Richmond Award acceptance speech.

Abstract

Thank you, Dr Coleman, Dr Gorsky, and Dr Zuckerman. I am very grateful for this honor from the Academy. It seems as if it were just a few years ago that I started KidsPac. In actuality, it has been nearly 20 years.KidsPac is a political action committee that accepts contributions from individuals and makes contributions to people running for federal office—the House and Senate—whom we believe will support good policies for very young children and their families. Occasionally we have supported some party activities.The first person I sought advice from in 1981—the very first—was Julius Richmond. He was then, as he remains today, a giant in the field, one who graciously shares his wisdom, advice, and caring. So, thanks to you as well, Dr Richmond.From the beginning KidsPac has sought federal programs and resources that would provide incremental advances for poor children and women: modest increases in feeding programs, Head Start, immunizations, and other such programs—all proven to be good investments in children—all backed by credible, scientific research.But these early incremental advances were only bits and pieces, and I tried to stay under the radar screen. I tried not to be visible to the broad public. This was a conscious strategy that I believed fit the times: a Democratic Congress and the Reagan and Bush administrations, all complaining about the federal budget deficit. This strategy also seemed to fit the general lack of interest the public and elected officials seemed to show for making larger and better investments in children's programs. I think of this as a “more, better, sooner” strategy. We wanted more money to do a better job for kids and families as soon as possible. Incrementalism.Then came 1992 with the promise of a Democratic administration and a Democratic Congress. Better yet, a President and a First Lady who really understood children's needs and policies.Before we could truly mobilize this new world, however, 1994 was upon us with the Gingrich/Lott Congress. Echoes of the 1980s, of overreaching government, Proposition 13 in California, Proposition 2½ in Massachusetts, Waco (Texas), welfare queens, Rush Limbaugh, and talk radio. President Clinton called for ending welfare as we know it and Vice President Gore had reinvented—read “downsized”—government. All of these voices merged into a crescendo of antigovernment feeling by 1995. Government didn't work, was bad, couldn't adequately address the real needs of children and families, and was too intrusive. These were the prevailing sentiments.Unfortunately, I'm afraid that much of this pessimism and antigovernment feeling still prevails today and, as a result, I think the bridge to the 21st century will remain a bit wobbly for children. Why?As you may recall, President Bush's number one education goal, pushed principally by then Governor Clinton, was that by the year 2000 all children should arrive in school ready to learn. I don't believe that we will achieve this goal. Nobody I know does. Here are some reasons why:If I sound a bit too glum, I apologize. I recognize that there has been some good news for children during the last year.I mentioned the antigovernment crescendo earlier. Let me return to this issue: the role of the government. The examples of the brain development conference and health care for uninsured children are instructive. The brain conference illustrates a fine use of the President's bully pulpit. The child health care package contains government money illustrating, I believe, a use of public money being dedicated for a public good: healthier children.I am reminded of that old story about the bank robber, Willy Sutton, who was asked why he robbed banks. His reply: “Because that's where the money is.” For poor children trying to make it across the bridge to the 21st century, the bank is still the government.As we move into the next millennium, it should be perfectly clear to most of us that the free market is not going to provide sufficient resources to take care of all of our children's most basic developmental needs. By basic needs, I mean at least nutritious food, basic health care, including prevention and early intervention services; high quality child care—developmentally appropriate and provided by well-trained, fairly-paid people; family support systems; and quality early education. Providing these basics to all of our children will cost billions of dollars. Billions.It is high time for each of us to acknowledge these facts publicly: to move beyond our incrementalist mindset and begin to address the full, real, basic needs that all of our children have and, if we are to be successful in this endeavor, we are going to need our government's bully pulpit, as well as a larger portion of its resources.My father tells a story about a man who went to a picnic next to a river. All of a sudden he looked in the river and saw a baby floating by. So he jumped in the river with all his clothes on and saved the baby. People cheered and he went back to the picnic. A few minutes later another baby floated by and he repeated his heroic actions. This continued with another 10 babies and finally the man started to run up a path—not to the river. The people yelled, “Where are you going?” He said, “I'm going to see who keeps throwing the babies in the river and try to stop him.” The moral of this old story is that we need to prevent that child from being thrown into the river. Prevention and