CB Forrest, N Halfon. N Engl J Med 2026;395:1147-1149. Declining Child Health in the United States — Addressing the Developmental Ecosystem
This commentary paints a broad picture of declining health for U.S. children and what is needed to change the trajectory. Here are some excerpts:
Child health has been deteriorating in important and alarming ways in the United States…over the past two decades.1 Infants, children, and adolescents in the United States are 80% more likely to die than their peers in other high-income countries…77% of Americans 17 to 24 years of age would be ineligible to enlist in the U.S. military without a waiver, for reasons including obesity, mental health problems, and other medical conditions.2…
Researchers, policymakers, and the media have tended to attribute these trends to independent challenges — an obesity crisis, a mental health crisis, loneliness, gun violence — with distinct programmatic responses and potential remedies supported by separate advocacy groups and funding streams. But many of them have common origins and drivers…Interventions that target a single risk factor may relieve immediate suffering but will generally be insufficient to change developmental ecosystems in ways that can reverse generational declines in health…
At the base of the iceberg are a developmental ecosystem’s foundational values, which are often expressed in shared narratives about childhood: that raising children is chiefly a private responsibility, that markets are the fairest arbiters of who can be healthy…and that public support should be provided for children’s health programs only in exceptional circumstances…
The influence of these beliefs can be observed in the choices that society has made, including spending less than peer countries on early-childhood programs, opting not to regulate digital platforms that profit from the commodification of children’s attention, and organizing health care systems around the treatment of illness, rather than the promotion of healthy development.
Related blog posts:
- No Exaggeration: Too Many Children Are Dying in the U.S.
- Longevity Gap Present Even in Wealthy Americans
- “How to Make America Healthy: the Real Problems — and Best Fixes”
- Firearms: #1 Cause of Pediatric Deaths & Households with Guns =More Deaths
- “Truly Prioritizing Child Health — The Missed Opportunities of the MAHA Commission”
- The Failing U.S. Health System
- Zip Code vs. Genetic Code
- Zip Code or Genetic Code -which is more important for longevity?
- How Will We Afford the Future of Medicine?
