Author Dr. Robert Saul

Raising Young Citizens in the Age of Columbine

We are failing our children – here and there

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As a pediatrician, I am deeply concerned about children.  But my concerns also relate to my roles as a father, spouse, citizen, inhabitant of the Earth and a person of faith.  My concerns have been lifelong thanks to parents (especially my mother) who emphasized our role to care for all as if they were family.  If that sounds like the Golden Rule (do unto others as you would have them do unto you), you are correct.

Unfortunately, our current administration has a new “Golden Rule” – gilding everything in sight in or around the White House in gold.  But this “Golden Rule” also ignores policies that affect children – here, in the US, and there, elsewhere in the world.  To ignore the plight of children and to establish policies that will not improve their plight and that will likely enhance their barriers to good physical, mental and social health is cruel and reprehensible in my estimation.

Numerous examples abound but let me just discuss several recent examples –

  • Here – A US health disadvantage, i.e., lower life expectancy and worse health outcomes, compared to other high-income countries has been known for some time, and in the past, was primarily an adult phenomenon. Recent analyses have worsened the picture.1,2 
    • The study by Forrest et al. compared statistics with composite data from 18 other nations of comparable economic standards – Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, and United Kingdom.
    • Unfortunately, US children’s health declined in comparison to the nations above for infant mortality, prematurity, sudden unexpected infant deaths, birth defects, firearms, motor vehicle crashes, substance abuse and homicide.
    • Chronic physical, mental and neurodevelopmental conditions were more common in US children.
    • Early menarche (onset of menstruation), early onset of puberty, deteriorating sleep health and mental health problems were also more prevalent in US children.
    • The risk of firearm death in the US was shocking. The risk in the US was 15 times greater than in the other countries.
    • An accompanying editorial to the Forrest article mentions 5 domains to consider for root causes –
      • Health care – Five percent of US children do not have insurance, and 40% have erratic care due to inconsistent coverage and care. This obviously also impacts mental health care and emergency care.
      • Behaviors and parental choices – decreased physical activity, unhealthy diet, early smart phone and social media access, and firearm access are all to be considered for public health intervention.
      • Social determinants of health3 – the non-medical factors affecting health (like income, job status, housing, education) are estimated to account for up to one-half of health outcomes. Our inability to address poverty and income equality are much more dramatic in the US.
      • Physical and social environments – the safety of neighborhoods and the environmental exposures in various places are certainly factors that affect the health differential seen.
      • Public policy – Policies in the US regarding health, firearms, early childhood education, social welfare, parental leave and wages can definitely provide some explanation as to the decreased outcomes compared to the other countries.
    • Wolf et al.2 present a dire prediction. “Without decisive action to change the trajectory, the US health disadvantage is likely to worsen.  Policymakers who are invested in enhancing children’s health must intervene.”
  • There – the current administration’s decision to withdraw support from the US Agency for International Development (USAID) is frightening in its impact and appalling in its inhumanity.4,5,6
    • USAID has been promoting US good will abroad. Our generosity is a source of pride for those in service and gratitude for those on the receiving end.  Our generosity helps our global security and our health security.  We do not live in isolation on this globe. Unrest and disease in one area at one moment in time is potentially on our doorstep hours or days later.
    • USAID has been saving lives. The global mortality rate has been halved since 2000, and USAID has been credited to reducing the under-5 yo mortality rate by more than 20 deaths per 1,000 live births.
    • USAID has had a dramatic impact on AIDS, tuberculosis and malaria, all major infectious diseases on the international scene.
    • USAID has provided significant assistance for malnutrition and potential starvation.
    • Investments in USAID have been estimated to have a significant return on investment. For example, every $1 spent on childhood vaccinations could return $16 to $44 on investment.
    • Coria et al. conclude by saying “abruptly reducing USAID operations threatens half a century of progress reducing childhood illness and death…as USAID withdraws as a foreign aid agency, we must not lose the gains achieved with its support. The global community must prioritize the health and well-being of our children.”

I contend that we are failing our children – here and there.  I realize that some will argue that this is hyperbole but those of us in the field of caring for children and families know that multiple factors are impeding our best efforts to improve the lives of all children.  We cannot accept those barriers, and we cannot accept the premise that some of worthy of support and that some are not.

The works cited above do give us a potential blueprint going forward when we get serious about really making a difference.  The five domains (health care, behaviors and parental choices, social determinants of health, physical and social environments, public policy) are tangible avenues for change for the US.  A renewed resolve for the world’s children can reverse our current debacle internationally.

One might consider that the announced “Make America Healthy Again” effort (so-called MAHA) is a good attempt to address the issues above.  I would argue that it is half-baked at best and even a cynical attempt to improve health while there are active attempts to attack the safety of vaccines.  In addition, erosion of the protections from chemicals (including plastics) and denial of the effects of climate change will have current and untold future harm on our children.7,8  Suppression of innovation poisons the entire system.9

There is only one Golden Rule and that does not mean changing the White House décor and ignoring the opportunities to improve the lives of all children.  The Golden Rule means we should be doing unto others what we would want done to and for our (all of our) children.  We cannot let the faux “Golden Rule” prevail.  We know that we can make a difference.  We should not be failing our children, wherever they are.

 

  1. Forrest CB, Koenigsberg LJ, Harvey FE, et al. Trends in US children’s mortality, chronic conditions, obesity, functional status, and symptoms. JAMA 2025;334(6):509-516. Doi:10.1001/jama.2025.9855
  2. Wolf ER, Rivara FP, Woolf SH. How we are failing our US children. JAMA 2025;334(6):491-492.
  3. https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html
  4. https://mychildrenschildren.com/voices-for-children/
  5. Coria AL, Wahl B, Thacker N et al. USAID’s role in saving children’s lives: past legacy and the future directions. Pediatrics 2025; 156(2):11-15. doi.org/10.1542/peds-2025-071260
  6. https://www.nytimes.com/2025/02/05/opinion/usaid-spending-trump-musk.html?smid=url-share
  7. https://www.nytimes.com/2025/07/29/climate/epa-endangerment-finding-repeal-proposal.html?searchResultPosition=2
  8. https://www.nytimes.com/2025/08/03/climate/trump-epa-endangerment-finding-climate-change.html?searchResultPosition=1
  9. https://mychildrenschildren.com/innovate-for-the-children/