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Advocacy in Pediatrics

June 27, 2023

Commentary From the AAP Committee on State Government Affairs

The American Academy of Pediatrics (AAP) established the Committee on State Government Affairs (COSGA) in 1992 with a mission to advocate at the state level on behalf of children, AAP state chapters, and pediatric professionals. COSGA chose articles, policy statements, and commentaries published after 1992 that it believed represented seminal points in advocacy for the states and chapters.

Advocacy in Pediatrics

Pam Shaw, MD, FAAP1

Affiliation: Chair, COSGA, University of Kansas Medical Center

Highlighted Articles From Pediatrics

The first article from 1998 concerns the implementation of the State CHIP (Children’s Health Insurance Program.1 The CHIP legislation represented a significant advance in insurance coverage for children after the establishment of Medicaid in 1965. Medicaid helped insure many children in the United States, but CHIP was designed to increase the safety net to include many children who although poor did not meet the fiscal eligibility criteria for the Medicaid program. Although CHIP is a federal program, each state was allowed to design the insurance program specific for its needs, much like Medicaid. This led to a need for advocacy at the state level and local pediatrician advocacy to speak up for the patients in each state. COSGA was able to provide state-specific help for pediatricians and made a difference in how the legislation was implemented and affected children in each state.

The next publication to highlight is a commentary published in Pediatrics in August of 2003.2 The current CEO of the AAP, Mark Del Monte, has stated that “advocacy is in the DNA of pediatricians.” Dr. Oberg outlines the advocacy of yesterday, today, and tomorrow, and why pediatricians advocate for their patients. He speaks to the origins of the AAP and that the AAP was established by visionary pediatricians to advocate for our patients. An important outcome that flowed from this vision occurred when the Accreditation Council for Graduate Medical Education required pediatric residency training programs to provide “a structured education experience that prepares residents for the role of advocate for the health of the children within the community.” Many of our colleagues in training have become involved in leadership in the AAP because of their work in advocacy, and the AAP has become an invaluable partner with residency programs in providing training and opportunities for advocacy for our future and current pediatricians.

We chose as our final publication to highlight a 2016 policy statement to which COSGA contributed: “Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance.”3 Because immunization is integral to the practice of pediatrics, this policy statement regarding exemptions was relevant and important to every pediatrician in practice. As the antivaccine campaigns have blossomed across the country, the issue of nonmedical exemptions has become a vehicle that has decreased immunization rates in children in each state. Every state has a different regulation regarding nonmedical exemptions, so COSGA plays an important role in helping pediatricians and AAP state chapters advocate for immunization policies that protect children on a state-by-state basis.


  1. Committee on Child Health Financing. Implementation principles and strategies for Title XXI (State Children’s Health Insurance Program). Pediatrics. 1998;101(5):944-948
  2. Oberg CN. Pediatric advocacy: yesterday, today, and tomorrow. Pediatrics. 2003;112(2):406-409
  3. Committee on Practice and Ambulatory Medicine, Committee on Infectious Diseases, Committee on State Government Affairs, Council on School Health, Section on Administration and Practice Management. Medical versus non-medical immunization exemptions for child care and school attendance. Pediatrics. 2016;138(3):e20162145
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