Diet, living situation, health care access, and other factors can increase children’s vulnerability to climate change health hazards. [6]

Children, including adolescents under the age of 18, are often more vulnerable than the general population to the health impacts of climate change because:

Children’s bodies are developing physically , which can make them more vulnerable to climate-related hazards like heat and poor air quality. They also breathe at a faster rate , increasing their exposure to dangerous air pollutants. 1

, which can make them more vulnerable to climate-related hazards like heat and poor air quality. They also , increasing their exposure to dangerous air pollutants. Children tend to spend more time outdoors than adults, increasing their exposure to heat and cold, rain and snow, outdoor allergens, and insect bites. 2

than adults, increasing their exposure to heat and cold, rain and snow, outdoor allergens, and insect bites. Children drink more water than adults per pound of body weight. 3 They swallow about twice as much water as adults while swimming. This can increase their exposure to certain contaminants in recreational waters and the risk of developing gastrointestinal or other illnesses. 4

They as adults while swimming. This can increase their exposure to certain contaminants in recreational waters and the risk of developing gastrointestinal or other illnesses. Children are developing emotionally , as their brains continue to grow throughout adolescence. Children can experience mental health impacts from major storms, fires, and other extreme events that are expected to increase with a changing climate. They also can suffer from other changes, such as having to move due to climate threats.

, as their brains continue to grow throughout adolescence. Children can experience mental health impacts from major storms, fires, and other extreme events that are expected to increase with a changing climate. They also can suffer from other changes, such as having to move due to climate threats. Young children depend on adults for their safety and well-being. This dependence can put children at greater risk during extreme events. For example, without adult help, children may not be able to keep their heads above floodwaters or get to safety during a storm.5

On this page:

Climate Change and Children’s Health and Well-Being A 2023 EPA report quantifies projected health effects to children from climate change. The report considers factors such as extreme heat, air quality, changing seasons, flooding, and infectious diseases.

Key Threats to Children’s Health

A number of climate-related hazards threaten the health of children in the United States. Below are examples of the potential health impacts of these hazards.

About 5 million U.S. children have asthma—an average of one out of every 14 children under the age of 18. [12]

Respiratory Illnesses

Climate change has the potential to increase outdoor air pollutants, such as dust from droughts, wildfire smoke, and ground-level ozone. Ground-level ozone and particulate matter are associated with increases in asthma and other respiratory conditions in children.10, 11 Climate change can also increase pollen and prolong the allergy season. Higher outdoor temperatures can lead to children spending more time indoors, where they can be exposed to indoor pollutants, such as tobacco smoke and mold.

Heat Illnesses

Extreme heat events are expected to last longer and become more frequent and intense as the climate changes.13 Heat-related illnesses can occur when a person is exposed to high temperatures and their body cannot cool down. Increases in average and extreme temperatures are expected to lead to more heat illnesses and deaths among vulnerable groups, including children.14 Heat can affect children who spend time outdoors playing and exercising.

Approximately 9,000 U.S. high school athletes are treated for heat illnesses each year. [17]

Young athletes are at particular risk of heat stroke and heat illnesses.15 Children who live in homes without air conditioning are also at risk. Young children and infants are particularly vulnerable to heat-related illnesses and death, as their bodies are less able to adapt to heat.16

Water-Related Illnesses

Runoff from more frequent and intense rains, flooding, and coastal storms can introduce more pollutants and disease-carrying organisms into water bodies where children swim and play or that communities use as drinking water supplies.18

These contaminants can impact drinking water supplies and recreational waters.19 Untreated, contaminated water can cause gastrointestinal illnesses for any individual drinking or coming into contact with it;20 however, children have a higher risk of gastrointestinal illness if they come in contact with contaminated water than adults.21, 22

Heavy rainfall has been linked to occurrences of gastrointestinal illnesses in U.S. children. [26]

Increasing water temperatures associated with climate change can also encourage the growth of bacteria and harmful algae in coastal waters.23 This can lead to harmful algal blooms, which can make people sick if they swim or play near them.24 Because of the ways children tend to behave in water, they are at greater risk for getting sick compared to adults.25 In some areas, rising air and water temperatures will also extend the swimming season, increasing children’s risks of getting gastrointestinal and other water-related diseases, as well as eye and ear infections.

