"And people were bringing children to him that he might touch them, but the disciples rebuked them. When Jesus saw this he became indignant and said to them, 'Let the children come to me; do not prevent them, for the kingdom of God belongs to such as these. Amen, I say to you, whoever does not accept the kingdom of God like a child will not enter it.' Then he embraced them and blessed them, placing his hands on them." (Mark 10:13-16)
Childhood is a time of growth, learning, wonderment and hope, filled with the potential of a full and prosperous life ahead. Unfortunately, not all children and young people are given the opportunities and support required to flourish and reach their full potential.
The events and circumstances that shape children's — and all people's — lives take place in the homes and streets of their communities, far from the offices and examination rooms where health care teams try our best to help our patients overcome the sometimes daunting obstacles endemic in their neighborhoods.
In 2024, about 16% of America's children lived in poverty, with 26% of children living with parents who lacked secure employment. In addition, 68% of fourth graders were not proficient in reading, and 74% of eighth graders were not proficient in math. Furthermore, 33% of children and teens (ages 10-17) were overweight or obese.1 And, approximately 64% of adults in the United States reported they had experienced at least one type of adverse childhood experience (ACE) before age 18. The Centers for Disease Control and Prevention describes ACEs as "potentially traumatic events that occur in childhood. … Also included are aspects of the child's environment that can undermine their sense of safety, stability and bonding."2
These statistics are alarming, but they are also related. Unhealthy environments can yield unhealthy children. Collectively called the social determinants of health, these are the things that affect our patients beyond the walls of the hospital or clinic: economic opportunity, education, built environment, discrimination and pollution. They are far more pervasive and impactful than the few moments children spend in the hospital or doctor's office.
What is more important about social determinants of health, however, is the cumulative effects of these experiences on the lives of children. Like a toxin, exposure to the social determinants — starting at an early age and compounding over time — likely increases the probability of a poor outcome in health and in life years later, at which point it will be difficult to repair.3
Working on issues related to these determinants is frequently described as working "upstream," in the context of the root causes of poor health, such as food insecurity or housing. In addition to understanding this in the context of a disease, such as diabetes, we must also appreciate "upstream" in terms of the span of a lifetime. Failure to provide solutions early in life, whether they are material, such as housing or healthy food, or societal, such as good schooling and family economic stability, places children on a perilous path from which it is more difficult to rescue later when they are downstream in disease and in life.
Like a toxin, exposure to the social determinants — starting at an early age and compounding over time — likely increases the probability of a poor outcome in health and in life years later, at which point it will be difficult to repair.
COMMUNITY BENEFIT: A WAY TO SUPPORT THRIVING YOUTH
SSM Health's vision is "Peace, hope and health for every person, family and community, especially those most in need." In living out this vision, SSM Health, in addition to providing clinical care, recognizes the outsized effect intervention has on the health and well-being of the children we serve and how it is an investment in the future of our community.
SSM Health's community benefit programs include initiatives specifically designed to help children and young people thrive. Some examples of this work in action include programs to support areas such as literacy, safety practices and nutrition.
Asthma inhalers: SSM Health St. Anthony Hospital in Oklahoma City has a first-in-the-nation partnership with the Brendon McLarty Memorial Foundation to help save the lives of Oklahoma K-12 public school students who experience asthma attacks at school.4 The foundation has begun supplying rescue inhalers and related medical supplies to every public school in Oklahoma, an effort sponsored in part by St. Anthony.
Cardinal Glennon Safety Program: SSM Health is the lead agency for Safe Kids St. Louis, a local chapter of the national Safe Kids program, which implements initiatives that help parents and caregivers prevent childhood injuries. There are safety initiatives for children and youth of all ages. These include safe sleep practices, car safety, and sports safety and injury prevention. It is open to the community and available all over the region; it provides education to first responders as well.5
Read, Talk & Play: SSM Health St. Mary's Hospital — Janesville (Wisconsin) provides Read, Talk & Play kits to every birthing family at the hospital to support early development. This is in partnership with the School District of Janesville to improve kindergarten readiness.
Period poverty: Menstruation is a major issue in education when girls don't have access to feminine hygiene products, which can lead to school absences and embarrassment. St. Anthony Hospital in Oklahoma City awarded a grant to a local school district to provide these products for free in dispensers in every girls' bathroom in the district's elementary, middle and high schools.6
Improving Black infant mortality: The Saving Our Babies project is a collaboration with all health systems in Wisconsin's Dane County to improve Black infant mortality. This initiative screens for social determinants in the prenatal setting and supports Black women with access to a doula and community health worker throughout pregnancy until the baby's first birthday.
