Dina C. Castro, M.P.H., Ph.D. Scientist, FPG Child Development Institute, University of North Carolina at Chapel Hill 15 th Annual Summer Public Health Research Videoconference on Minority Health, University of North Carolina at Chapel Hill, June 9, 2009,

Health Disparities Disparities in health status and access to health care between different racial, ethnic and socioeconomic groups in the U.S. are a demonstrated fact. There is increased awareness about health disparities, and attempts to reduce them.

The Educational Gap (1) Likewise, there is abundant documented evidence of the marked educational gaps between different racial, ethnic and socio-economic groups. The education gap begins before children go to kindergarten, and the gap widens as children continue their schooling. The end results are low achievement and high school dropout rates among minority populations.

The Educational Gap (2) Just like in the case of health, there have been numerous efforts to increase awareness about these problems, and attempts to reduce educational inequities. Initiatives have included designing, testing and training on selective interventions, and also promoting progressive policy making at local, state and national levels.

Are these, two different problems? This conference presents us the challenge of looking at health disparities and education inequities simultaneously. What can we say about both of them? What do they have in common? Do they intersect?

How do child health disparities intersect with the school readiness gap? (1) Research has shown that children learn better when they are physically and emotionally healthy. Also, new knowledge of early brain and child development show that children early experiences can affect their learning trajectories (High, 2008).

How do child health disparities intersect with the school readiness gap? (2) Health problems affect young children directly and indirectly, example: Lead poisoning → child ’ s cognition, behavior problems Racial differences in health conditions and in maternal health and behavior may account for up to 25% of the racial gap in school readiness (Currie, 2005). Minority children living in poverty are not only more likely to have particular health conditions but they also are less likely to be treated for them.

Are these, two different problems? (2) The evidence indicates that high-risk populations for health problems are usually also high-risk for educational problems, and vice-versa. Thus, beyond their particular characteristics, health disparities and education inequities seem to be two related outcomes of the same mother- problem: socio-economic inequities. And, as it is known, socio-economic inequities affect racial and ethnic minorities harder than the majority population.

What does the evolution of these two problems tell us? (1) Recent reports show scarce progress in reducing the educational gaps, and that declining investments in education put America’s children at higher risk. Likewise, recent data indicate that the U.S. is failing to make significant progress toward the Healthy People 2010 goal of eliminating health disparities.

What does the evolution of these two problems tell us? (2) Could that be just a coincidence? Probably not. Should these two problems continue being addressed only from the scientific, applied clinical and educational practices perspectives, we may be going nowhere. Scientific, clinical or instructional considerations are indeed necessary to understand and solve these complex problems, but certainly are not sufficient.

Strategic Considerations (1) The U.S. is undergoing an unprecedented effort to rescue the economy with the hope that it will take us to a better future. Let’s discuss how we can rescue the human component of the current crisis through a comparable vigorous effort, using all the scientific, technological, financial and political resources necessary to succeed.

Strategic Considerations (2) The present economic crisis could be a good time and environment to sharpen the strategies that may lead to significantly reduce health disparities and education inequities. From the scientific and technical standpoints, it is necessary to continue elucidating the best practices to address child health disparities and education inequities, with emphasis on promotional and preventive approaches, rather than remedial ones.

About child development and school readiness (1) Based on the previous considerations, child development and school readiness, are a clear example of how health and education intersect, and how these two are intertwined factors. Depending on how adequately they are addressed, they may result in either a healthy, high achieving, self-confident child, or a less healthy, low achieving, insecure and emotionally vulnerable child.

About child development and school readiness (2) Health is considered a key component of getting young children ready for kindergarten: National Education Goals Panel National School Readiness Indicators Initiative National Governors’ Association Evaluations of comprehensive approaches to early childhood interventions have demonstrated the need and importance of proactively supporting child health.

What can be done? Increase access to high quality, comprehensive programs such as: Head Start. Involve families and communities (Ready schools, ready families, ready communities). Prepare educators and health professionals to work as a team. Engage the community and society at large: Commitment and support from leaders to make investing in children’s well-being a priority.

Changing demographics Among minority children, Latinos are the fastest growing group, and as with other minorities, they are more likely to live in poverty than non-Hispanic white children. Many of these children are from immigrant families; however, most of them are U.S. citizens (93%). Nationally, young Latino children have the lowest scores in measures of school readiness. They have the highest percentages of uninsured children.

Changing demographics: What can we do? Increase access to health care services and child health insurance Information about available early care and education programs Increase access to child care subsidies Family support programs that are culturally and linguistically appropriate Training health and education personnel to provide culturally responsive services

Reducing disparities: What can we do? “To tackle…the inequities through political commitment on the principles of ‘closing the gap in a generation’ as a national concern” “..to contribute to the improvement of the daily living conditions contributing to the health and social well-being…involving all relevant partners, including civil society and the private sector” 62 nd World Health Assembly (May, 2009)