Overlapping Vulnerabilities When children are also part of other groups vulnerable to climate change, this compound effect can increase their health risks. For instance, Native American/Alaska Native infants are hospitalized more for diarrheal disease than infants in the general U.S. population—often due to a lack of safe and reliable drinking water.7 Extreme rainfall and warmer temperatures, which have been linked to bacterial contamination of drinking water, are expected to further impact tribal water supplies.8 In addition, children in low-income households and non-white children are more likely to be exposed to extreme heat and air pollution. They are also less able to escape from extreme weather events.9

Insect- and Tick-Related Diseases

Climate change is expanding the habitat ranges and length of time when insects and ticks are common.27 In some regions, that results in a northward expansion of where ticks may live; while other areas could also see ticks active for longer periods throughout the year.28 Warmer temperatures associated with climate change can also increase mosquito development and biting rates, while increased rainfall can create breeding sites for mosquitos.29

Because children spend a lot of time outdoors, they are vulnerable to insect and tick bites that can cause illnesses like West Nile virus and Lyme disease. In rare cases, West Nile virus can lead to serious or fatal sickness.30 Separately, studies show that children between the ages of 5 and 9 report a higher frequency of Lyme disease compared to most other age groups.31 Lyme disease can cause chronic pain and neurological problems if not treated early.32

Food System Impacts

Children and adults were food insecure in 8.8 percent of U.S. households (3.3 million households) in 2022. [38]

Proper nutrition is essential for children’s physical and mental growth. Extreme events, such as wildfires, floods, heat waves, and droughts may disrupt food production and distribution, increase costs, and limit availability. These impacts could make it harder for children to get healthy food.33 Diseases, pests, and water shortages can also affect crop productivity and quality.

Most U.S. households are currently food secure. This means they have consistent, dependable access to enough food for active, healthy living. But millions of households with children experience food insecurity at times during the year. This means their access to adequate food is limited by a lack of money and other resources.34

Climate change may affect certain disease-causing organisms in the food chain.35 For instance, Escherichia coli (E. coli) could increase with a warmer and more humid climate.36 These climate changes, combined with other social and economic factors, may increase children’s vulnerability to some food-related illnesses. For example, children are more prone to severe illness or complications from E. coli infections.37

Mental Health Effects

Climate change is directly and indirectly influencing mental health for children. Children who go through a natural disaster or extreme weather event may have anxiety, depression, trouble sleeping, phobias, and post-traumatic stress.39 Children’s ability to cope with these events depends on many factors, including their living situation and support systems. There may be a perception that children are resilient to traumatic events. However, mental health impacts may last into adulthood, especially if left untreated.40

In addition to the acute distress that children are experiencing more frequently from climate disasters, broader climate distress can build up over time, increasing the risk of mental health issues such as anxiety and depression.41 Although climate distress is not a clinical condition, some children may develop new mental health disorders or experience exacerbations of existing conditions with ongoing distress from the changing climate.42

Despite recent progress, Alabama trails much of the nation in child wellbeing, new data shows.

Alabama dropped from 39th to 43rd this year in a national ranking, called the Kids Count Data Book, released this week. The report measures several indicators of children’s health and wellbeing, including child poverty, infant mortality rates and education.

Experts warned that high housing costs, as well as access to health insurance and quality maternal health care, remain key challenges for many Alabama families.

“The latest data on child well-being in Alabama is a compelling call to action — a clear reminder that we must continue to invest in the policies and programs that uplift all our families and build a stronger future for every child,” Apreill Hartsfield, Alabama Kids Count director of VOICES for Alabama’s Children, said in a news release.

This year, Alabama saw the biggest declines in health and academic rankings, and no improvement in economic or community factors.

The report compares the latest available health, education and economic data against pre-pandemic figures. This year’s findings showed:

Graduation rates are dropping. The share of Alabama high schoolers not graduating on time increased from 9% in 2020-21 to 12% in 2021-22, causing Alabama’s rank to drop from first in the nation the previous school year to 13th.

Middle school math scores are lagging. Only 18% of Alabama eighth graders scored at or above proficient in math in 2024, a drop from 21% in 2019 and 19% in 2022.

Child poverty rates remain stagnant. While fewer children live in places with concentrated poverty, the overall child poverty rate in Alabama (21%) has not changed since 2019.

Housing costs are rising. One in four Alabama children live in homes with a high housing cost burden, meaning families spend more than 30% of their income on housing.

