A Moral Imperative for Children
Authors: Danielle Laraque
Journal: JAMA (2009)

IT IS UNCLEAR WHY THE UNITED STATES LACKS BROAD, COMprehensive policies that consistently address the status of children (those younger than 18 years). In the United Nations Children’s Fund’s (UNICEF’s) Innocenti Report Card 7 on child well-being in wealthy countries, an analysis of child well-being is composed of 6 dimensions: material well-being, health and safety, educational wellbeing, family and peer relationships, behaviors and risks, and subjective well-being (as measured by child report). These 6 dimensions are captured in a broad survey designed to monitor the progress of children from a holistic view. The dimensions reflect the concepts articulated in the United Nations Convention on the Rights of the Child. The Organization for Economic Co-operation and Development countries listed in the report are the 21 of 30 participating countries for which complete data were available. In this analysis, the United States ranks 21 of 21 countries for health and safety and 20 of 21 countries for all composite measures, excluding subjective well-being, which, ironically, is not reported for US children. There are some possible explanations for the lack of focus on child well-being in the United States. In a recent article, it was stated that the United States is “a nation built on commitment, certainly to freedom and capitalism.” Both freedom and capitalism carry their burdens with respect to societal commitment to children. An example is the lack of universal health insurance in the United States. Vladeck, in reflecting on this subject, considers historical, cultural, political, and structural explanations for why the United States is the only industrialized, advanced nation to not have universal health insurance for its population, inclusive of its children. He proposes that Americans as a group have more negative attitudes about government than most other individuals from other countries. Furthermore, he states that this rejection of government is a general cultural tendency to reject authority with a preference for individualistic, independent, and, perhaps, “freer” choices. The politicalstructural explanation for the lack of universal coverage is grounded in the fabric of capitalism, an opportunistic, supplyand-demand system that does not generally support the redistribution of wealth. Vladeck further argues that political contributions are often evaluated in terms of “simple return on investment.” A simple return on investment places material gain above all and is the framework for operation. Many have tried to counter the arguments against broad support for children by precisely framing the need in economic terms. “Investing” in children, it has been argued, is sound policy and merits support because it is an investment in “human capital.” In arguing on behalf of children, many have sought to define the “whole child,” a life span approach, gains in disability-adjusted life-years, and even a holistic view of mind and body. There is wisdom in achieving the goal of improved outcomes for children during the course of their lives and, thus, maximizing benefit for society as a whole. These efforts are laudable but must be embedded in basic concepts and understanding of the intangible, that is, that a human life has no price. Noneconomic arguments must be part of a civilized society. These arguments must rest on the belief of right and wrong. Competing forces to achieving holistic policies of child health in the United States are also represented by the lack of support for a truly comprehensive, integrated health system encompassing mental health. In 1982, Knitzer spoke out for the most vulnerable in pointing out in stark terms the plight of children experiencing socioemotional problems. She used case examples to discuss a system that had failed to deliver needed services to children and also helped to humanize the many stories that could not be envisioned by others. She included children from all walks of life, but often from impoverished circumstances, who were burdened with depression, aggression, posttraumatic stress, and other serious emotional disorders. Her lens into the lives of these children was cast nationally—and in differing communities to get a broad representation of the problems, the challenges, and, most importantly, the reachable solutions. Two basic principles have emerged from discussion of her work—the need for universal access to health care and that health is always inclusive of mental health. It is unfortunate but not entirely surprising, then, that the United States (along with Somalia) has not ratified the United Nations Convention on the Rights of the Child. The convention and its 54 articles articulate the fundamental rights of children. Starting with a preamble, the convention ar-