early intervention. Good ideas. I used to think they were enough.I'm now reconsidering. Maybe we have to look more closely at the nature of the river into which these babies are being thrown. Instead of thinking of the river as a medium for carrying babies, let's think of the river as the ether, the electronic air space in which we all live and to stretch the metaphor a bit more, let's think of each of the babies as the embodiment of the societal message that says “you can do this on your own with nobody's help.” We don't need government. So where are these “messages” coming from? Where is the source of the river?A recently completed study by the National Committee for Responsive Philanthropy reported on the giving patterns of 12 core conservative foundation for the years 1992, 1993, and 1994. During those years, these 12 foundations awarded $210 million in grants. In its conclusion, the report states,“ … the heavy investments that conservative foundations have made in New Right policy and advocacy institutions have helped to create a supply-side version of American politics in which policy ideas with enough money behind them will find their niche in the political marketplace regardless of existing citizen demand.” It should not be a surprise to us that a constant stream of antigovernment messages emanates from the recipients of these grants.My point today is that the water—the air waves—is being contaminated and that we must pay attention to this environment—to the river's source—if we are to understand the American people's current and future sense of government and its possibilities.So here is where I believe we are. The free market is leaving too many children behind. In the year 2000 too few children will arrive in school ready to learn. We need the public trust and government resources to help these children attain their full potential. But if the airwaves are contaminated with all this antigovernment talk, creating all this antigovernment feeling, how will we secure the resources that children and families so desperately need? I believe this question is our most serious challenge, and I do acknowledge that these message streams come from many different sources, including labor unions. But the preponderance of antigovernment messages overwhelms the other messages.A friend of mine recently wrote a book about the stock market in which he talked about people who try to discern patterns in the marketplace. He writes, “The human mind is a pattern-seeking mind. We are all descended from people who were good pattern finders because at some point our ancestors were walking around with some fellow hinters and there was a little rustle in the tall grass 100 feet ahead. And Og said, ‘That’s the wind.' And Magog said, ‘I think it’s a leopard.' And Og marched forward and was leopard lunch. Your ancestor is Magog, who read that rustle right. We are all descended from people who were very good at finding patterns in things.”If we want children to do much better, I believe that there at least three patterns we must face and understand as we move into the future.The reason that the politics of health insurance for uninsured children was so good, was that the benefits accrued to a highly appealing electoral segment: the working poor. Republicans and Democrats both wanted to help this electoral block. (36% of voters have a family income of <$30 000 a year; 35% of voters have a high school education or less.) Furthermore, most Americans are fair and believe that anyone who works hard and plays by the rules ought not to be living in poverty and ought to have health insurance available for his or her children. If you will, these are the “deserving poor.” Because poor children were already covered by Medicaid, there was no need to raise “the deserving poors'” concerns about health in the health care debate.It will be interesting now to see how the child care resource allocation debate plays out. Will the poor who do not have enough quality, affordable, and accessible child care have to compete against the working poor for the meager resources that will be put forth? With what results?Right before the recent market plunge there was talk of a budget surplus possibility in the next few years. There are at least four different approaches being discussed on how to spend this money:Does anyone seriously believe that the last category can win out over the other three?I have already discussed this pattern—the constant, intentional drumbeat against government and the need for government investments. I believe the future for poor children in this country cannot improve sufficiently until this perception is reversed.Which brings me to this question: “What can we do?”First, we must continue to work hard to discern and discuss these and other patterns with anyone and everyone who will listen.Second, we must work together, both within the Academy and across coalition lines, to offer alternative views to this antigovernment crusade, particularly because of its harmful effects on children and families.Finally and most important of all, we must commit to making sure that each of us finds time in the next year to make at least five phone calls and arrange for five meetings: one to each of our US Senators; one to our representative in the Congress; one to our state Senator, and one to our state representative. We bring to them the wisdom and passion of our experience. Effectively communicating your experiences with children and families and the