Fewer children are insured. Nearly 46,000 Alabama children did not have health insurance in 2023 – an increase of 33% from 2022 and 2019.

Teen birth rates are decreasing. The state is seeing a steady decline in teen births, from 20 births per 1,000 teens in 2023 to 26 births per 1,000 teens in 2019. The national average is 13 births per 1,000 teens.

The report compares the most recent available data across a variety of metrics, but the state has reported some updates in certain topics. In 2023-24, 90% of eligible students graduated on time.

Academic gains and gaps

In the academics category, Alabama dropped from a ranking of 34th in the U.S. in 2024 to 38th this year.

VOICES for Alabama’s Children warned that, combined with broader declines in child wellbeing, dips in math scores and graduation rates “underscores ongoing challenges facing our schools, students and families.”

Alabama has made several key gains among younger students in reading and math, managing to slightly improve or hold scores flat while other states regressed during the pandemic. Middle school scores, however, continue to fall, and gaps between white students and students of color are widening.

Leaders have also put more effort into making sure students are ready for college or the workforce once they graduate. Recent data shows that while graduation rates remain at about 90%, college and career readiness rates are now the highest they have ever been at 84%.

The Alabama State Board of Education is expected to reveal 2024-25 reading and math scores and the most recent graduation data at its June work session this week.

The report highlighted a few bright spots in educational attainment and early childhood intervention.

According to the report, 91% of children live in families where the head of the household holds a high school diploma – an increase from 89% in 2019. More of the state’s young children under three years old also are getting early intervention services.

Alabama’s rural areas are hit hardest

Child wellbeing largely depends on ZIP codes, data shows. Across the state, poor health and academic outcomes are most pronounced in deeply impoverished areas.

More than one in five children (21%) in Alabama live in poverty – a rate that has remained stagnant throughout the pandemic. Another 10% of children live in extreme poverty, meaning they live in a household with an annual income that is less than 50% of the annual poverty threshold.

Data shows Alabama’s Black Belt and rural areas in the northern part of the state have some of the worst economic outcomes for children. In Sumter County, for example, the extreme childhood poverty rate is more than triple the state average at 31%.

Explore more data on your county or local school district here.

About 1% of K-12 students in Alabama report experiencing homelessness, but in a cluster of counties surrounding Montgomery, those rates range from 5% to up to 16%. Perry County also had the highest percentage of teens not attending school and not working at 26% – more than triple the state average.

The western part of the Black Belt, including Perry, Greene and Tuscaloosa counties, also faces some of the largest gaps in prenatal and maternal healthcare. In Perry County, the infant mortality rate has skyrocketed from 12% in 2021 to 20% in 2022, while the state average remains around 7%.

Policy recommendations

Advocates say there are a few areas where the state can take immediate action.

More Alabama children (71% in 2023, compared to 69% in 2019) live in a household where at least one parent had a full-time, year-round job. However, during the same period, the percentage of children in families facing high housing costs rose from 24% to 25% – a difference of nearly 12,000 children.

“Policies that promote adequate housing, encompassing affordability, safety, comfort, accessibility and cultural suitability, are essential for meeting basic needs and supporting families in achieving economic stability,” VOICES for Alabama Children wrote in a news release. “For children, this results in improved health outcomes, enhanced academic performance, and increased access to community resources.”

The number of uninsured children in Alabama, about 46,000, increased by 33% in 2023 compared to the 37,000 who were uninsured in 2019.

The organization attributes the spike to the end of pandemic-related coverage, as well as the state’s refusal to expand Medicaid.

“Access to health care coverage improves outcomes by facilitating early detection of issues, ensuring timely treatment, and increasing the likelihood that children are covered when adults in the household have insurance, supporting long-term family health and well-being,” the release stated.

President Trump has made a slew of immigration policy changes focused on restricting entry at the border and increasing interior enforcement efforts to support mass deportation. These include rescinding protections against enforcement action in previously protected areas such as health care facilities and schools. While many of these actions focus on the estimated 11 million undocumented immigrants in the U.S., they will have ripple effects among the much larger number of people in immigrant families, including millions of U.S.-born citizen children. During the first Trump administration, restrictive immigration policies and increased enforcement activity led to increased fears among immigrant families across immigration statuses that had negative effects on health and well-being, employment, and daily life. They also could lead to family separations as well as mass detentions, which can have negative mental and physical health impacts on immigrants across statuses and their children. Mass deportations also could negatively impact the U.S. economy and workforce, given the role immigrants play, particularly in certain industries, including health care.

