Child and Family Health Research and Policy in Coming Decades; Children’s HealthWatch’s Second Twenty Years

Children’s HealthWatch was born out of concerns that policies like the Personal Responsibility and Work Opportunity Reauthorization Act (PRWORA) of 1996, the so-called “welfare reform” law, instead of improving public health or the standard of living, could cause great harm to the health and well-being of young children and their families. The pediatricians, child development specialists and others who founded Children’s HealthWatch could see the effects of family hardships “written on the bodies” of the babies cared for at each research site, and determined to try and assess the health impacts of the welfare reform law and similar policy changes.

We succeeded in determining and showing, through carefully conducted empirical research, that the punitive policies comprising PRWORA were in fact strongly connected to a great deal of harm to the health of babies and toddlers, as well as their caregivers. With others, we pioneered research on relationships of food insecurity to bad health outcomes in young children and their caregivers. We also learned early on that food insecurity is part of a constellation of family hardships that includes housing instability, household energy insecurity, and difficulties paying for healthcare and medicine. And we found that these hardships rarely occur individually, but more often co-occur, and exacerbate each other.

This led us to examine differential health impacts of multiple hardships, finding that when experienced together the hardships are related to worse health outcomes than when experienced alone. We were not greatly surprised to find that the larger the number of hardships families experienced, the worse was the health of children and caregivers in those families.

But some of us at Children’s HealthWatch, being incurable optimists, still thought and talked to each other in terms of “what if we could make things different?” What if we could change all that? What if working families didn’t have to struggle with multiple hardships? What if the young children showing up in our data with increasing frequency in families struggling to buy healthy food, pay their rent and utility bills, and get healthcare for their children and themselves didn’t live under the weight of these multiple hardships? What if instead they and their families were hardship free? What if all those children lived with parents earning living wages, able to avoid the toxic stresses accompanying poverty, and the hardships it includes? What if we honestly confronted white privilege, came to fully understand it, and eliminated racism from our society?

We realized that just saying these “what ifs?” buoyed our spirits and gave us hope. And when we forced ourselves to think through how they could be made real, all the steps that would be necessary to make each “what if” come true, all the costs and all the benefits involved, we were often shocked. What we realized was that practically all the “what ifs” could happen! It would never be easy to make them happen, and it was clear that it would be a really hard thing to make some of them happen. But when we put our heads together, and our hearts into it, we realized “We can do that hard thing!” Yes, it is a hard thing, but we can do that hard thing![i]

This process of thinking through the steps, and all the conditions necessary to make a hard thing happen, and realizing with elation that it can really happen, was the spark that caught and burned brighter and brighter, becoming The What If Project, Children’s HealthWatch’s System Simulation Project. What if we could show, using simulations, what is needed to do some of these hard things? What if we showed that the benefits of making many of these hard things happen far out-weigh the costs? And what if we showed clearly that we all would be far better off if we did these hard things together, and made success the norm for all children and their families, instead of poverty and failure?

We have completed several What If projects since we began just a few years ago, and are now working on several more, including what if we did the hard thing of making high-quality childcare affordable for all families in Massachusetts now receiving childcare subsidies? Is it possible that doing that hard thing could also help reduce rent burdens of the many families who pay as much as 50% or more of their income for rent?

We are also working on our most ambitious What If Project to date; simulating the very hard thing of making all children in the United States hardship free, and how that would change their school readiness, education attainment, employment, and lifetime earnings. What if every child in the country was able to fulfill their potential and succeed, and give back to their families, communities, and country, to our common good? That is a REALLY hard thing, but you know what, I really believe we can do that hard thing, together.

At Children’s HealthWatch we are preparing for the beginning of our second twenty years of research and policy work to protect and improve the health of young children by improving their families’ economic circumstances. And in spite of the nightmare our political economy has become, we are hopeful. In terms of its ability to provide a healthy, happy quality of life for working people and families, our political and economic system is being thrown under a bus. But it is not dead yet, and we believe it is still possible to drag its battered body out from under that bus, dust it off, clean it up, apply necessary bandages, give it a good infusion of honesty, respect, racial equity and justice, and commitment to the common good, and rehabilitate it, breathing new life into it so it can work for ALL OF US. And we are going to do that hard thing!

We have a vision of a better world, and we are going to work like we are living in the early days of a better world![ii] So come on and join us, and help! You will never regret it.


[i] The line “We can do that hard thing” is a paraphrase of a line from a Carrie Newcomer song, on her album “The Beautiful Not Yet.” Newcomer says she borrowed it from Barbara Kingsolver.

[ii] The line “work like we’re living in the early days of a better world” is a paraphrase of lines from Scottish writer and artist Alasdair James Gray’s book “Unlikely Stories, Mostly” (1983), (“Work as if you were in the early days of a better nation”). Gray apparently paraphrased them from Dennis Lee’s Civil Elegies (And best of all is finding a place to be in the early days of a better civilization). “Work as if you live in the early days of a better nation”, is now engraved on a wall of the Scottish Parliament building.