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The time to act is now
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Society's Child, Janis Ian, 1967
Parallels, Yes, Chris Squire, 1977
My Silver Lining, First Aid Kit, 2014, Johanna and Klara Söderberg
In my last several columns, I have attempted to advocate for children by suggesting partnering with venture capitalists, expanding the political base for a children's agenda by the force of a human capital argument winning over previously unsympathetic audiences. Now I would like to express a profound hope that these opportunities will be soon advanced.
From the heart
Why now? Enough time has passed, too many have been harmed, and the task becomes more difficult with time. Undeniably, there is a lack of political will to transform our social contract with children. Empowering an alternative strategy is difficult. Difficult, however, is a relative term. When Janis Ian wrote the above lyrics as a 13-year-old young woman in New Jersey in 1964, interracial love was not only unspeakable, it was illegal in many states. Nothing worth fighting for is ever easy. Except, as the Yes song states, it's really down to your heart.
The problems of sustainability justice, inequality, fair access to health care, food, housing and education are at their core political challenges. While economics can delineate equations to explain human conditions, political will is required to change the lives of our children and the future vitality of our society. Our democracy is endangered by many things, though perhaps nothing more acutely than the corrupting influence of extreme wealth. Those among the top 0.1% of income who choose to are able to disproportionally influence politicians, the political agenda and the laws of the land all too often to perpetuate their privileged status at the expense of the rest.
William T. Gerson
Hedge fund operators, corporations and the superrich distorted by the power of their wallets and not the strength of their ideas” although they attempt even that by purchasing think tanks and universities. A child's needs, among other wants, are considered commodities that can be bought which is easier for those with means; the consequences of which, unfortunately, leads to increasingly separate and unequal communities.
Even the justice branch of our government disappoints. The Supreme Court has given political speech to corporations and religious freedom to companies but still no voice to children. The 11th US Circuit Court of Appeals has entered the offices of Florida's pediatricians and denied their ability to ask patients about guns, putting our children at greater risk.
The courts are not alone in their mischievousness. Few political leaders seem interested in a new agenda. Without a voice, our children are relegated to steerage class brought along for the ride and given little chance to be heard above the water line unless they misbehave or are victimized further by others.
Never too late to act
My silver lining: It is not too late. I do not paint a bleak picture because I believe there is no hope, but to express an outrage that might enlist an overwhelmed or demoralized base in a transformative agenda. Who are we as a nation? We must determine how we can recapture and reinvest in our most valuable infrastructure: our children.
As pediatricians, many of you wonder why it is our concern. We are busy surviving a suddenly changing medical landscape, in many cases fighting for the viability of our practices. Electronic health records, vaccine re-imbursement and documentation issues, expanding hospital-based networks of care, and a litany of unfunded mandates cloud our vision.
The political world is even uglier than the medical, so many may wonder why we should interject more frustration. My answer is simple. It has always been our cause. It is in our DNA. We cannot separate advocacy for children from the practice of pediatric medicine.
Once convinced of the primacy of a children's agenda, its advancement still faces significant remaining obstacles. The distorting effect of an aging population on our national budget pits generational voices in the political arena. Even if those of us closer to Medicare than day care advance a children's agenda for the sake of all of our children and grandchildren, there will be even less room in the future for discretionary spending as entitlement payments to older Americans creeps up toward 50% of the total budget.
The Urban Institute in 2012, looking at 2008 data of combined local, state and federal spending directly benefiting Americans aged at least 65 years compared with those younger than 19 years found a per capita discrepancy of $26,355 vs. $11,822. How will an enhanced children's agenda hope to compete? Who will ask for less spending for the elderly, or even more radioactive an increase in taxes?
The how and who questions are trickier than the why. What I do know is that sustainability is the next frontier. Underpinned by issues of social justice and fairness, a sustainability argument is going to be increasingly powerful going forward. A children's agenda is logically positioned at the core of any such movement. It just needs to be given a voice. That is our job.