The extent to which President Trump will be able to carry out his plans without additional legislative action and in the face of potential court challenges remains uncertain. However, these plans are already affecting immigrants’ daily lives and increasing fears, with Immigrations and Customs Enforcement (ICE) agents carrying out raids across communities, and reports of nearly 1,000 people arrested in one recent day. This brief discusses the potential implications of increased enforcement actions under the Trump administration for the health and well-being of families and potential broader impacts for communities, the workforce, and the economy, including health care.

What actions is President Trump taking to increase interior enforcement and who may be affected?

Upon taking office, President Trump issued a series of executive orders focused on restricting immigration and increasing interior enforcement activity. These include orders limiting birthright citizenship, declaring a national emergency at the Southern border and restricting access at the border, expanding enforcement policies, suspending the refugee admissions program, and rescinding numerous Biden-era policies, including a policy that protected against enforcement in “sensitive areas,” including schools and health care facilities. Many of the changes outlined in the orders may require legislative or regulatory action to implement, and many are likely to be challenged in court. For example, a federal judge has already blocked the order to end birthright citizenship through a temporary restraining order. However, these changes are already increasing fears and uncertainty among families and communities. Other changes may put other groups with lawful status at risk of losing protections, including Deferred Action for Childhood Arrivals (DACA) recipients and people with Temporary Protected Status (TPS) designations from some countries. The administration recently revoked TPS for Venezuelans living in the U.S., which will make them at risk for deportation in coming months and eliminate their work authorizations.

While enforcement actions are focused on undocumented immigrants, they will have ripple effects across millions more people living in immigrant families, including U.S.-born citizen children. As of 2023, there were 47.1 million immigrants residing in the U.S., including 22.4 million noncitizen immigrants, of whom an estimated 11 million are undocumented. Additional immigrants that currently have lawful statuses may be at risk for enforcement actions under new policies if they lose protections, including nearly 1.2 million immigrants who either have or are eligible for TPS, the over 530,000 active DACA recipients, and individuals in the U.S. with pending asylum cases. Millions of additional individuals living in immigrant families also are likely to be impacted. Many undocumented immigrants live in families with mixed immigration statuses that may include people with lawful status and U.S. citizens. As of 2023, 19 million, or one in four, children in the U.S. had an immigrant parent, including one in ten (12%) who are citizen children with a noncitizen parent. An estimated 4.4 million U.S.-born children live with an undocumented immigrant parent.

What are the likely impacts of enhanced enforcement activity on the health and well-being of immigrant families?

Prior KFF focus groups with immigrant families during the first Trump administration found that restrictive immigration policies, including increases in detention and deportation, led to increased fears among immigrant families across immigration statuses that had negative effects on health and well-being. Immigrant families, including those with lawful status, reported experiencing resounding levels of fear and uncertainty. Some also reported changes in daily life such as increased difficulty finding employment, leading to increased financial strains on families. Some parents, particularly those who are undocumented or who have an undocumented family member, said they would only leave the house when necessary, such as for work; limit driving; or no longer participate in recreational activities, leading to children spending many hours inside. Parents and pediatricians reported a broad array of impacts of increased fears among children, including behavioral changes, such as problems sleeping and eating; psychosomatic symptoms, such as headaches and stomachaches; and mental health issues, such as depression and anxiety. Parents and pediatricians also felt that fears negatively affected children’s behavior and performance in school. Pediatricians expressed significant concerns about the long-term health consequences of these fears for children, including the damaging effects of toxic stress on physical and mental health over the lifespan, negative effects on children’s growth and development, and compounding social and environmental challenges that negatively impact health.

