National Children’s Day — lower-income families are excluded from getting specialized medical care

National Children’s Day — lower-income families are excluded from getting specialized medical care
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This weekend, we’ll celebrate National Children’s Day. And while it’s easy for this annual event to be overlooked, sandwiched as it is between National Strawberry Rhubarb Pie Day and National German Chocolate Cake Day, taking a moment to reflect upon the health status of our nation’s children seems a fitting way to partake in the “celebration.”

As the country grows increasingly wealthy, many individual American families are not. Programs that provide health care for countless American children continue to face funding uncertainty. Consider this in the context of perennially under-supported public education programs with the associated reduction of children’s access to school-based sports and physical education. The net result is a significant disparity amongst our nation’s youth regarding access to safe sports participation and sports-related health-care services.

The repercussions of this disparity play out in several ways. While kids from affluent families have become avid “consumers” of organized sports and their costly accoutrements like camps and private coaches, children from lower-income households may be priced out of extracurricular sport participation. For these kids especially, school-based sports programs provide critical opportunities to participate in physical activity, a key component of children’s health.


In fact, we recognize that participation in regular physical activity helps prevent obesity, heart disease, and diabetes (National Pie and Cake Days notwithstanding). Kids who are physically active report fewer symptoms of depression and anxiety.

There is a wealth of data demonstrating an association between physical activity and cognitive function; active kids perform better on standardized tests and have higher grade-point averages than less-active peers.

Herein lies a key health disparity. Many kids who rely on our public education system for the opportunity to participate in sports never get that chance. They miss out on the various health benefits that physical activity confers. Admittedly, this concept is not novel. But kids who rely on public programs for health care get a second hit that we don’t talk about as frequently: public health insurance closes doors.

Say, for example, that a child with public insurance does participate in sports. What happens if that kid gets injured? Research tells us that kids with publicly-funded insurance who require specialized care for musculoskeletal injuries like fractures or ACL tears are regularly turned away. In 2013, investigators identified five orthopedic offices in each state and called to make an appointment for a fictional 10-year-old patient with a routine fracture.

Each office was contacted twice, once in which the “script” described a privately-insured patient, and a second time, when the same patient instead had public insurance. The privately-insured patient was given an appointment 82 percent of the time, compared to only 24 percent of the time for the publicly-insured patient.

A similar study was performed in Ohio in 2012, in which the fictitious patient was a 14-year-old male with an ACL tear. Here again, orthopedic offices were contacted twice to make an appointment for this “patient” —  once in which he was described as being privately insured and once as publicly insured.

Of the 42 offices contacted, 90 percent offered an appointment to the fictitious privately-insured patient within 2 weeks; only 14 percent of the offices offered this to the publicly-insured one. The difference in access to specialized care was greater than 6-fold.

As recently as May — National Physical Fitness and Sports Month — the results of an investigation on health-care disparities were presented at the Pediatric Orthopedic Society of North America’s Annual Meeting. Neeraj Patel M.D., the presenting author and one of my pediatric orthopedic sports medicine colleagues, reported that publicly-insured, black and Latino children with ACL tears were significantly more likely to have a delay in surgical care than privately-insured and white children, respectively.

This is important not simply because it’s inequitable, but because lack of access to timely care affects patient outcomes. For ACL tears in particular, surgical timing is critical: the longer a young athlete waits to be evaluated for surgery, the greater the risk of sustaining additional injuries.

There is a clear connection between the length of time from ACL tear to surgical reconstruction and both the presence and severity of associated cartilage injuries. These secondary injuries render kids vulnerable to the premature development of knee arthritis.

Arthritis, in turn, may translate into debilitating pain and inability to remain in the workforce. This isn’t just bad for patients. It’s bad for their families, communities and ultimately, our economy.

What to do about this systematic double-hit to the health of our children? Let’s focus on achieving equitable distribution of public services — like gym class and health insurance — to all American children. And while designing and implementing effective long-term policy for children’s health care is a complex assignment, National Children’s Day seems as good a time as any to begin this critical task.

Cordelia W. Carter, MD is an assistant professor of Pediatric Orthopaedics and Sports Medicine at the Yale School of Medicine and Chair of the Women’s Health Advisory Board for the American Academy of Orthopaedic Surgeons.