and shared risk^1,5 to promote efficient use of resources might simply not have been mentioned in the articles or might be an avenue that regional health collaboratives such as Ohio PVS could investigate, in line with calls for a focus on sustainability to support long-term health impact.^1,5 

Taken together, the interrelated set of health topics and interventions in this initiative have the potential to be a mutually reinforcing system over time. For example, the initiative in Chavez et al⁹ to increase the use of Earned Income Tax Credits (EITCs), which specifically has documented associations with reduction in low birth weight,¹⁵ higher children’s achievement test scores over time,¹⁶ lower children’s behavior problems including depression and anxiety,¹⁷ and preventing adverse childhood experiences (ACEs)¹⁸ that are associated with long-term health issues. Data from the Quebec Longitudinal Study of Child Development indicate that children with higher receptive vocabulary and math skills in kindergarten have better dietary and physical activity habits in fourth grade.¹⁹ Evidence-based home visiting models—selected in this initiative to help reduce infant mortality¹⁰—may also affect child cognitive outcomes (eg, kindergarten readiness) and maternal life course outcomes (eg, repeat pregnancies among adolescent mothers).²⁰ Evidence has linked teen pregnancy to infant mortality²¹ and kindergarten readiness.²² Positive outcomes from a single intervention for one health area could thus have additional impact in one of the other health areas over time.

Other strengths of these initiatives include identifying priority health topics based on national and local data, and attention to progress and outcome monitoring within a learning network. Future evolutions of this initiative—and perhaps similar initiatives that could also be anchored in children’s hospitals²³ across the United States—could incorporate data sharing to support continuous quality improvement toward achieving health goals. Future efforts could also be expanded to include other significant and related public health issues for children and adolescents, such as promoting optimal development and preventing developmental delays to support domains of kindergarten readiness beyond literacy,²⁴ promoting physical activity in schools,²⁵ additional approaches to preventing ACEs,²⁶ and promoting child and adolescent mental, emotional, and behavioral health.²⁷ Additional approaches and interventions could be integrated to further leverage the implementation opportunities created via these initiatives—for example, expanding beyond EITC to expand to other benefits with documented associations with child poverty and health such as Supplemental Security Income for children with disabilities in families with low income.²⁸ In addition to the responsibility and honor of caring for children given their dependence on adults, investments in children’s health can have long-term payoffs to the nation. A 2023 Congressional Budget Office analysis of the fiscal effects of Medicaid spending concluded that such investments in childhood health increase earnings in adulthood, with those higher earnings suggesting greater tax revenues and lower transfer payments in the future.²⁹ 

The articles in this supplement represent coordinated investments in children’s health that capitalize on data, mutually reinforcing evidence-based interventions, continuous quality-improvement processes, shared investments, and multidisciplinary collaboration and community engagement, over and above the publicly funded health services available to eligible children in the communities served. As such, the Ohio PVS initiative may offer a view into new best practices for protecting the health of every child and improving the future of the nation.