Increased fears under the first Trump Administration also led to growing reluctance among some families, including lawfully present immigrants and citizen children, about participating in programs and seeking services for which they are eligible, including health coverage and care. In KFF focus groups with immigrant families during the first Trump administration, parents noted that they highly prioritize their children’s health and generally viewed hospitals and doctors’ offices as safe spaces. However, there were some reports of changes in health care use, including decreased use of some care, and decreased participation in Medicaid and CHIP and other programs due to increased immigration-related fears. Despite efforts by the Biden administration to reduce these fears, data from the KFF/LA Times Survey of Immigrants showed that, as of 2023, nearly seven in ten (69%) likely undocumented immigrants, a third (33%) of lawfully present immigrants, and over one in ten (12%) naturalized citizen immigrants said they ever worried that they or a family member could be detained or deported. Moreover, about a quarter (27%) of likely undocumented immigrants and nearly one in ten (8%) lawfully present immigrants say they avoided applying for food, housing, or health care assistance in the past year due to immigration-related fears (Figure 1). Fears about accessing health care services may be enhanced under the second Trump administration, given the recission of a policy dating back to 2011, that protected against enforcement activity in sensitive areas, including health care facilities. Health care providers will face new challenges helping families feel safe accessing health care, protecting patient information, and establishing protocols to respond to potential encounters with ICE agents. Additionally, Florida and Texas have implemented policies that require hospitals to request immigration status from patients, which may further enhance fears about accessing care.

KFF interviews with individuals who had a family member detained or deported during the first Trump administration reported broad negative impacts on health and well-being. Respondents reported that detention and deportation of family members often occurred suddenly and unexpectedly, leaving families in shock and unprepared. One of the most immediate and significant effects on families was the loss of income, which left them struggling to pay their bills, including rent, food, and utilities. They further reported disruptions to children’s daily lives, and, in some cases, older children assuming new responsibilities and changing plans, such as no longer attending college, to support the family. Families also reported direct health impacts, including symptoms of depression and worsening chronic conditions. Some families reported losing health coverage and increased barriers to accessing coverage or care due to fears and increased financial challenges.

Other research shows that immigration enforcement raids and family separations can lead to worsened physical and mental health of both parents and children of deported parents. Exposing children to traumatic events and prolonged or toxic stress such as raids and separation from a parent disrupts a child’s healthy development and can result in short- and long-term negative effects on physical, mental, and behavioral health. Research has found that living near areas subject to immigration enforcement raids increased the risk of negative mental health among children of immigrants and worse birth outcomes among both Hispanic immigrant mothers as well as U.S.-born Hispanic mothers as compared to non-Hispanic White mothers. Education outcomes also worsened among Hispanic children in areas impacted by raids compared to White children. One potential consequence of raids and detentions and deportations is the separation of parents from their children. Studies have found that children and caregivers impacted by family separations experience worse mental health, including anxiety, depression, and posttraumatic stress disorder. Family separations can also lead to financial challenges for mixed-status households due to loss of income.

Prior experience suggests that immigrants held in detention facilities may not receive sufficient health care and face unsafe conditions. As the Trump administration escalates enforcement actions, the number of people held in detention facilities will grow likely beyond current capacity. Research showed that detainees, including children, experience poor conditions and inadequate care in detention facilities. An analysis found that most of the deaths of immigrants in detention occurred among “relatively young and healthy men” and were associated with ICE violating their own medical standards. Detention and solitary confinement can also worsen the mental health of immigrants. Studies show high levels of psychiatric distress, including depression and post-traumatic stress, among detained immigrants and their children, even after short detention periods. Research on immigrant detention centers have also found gaps in care for pregnant Hispanic migrants and that LGBT detainees experience higher rates of harassment than non-LGBT detainees.

What are the potential impacts of enhanced enforcement activity on the nation’s economy and workforce?

Mass deportations could also negatively impact the U.S. workforce, given the role immigrants play, particularly in certain industries, including health care. Most immigrants say they came to the U.S. for better work and educational opportunities. Immigrants and their U.S.-born children fill unmet labor market needs and have been the primary drivers of workforce growth, accounting for 83% of the growth in the U.S. labor force between 2010 and 2018. Research shows that immigration does not displace nor lead to more unemployment among U.S. born workers as they often do not compete for the same jobs. Immigrants and their adult children play outsized roles in certain occupations, including agriculture, construction, and health care (Figure 1). As the U.S. 65 and older population grows, deportation of immigrants may exacerbate the health care workforce shortage. Immigrants and their adult children make up a larger share of physicians, surgeons, and other health care practitioners than they do of the population and play a particularly large role as direct care workers in home and community-based settings.