essential role of government in building the future of our children and our country can make all the difference. Children really need your help—our help.Thank you very much.Pediatricians have often asked what they can do to become more actively involved and more effective in the political process to support young children. The answer is pediatricians can get involved immediately and play a critical role in the education of state legislators, governors, and their staffs. Why? Because a changing cohort of new policy decision-makers at the state level needs to develop a base of scientific understanding about young children's development. This understanding is a prerequisite for their support for government investments that need to be targeted to young children and their families.There is a continuing trend toward devolution—a process by which the federal government turns over resources and decision-making powers to the states. As devolution unfolds, more and more important decisions regarding the role of government and the allocation of limited resources will be made by state legislators, governors, and their staffs. As more and more of these allocations are made at the state level, the critical question is, “how will young children fare?”For many years there has been a “professional class” of staffers in the US Senate and the House of Representatives who have come to know the issues and the science of early childhood. For most staffpersons and elected officials in state legislatures and state houses, this foundation of knowledge and understanding has not yet been developed. If the interests of children are going to compete successfully for limited resources against other powerful constituencies, educating these policymakers about the early childhood years must proceed immediately.In some states term limits, laws that require elected officials to leave office after a designated number of years, have been enacted. Shorter terms for state legislators further complicates the task of educating state legislators and staffers.Finally, although the national economy is doing well and the federal budget is in surplus, and many states are also experiencing surpluses, few expect this rosy economic situation to continue forever. This is why it is critical to educate our state legislators now.Unfortunately, a recent study by the State Legislative Leaders Foundation (Keys to Effective Legislation for Children and Families, 1995) presented a troubling picture of advocacy for young children at the state level. For many legislative leaders, young children's issues were equated with education. Many leaders did not know any children's advocates. Many described a hostility toward advocates whom they claimed expected the legislative leaders to do “the right thing” for children meaning, “put more money in my favorite program” without explaining why it may be in the leaders' self-interest to make investment choices for children. Most advocates were thought to be ignorant about how their state or local government's legislative process worked.This current situation presents pediatricians with a great opportunity to impact positively on the lives of young children by becoming more effective politically. Public opinion polls reflect what state legislative leaders have told us: you can trust pediatricians and you can benefit from listening to them.One way for each pediatrician to start would be to make a commitment to write, call, or best of all, meet with her or his state representative, state senator, congressperson, and two US senators over the next year. Each pediatrician could contact his or her legislator by telephone or write to set up a meeting. This should be done by the pediatrician, not by someone else in the pediatrician's office. The purpose of the meetings would be to begin to establish a relationship between the pediatrician and the legislator and/or the appropriate staffpersons. The following talking points are a suggestion as to how to initiate such a call or letter:State chapters of the Academy can provide each pediatrician with names, telephone numbers, and addresses of their local elected officials. They could provide a script or talking points for each pediatrician. Each pediatrician would then report back to their state chapter on their initial contact with the legislators and staffpersons. The state chapter could organize participating pediatricians by state legislative districts, coordinate joint visits to decision-makers, and create linkages with other local advocacy groups. Each state chapter would then be able to identify those pediatricians who would be most effective in providing public testimony and media appearances in response to policy issues relating to young children. Identifying pediatricians by subspecialty would also be useful for decision-makers.The involvement of pediatricians in the education of state legislators and their staffs matters. In the next few years state and local governments will be trying to figure out how best to—or whether or not to—allocate billions of dollars for programs that can enable our young children to get a healthier start and improve their chances to arrive at school ready to learn. Unfortunately, too many legislators still believe that a 2-year-old child is just a short 10-year old child. Now is the time for pediatricians to educate the legislators and their staffs on a bipartisan basis, so that our nation's young children can make it across the bridge to the 21st century.