Drop-in center: SSM Health DePaul Hospital — St. Louis partners with the Epworth Drop-In Center in Normandy, Missouri, the Institute for Family Medicine and Operation Food Search to provide health care, food and nutrition education to homeless and at-risk teenagers and young adults seeking support at the drop-in center. The Institute for Family Medicine provides a nurse practitioner two days a week, and Operation Food Search provides healthy food bags and on-site cooking classes.7
Thrive by Five: Through a partnership with St. Mary's Hospital — Janesville and the Rock County Public Health Department, the Thrive by Five coalition was launched in spring 2023 to support families and young children through coordinated resources, child development and literacy support. The coalition includes more than 15 partners across Wisconsin's Rock County.
Food distribution for families: Through our regional Bread Basket program, SSM Health St. Louis conducts 18 food distribution events throughout the region annually. In 2023, we served more than 2,500 households consisting of approximately 9,000 individuals, of which more than 3,800 were children under the age of 18. From January through early December 2024, we held 15 events serving more than 1,800 households consisting of more than 5,700 individuals, of which about 2,600 were children under the age of 18.
Vaping prevention: SSM Health teaches vaping prevention and provides mental health support to Marshall Middle School students in Janesville. Since 2022, more than 1,500 middle school students have been taught an evidence-based vaping prevention curriculum by staff at SSM Health.
'Adopting' a school: SSM Health St. Mary's Hospital — Madison "adopted" Lincoln Elementary School, located in a low-income neighborhood in Madison, Wisconsin. This partnership allows hospital staff to conduct education in the school and provide access to socks, underwear and hygiene products for families.
Behavioral Health Urgent Care: During the height of the pandemic in 2020, SSM Health opened this walk-in facility in St. Louis, the first-of-its-kind in Missouri.8 Although the center was intended to serve adults, the need for youth mental health services was so great that we opened the urgent care to children and adolescents after a month of operation. Since then, SSM Health has opened a second behavioral health urgent care in the St. Louis region with high demand for services, particularly among children and teenagers.
COMMITMENT TO PEACE, HOPE AND HEALTH
While we acknowledge the value of what we have accomplished in trying to keep our children safe and healthy, we also know that it is not enough. The heavy burdens that inhibit children from their opportunity to flourish, particularly those who live in poverty, are beyond the capabilities of health care alone.
This is why, in addition to our clinical and social programs, we must partner with those in the community and, most importantly, be passionate advocates every day for those things outside of health care that we know impact our children and, by extension, our future. I encourage every person reading these words to join us in these crucial endeavors.
As abolitionist Frederick Douglass once professed, "It is easier to build strong children than to repair broken men."
DR. ALEXANDER GARZA is chief community health officer for St. Louis-based SSM Health. He is the winner of CHA's 2022 Sister Carol Keehan Award.
NOTES
- "2024 Kids Count Data Book," The Annie E. Casey Foundation, June 10, 2024, https://www.aecf.org/resources/2024-kids-count-data-book.
- "About Adverse Childhood Experiences," U.S. Centers for Disease Control and Prevention, https://www.cdc.gov/aces/about/index.html.
- Geoffrey R. Swain, "How Does Economic and Social Disadvantage Affect Health?," Focus 33, no. 1 (Fall/Winter 2016/2017): https://www.irp.wisc.edu/publications/focus/pdfs/foc331a.pdf; Dr. Paula Braveman and Dr. Laura Gottlieb, "The Social Determinants of Health: It's Time to Consider the Causes of the Causes," Public Health Reports 129, no. 1 (2014): https://doi.org/10.1177/00333549141291S206.
- "Foundation Leads First-in-Nation Effort to Save Lives of Oklahoma Public School Children Suffering Asthma Emergencies," SSM Health, November 18, 2022, https://www.ssmhealth.com/newsroom/2022/11/foundation-leads-effort-save-children-with-asthma.
- "SSM Health Cardinal Glennon Safety Program," SSM Health Cardinal Glennon Children's Hospital, https://www.ssmhealth.com/cardinal-glennon/services/specialty-programs-for-patients-families/safety-program.
- Lisa Eisenhauer, "School District Gets a Hand from SSM Health Hospital to Take on 'Period Poverty'" Catholic Health World 38, no. 19 (December 1, 2022): https://www.chausa.org/publications/catholic-health-world/archive/article/december-1-2022/school-district-gets-a-hand-from-ssm-health-hospital-to-take-on-period-poverty.
- "Epworth Drop-In Center," Epworth, https://www.epworth.org/services/epworth-drop-in-center/.
- Andrea Smith, "SSM Health Opens Behavioral Health Urgent Care to Treat Depression, Anxiety and Other Mental Illnesses," Ladue News, November 6, 2020, https://www.laduenews.com/health-and-wellness/ssm-health-opens-behavioral-health-urgent-care-to-treat-depression-anxiety-and-other-mental-illnesses/article_9efce6d9-ac8a-54f6-be1a-7211c297e120.html.