Mass deportations may also reduce the billions of dollars immigrants, including undocumented immigrants, pay in federal, state, and local taxes, which help subsidize health care for U.S.-born citizens. It is estimated that more than a third of their tax dollars are payroll taxes that fund programs they cannot access, including Social Security, Medicare, and the federal share of unemployment insurance. Children of immigrants also contribute more in taxes on average than their parents or the rest of the U.S.-born population. The Congressional Budget Office (CBO) estimates that the recent immigration surge will reduce the federal deficit over the next decade. Research further finds that immigrants pay more into the health care system through taxes and health insurance premiums than they utilize, helping to subsidize health care for U.S.-born citizens. Earlier research found that without the contributions undocumented immigrants make to the Medicare Trust Fund, it would reach insolvency earlier, and that undocumented immigrants result in a net positive effect on the financial status of Social Security.

Expanding capacity to carry out mass deportations would likely be a significant cost to taxpayers and may require additional allocations by Congress. New estimates suggest that Trump’s plan to deport millions of undocumented immigrants could cost hundreds of billions of dollars. Trump’s selected border czar reported an estimated cost of $86 billion. Increases in enforcement activity would likely strain limited resources at ICE and the current system of detention centers, which is already at capacity. Expanding detention capacity to support large-scale deportations would require large investments in infrastructure, including setting up new detention facilities, expanding immigration court capacity, increasing the use of private contractors, and paying for more flights used for deportations.

Achieving Lifelong Health Starts with Improving Child Health and Wellbeing

A 570-page National Academies report, co-led by Tina Cheng, MD, MPH, Cincinnati Children’s, and James Perrin, MD, Harvard Medical School, provides a strategic roadmap to revolutionize the U.S. child and adolescent healthcare system

“U.S. children are not well. Increasing morbidity and mortality threaten their health and wellbeing and that of the coming adult workforce. The crisis comes in the context of decades of policies that disadvantage racially and ethnically diverse and low-income communities and have resulted in inequitable opportunities for children and disparate outcomes that start in childhood and extend into adulthood. National progress to reverse this crisis and improve long-term outcomes for all Americans will come only from a dedicated and ongoing commitment to focus on children, youth, and their families.”

This statement comes from a recently published by the National Academies of Sciences, Engineering, and Medicine, which emphasizes the urgent need for a committed, national focus on systemic change to better serve all children and families.

The report, “Launching Lifelong Health by Improving Health Care for Children Youth, and Families,” underscores the importance of investing in children now to secure a healthier and more prosperous future for all.

CALLS TO ACTION: TRANSFORMING CHILD HEALTHCARE

The report outlines five key strategic goals for overhauling the child and adolescent healthcare system:

Elevate Child and Adolescent Health Prioritize child and adolescent health at all government levels through integrated programs and impactful policies. Finance Health Systems for Prevention and Promotion Reform Medicaid and CHIP for full coverage and adopt value-based payment models that reward prevention. Strengthen Community-Level Health Promotion Increase funding for community health initiatives, reduce disparities, and enhance school-based health programs through local partnerships. Engage Families and Communities Co-design child-centered systems with communities and invest in a diverse, culturally competent healthcare workforce. Implement Measurement and Accountability Implement equity-focused measurement systems, enhance cross-agency collaboration, and ensure transparent health data reporting.

A VISION FOR EQUITABLE CHILD HEALTHCARE

“The United States is one of a few resource-rich countries in the world that does not entitle young children to health care, with resulting disparities and some of the lowest rates of access to preventive care and routine services among resource-rich countries,” the report states. “As a result of persistent disparities in prevention and health promotion, many U.S. cities and states report high rates of infant mortality, preventable disease outbreaks, and high costs of care for many specialty conditions. Large subsets of U.S. children face barriers to positive mental and physical health and wellbeing as a result of poverty, food insecurity, unsafe or unstable housing, neighborhood segregation, insufficient access to high-quality care, and other adverse childhood experiences.”

The report envisions a broad, cross-sector child and adolescent health care system that promotes flourishing equitably, builds on community strengths, and addresses family and community needs to create the environment that all children need to thrive.

INSPIRING CHANGE

Cheng presented highlights of the report during an hour-long Pediatric Grand Rounds event held at Cincinnati Children’s on Jan. 14. 2025.

Watch a recording of the entire presentation.

She opened her presentation quoting American writer and civil rights activist, James Baldwin, whose words still resonate today: “The children are always ours. Every single one of them… We will all profit or pay for what they become.”

Noting that significant cuts have been proposed for Medicaid, Cheng said, “I think people are aware that half of U.S. children are enrolled in Medicaid and CHIP. We need to protect kids in the cuts that occur.”

