By Carissa Stanton, MD, FAAP
There is immense work being done to defend and improve nutritional programs for children. WIC and SNAP program funding and implementation is being defended. These are important programs considering 1 in 6 American children have food insecurity, which leads to poor health and increase healthcare costs, as well as poor development and education. There is also work to uphold nutritional standards in programs such as school lunch. 30 million American children receive school lunch, so it has a huge impact on the well-being of children. There was recently a retraction of improved standards for school lunches which included increased whole grain, lower sodium, and increased vegetables/fruit standards. Work is being done to prevent this step back in quality of food served to American children.
An unfortunate new problem in children and adolescents is e-cigarette use. We had seen a decrease in tobacco use by teenagers, which is a huge public health victory to have less Americans start and get addicted to tobacco and nicotine. Unfortunately, e-cigarette and vaping has been introduced into America, and nicotine use is increasing. Recently tobacco cigarette use is even increasing because vaping often leads to cigarette use. The AAP joined other organizations to take legal action against the FDA due to lack of enforcement of tobacco regulations on e-cigarettes. The current administration has failed to perform full pre-market reviews of e-cigarette products that is required under the 2009 Tobacco Control Act. That law bans candy and fruit flavored cigarette products that are marketed towards children, so the lack of full enforcement allowed e-cigarette products with flavorings and packaging targeting adolescents to be put on the market (search google for “juice box e-cigarette” and you will be amazed at the products that mimic juice and candy). Which in turn has created a new generation of Americans addicted to nicotine that we are advocating to turn around and stop.
Dr. Marsha Griffin, co-chair of the AAP Immigrant Health Special Interest Group, spoke about her work at the U.S. southern border. She stated that when she is asked what is happening at the border, her response is “evil, evil is happening at the border”. People who are fleeing deplorable conditions are seeking refuge in the USA, and instead are treated like criminals and families are torn apart. Children being held captive are experiencing emotional and physical trauma, and we know the consequences of adverse childhood events. There is dysfunction occurring in the Department of Homeland Security, and unfortunately humans are being caught in the middle.
The AAP chose preventing gun violence as the priority topic to take to Capitol Hill. It is unfortunate this is such a major problem for American children right now. Gun violence is now the 2nd cause of death of American children, and guns kill twice as many children as cancer. 83 children a day are shot in America, that equates to 200 school buses of kids per year. Therefore this is a huge public health crisis. And 93% of kids in developed countries who die from guns are from the United States, so other countries have found ways to decrease gun violence. But unfortunately in the United States there is resistance to treating gun violence as a public health problem and finding solutions.
There are many things that can be done to address the issue, but the AAP is currently focusing on research funding and universal background checks. It is difficult to understand why this is the 2nd cause of death of American children, yet gun violence is one of the least funded and researched public health problems. Think of other public health problems such as child passenger safety and SIDS: research helped find the problem and solution. The same should be done for preventing gun violence. Therefore the AAP is asking congress to appropriate at least $50 million to CDC research on firearm safety and injury prevention. And the work of the AAP and other organizations is paying off. On April 28th the House Appropriations Committee proposed to appropriate $25 million to CDC and $25 million to NIH to research firearm injuries and prevention. Any step forward is a victory in this advocacy marathon!
Beyond research, there are common sense solutions that could help prevent guns from being sold into the wrong hands. Background checks is a proven intervention that helps keep communities safer by ensuring guns aren’t sold to individuals at high risk of perpetrating gun violence. The Brady Handgun Violence Prevention Act (which was named after James Brady who was shot during an attempted assassination of Ronald Reagan), was signed in 1993 and called for a background check when purchasing a firearm. Since that time, the internet and gun shows have developed loopholes around this legislation, and now 1 out of 5 guns are sold through these loopholes without a background check. Therefore new legislation needs to be done to close these loopholes so the Brady Law can be fully enforced. The majority (some polls say as high as 90%) of Americans want universal background checks. The House has already passed The Bipartisan Background Checks Act of 2019 to close these loopholes. There is a bill introduced by Senator Chris Murphy in the senate (S42 Background Check Expansion Act), but it is already meeting resistance and has not made it out of committee to be voted upon.
Advocacy in Action
I was humbled by the work individuals and organizations do on a daily basis to fight for children. For nutrition and food access, the Food Research and Action Center (FRAC) and the Center for Science in the Public Interest (CSPI) are working to improve and secure programs for children. The Truth initiative is combating tobacco use. The Gifford foundation and Brady campaign are working to help prevent gun violence. There are legislators who are champions for children. Representative Schrier, who is the 1st pediatrician in congress, has the expertise and passion to push for improvement from within congress. Kansas’s own Representative Sharice Davids has also shown support for children. She was the only representative from Kansas who voted yes for the Bipartisan Background Checks Act. And of course the AAP’s staff in Washington DC and the State and Federal Government Affairs committees tirelessly working to do what they can to influence policy to benefit children.
We have our own leaders that are making their mark. Dr. Dena Hubbard, KAAP Public Policy Committee chair, was a panelist for the Foster Care plenary at the conference due to her efforts that helped pass Family First in Kansas. Dr. Dennis Cooley, District VI Chair and past member on the AAP Committee on Federal Government Affairs (COFGA), was a speaker on effective advocacy at the conference. And of course Dr. Pam Shaw, the AAP President-Elect candidate who has been a leader in Kansas chapter and national AAP, was discussed in anticipation of the upcoming election.
The last day of the conference was the culmination of the previous 2 days’ training: 320 pediatricians took to Capitol Hill to advocate for children. Dr. Pamela McKean, a fellow Kansas pediatrician, and I met with staff from Senator Jerry Moran and Senator Pat Robert’s offices. Dr. Dena Hubbard and I met with staff from Representative Sharice David’s office. We discussed why gun violence is a problem for American children, told personal stories of how it is affected us and our patients, and asked them to support funding for research and universal background checks. Not only are these meetings important to help legislators know what their public’s opinion on issues, but it makes connections for future issues that legislators may need our expertise and opinion.
AAP President, Dr. Kyle Yasuda, taught us to always be ready to deliver your message, you never know when or where an opportunity will present to advocate for children. This was tested when I found myself waiting at a crosswalk next to Senator Bernie Sanders. I seized the opportunity to have a discussion about preventing gun violence in children! This was a defining moment that proved the conference taught me well and awakened my passion to stand up and speak out for children!
And these opportunities occur not only at the federal level, but local and state levels such as school districts and state legislation that can impact children’s lives. Our elected officials rely on our vote to keep their job. So we need to let them know what we would like them to do on upcoming legislation or decisions, and let them know when we agree or disagree with what they have done. As Mark Del Monte, AAP CEO, said: “if you have the confidence to stick needles in baby’s backs, you can have the confidence to speak up for them!”. We also have the passion to help children that drives us to call, write, meet, donate, and speak up on issues that affect children. This quote from Dr. Paul Wise describes why we consider advocating for children part of our job and responsibility: “Pediatricians are the ultimate witnesses to failed social policy”. Conversely, we are also the witnesses to successful social policy. So let’s keep up the good work to advocate to improve policies for children! The KAAP and AAP have resources and contacts on their websites to assist you with logistics of contacting elected officials. And you could always experience the Legislative Conference for yourself!