Advancing Equity through Advocacy

Advocacy for Healthy Housing

Housing is known to have a profound impact on child health and development. This session explored housing-related problems that children and families have long faced, which disproportionately affect people of color and those with lower socioeconomic status. The COVID-19 pandemic has recently exacerbated housing concerns, such as:

• quality of housing, including whether the built environment has lead paint, mold or other hazards; 
• housing instability, including homelessness or frequent moving that each bring about a tremendous amount of stress for those affected; and 
• housing affordability, including how much money families put toward housing and whether they have enough left over to buy nutritious food or access preventative health services. 

The housing panel featured Patricia Garcia, MD, a hospitalist at Connecticut Children’s who serves as the medical director of Connecticut Children’s Healthy Homes Program, Melvyn Colon, the director of Southside Institutions Neighborhood Alliance, and Elysa Gordon, vice president and senior advisor of the Hartford Foundation for Public Giving.

While housing issues have long been a concern for residents of urban areas, such as Hartford, which are predominantly occupied by people of color, the panelists each commented on how these concerns have escalated during COVID-19 due to the increased time children and families are staying at home. Lead poisoning is a major concern for young children, as the brain rapidly develops from birth to age 5, and such poisoning can lead to cognitive and other developmental delays that not only affect children in their younger years, but also throughout their lives. In addition, older children and even adults can face serious health setbacks due to lead exposure. Other risks that escalate for children who are homebound during COVID-19 include exposure to smoke or mold, which can exacerbate allergies and asthma symptoms, as well as injuries from unsafe stairways and other conditions in homes.

In terms of advocating for housing-related changes in urban and even suburban communities, our panelists acknowledged that health and housing challenges tend to present differently depending on the community. Regardless of city or town, our panelists encouraged organizations to identify key stakeholders, including residents, and engage in open conversations. Next, they should work together to define the priorities they plan to address, identify action steps, and be ready to leverage existing resources to ensure the actions are sustainable, which could better position the collective for external funding.

The Building for Health cross-referral initiative serves as a great example of how such collaboration can be effective. The initiative materialized after a call-to-action from the Hartford office of the Local Initiative Support Corporation (LISC) for organizations in the health, housing and energy sectors to work together to improve the quality of life for city residents. Building for Health serves as a “no wrong door” community-focused model to detect opportunities to enhance the health and well-being of residents through home upgrades or other services. Once needs are identified by one organization, the model provides a path for that organization to refer and link families to relevant supports in organizations from other sectors, so families don’t have to track down such help on their own. The initiative is community-led, actionable, sustainable and scalable to additional communities.

Advocacy for Child Health Services Transformation

We know the critical importance of transforming child health services to enhance outcomes for children in their younger years as well as into adulthood. However, much of the current focus of healthcare transformation remains on achieving cost savings through modifications to expensive care for elderly residents and adults who live in nursing homes. We must call attention to the needs of children and families as part of reform efforts, which will have a greater long-term return on investment.

The child health services transformation panel featured Dr. Ruth Loomis, a pediatrician who practices in Bristol, Dr. Nancy Trout, a pediatrician at Connecticut Children’s who serves as co-director of the Kohl’s Start Childhood Off Right childhood obesity prevention program, Tanya Barrett, a senior vice president at United Way of Connecticut, and Vicki Veltri, the executive director of the State of Connecticut Office of Health Strategy.

During our robust discussion, our panelists focused on a number of important issues, such as:

• the importance of allowing parents to set the agenda for well-child visits to ensure their concerns are addressed; 
• screening for social and environmental factors that impact child health, such as food insecurity which is affecting families in far greater numbers due to the pandemic; 
• referring families to United Way 211 and the Child Development Infoline to connect with services and resources that can help in times of need; and 
• the critical need for families to maintain well-child visits and keep vaccinations up to date during the pandemic. 

In order to achieve the change we seek, we must embrace an approach that strengthens families to promote children’s optimal health, development and well-being. We also must acknowledge that the key drivers of health outcomes for children stem from social, environmental and behavioral factors in their lives. In addition, we should embrace the notion that services for children and families must be universal, but also targeted to reach those who are most at-risk of poorer outcomes. At Connecticut Children’s Office for Community Child Health and our Help Me Grow National Center, we refer to such an approach as targeted universalism.

Our panelists focused on key priorities that we should embrace to drive child health services transformation, such as:

• developing strategies to best strengthen child health services to better promote child health, development and well-being; 
• examining all of our work through the lens of racial and social justice to reduce the social inequities that are exacerbated by the COVID-19 pandemic and highlighted by the ongoing racial justice movement; 
• and ensuring the sustainability of pediatrics in an era of increased retail clinics through payment reform and by demonstrating the cost savings, cost benefit and return on investment associated with child health services transformation. 

Our panelists spoke of the critical importance of addressing issues related to mental health that have grown during the pandemic, the need to close learning gaps that have widened for children in urban areas due to technology and instruction challenges related to remote learning during the pandemic, and a desire to better figure out how to serve families at home. They also touched on the need to ensure payments for pediatric primary care services are sufficient and remain available for both in-office and telehealth appointments, a need to better integrate primary care practices with retail clinics, and a need to address challenges related to ensuring access to health insurance for families that have lost jobs during the pandemic.

Advocacy Options

It is critical to address the inequities that too often lead to poorer outcomes for people of color or those with lower socioeconomic status – inequities that have long existed but are now at the forefront because of the COVID-19 pandemic and the ongoing movement for racial and social justice. Advocacy is an important way to go about that. It can take many forms – meeting with a legislator, writing an Op/Ed, or even rallying support for a project in a community. We all have the potential to make a difference by speaking up for children and creating the change we need to see.