Cheng framed support for Medicaid as an economic investment, reinforcing that investing in child health is investing in America’s future workforce.

“It has been shown that Medicaid enrollment during childhood increases earnings during adulthood. This is nothing new to us, but I think a lot of people do not realize that,” she said.

She called for a national coalition and public campaign under the banner, “Children First for a Prosperous America,” to reshape public and policymaker perspectives on child health.

Cheng to speak in Ottawa

Cheng will discuss the 2024 NASEM report during the opening keynote address on April 14 at the 2025 Children’s Healthcare Canada Annual Conference.

More events are in the planning stages.

ABOUT THE NASEM COMMITTEE AND REPORT

The National Academies of Sciences, Engineering, and Medicine Committee on Improving the Health and Wellbeing of Children and Youth Through Health Care System Transformation was co-chaired by Cheng and James M. Perrin, Harvard Medical School. Committee members included Louis P. Appel, People’s Community Clinic; Christina Bethell, Johns Hopkins University; Ashleigh Ficarino Bowman, University of South Alabama; Nathan T. Chomilo, University of Minnesota Medical School; Ashleigh D. Coser, Health Service Psychologist with the Cherokee Nation; Alison E. Cuellar, George Mason University; Hala H. Durrah, Patient Family Engagement Consultant; Carole R. Gresenz, Georgetown University; Kelly J. Kelleher, The Ohio State University; William Martinez, University of California, San Francisco; Philip O. Ozuah, Montefiore Einstein Medicine; Sarah A. Stoddard, University of Michigan; Lequisha S. Turner, University of Nebraska Medical Center Munroe Meyer Institute; Jennifer R. Walton, University of Miami Miller School of Medicine. Staff supporting the report included Julie Schuck, Study Director; Abigail Allen, Associate Program Officer; Sunia Young, Research Associate; Shaakira Parker, Associate Program Officer; Emma Moore, Senior Program Assistant.

This consensus study report “Launching Lifelong Health by Improving Health Care for Children, Youth, and Families” was sponsored by the Academic Pediatric Association, Agency for Healthcare Research and Quality, American Academy of Pediatrics, American Board of Pediatrics, Children’s Hospital Association, Health Resources and Services Administration, Robert Wood Johnson Foundation, Silicon Valley Community Foundation, and The David & Lucile Packard Foundation.

Presidential Actions ESTABLISHING THE PRESIDENT’S

MAKE AMERICA HEALTHY AGAIN COMMISSION

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered:

Section 1. Purpose. American life expectancy significantly lags behind other developed countries, with pre‑COVID-19 United States life expectancy averaging 78.8 years and comparable countries averaging 82.6 years. This equates to 1.25 billion fewer life years for the United States population. Six in 10 Americans have at least one chronic disease, and four in 10 have two or more chronic diseases. An estimated one in five United States adults lives with a mental illness.

These realities become even more painful when contrasted with nations around the globe. Across 204 countries and territories, the United States had the highest age-standardized incidence rate of cancer in 2021, nearly double the next-highest rate. Further, from 1990-2021, the United States experienced an 88 percent increase in cancer, the largest percentage increase of any country evaluated. In 2021, asthma was more than twice as common in the United States than most of Europe, Asia, or Africa. Autism spectrum disorders had the highest prevalence in high-income countries, including the United States, in 2021. Similarly, autoimmune diseases such as inflammatory bowel disease, psoriasis, and multiple sclerosis are more commonly diagnosed in high-income areas such as Europe and North America. Overall, the global comparison data demonstrates that the health of Americans is on an alarming trajectory that requires immediate action.

This concern applies urgently to America’s children. In 2022, an estimated 30 million children (40.7 percent) had at least one health condition, such as allergies, asthma, or an autoimmune disease. Autism spectrum disorder now affects 1 in 36 children in the United States — a staggering increase from rates of 1 to 4 out of 10,000 children identified with the condition during the 1980s. Eighteen percent of late adolescents and young adults have fatty liver disease, close to 30 percent of adolescents are prediabetic, and more than 40 percent of adolescents are overweight or obese.

These health burdens have continued to increase alongside the increased prescription of medication. For example, in the case of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder, over 3.4 million children are now on medication for the disorder — up from 3.2 million children in 2019-2020 — and the number of children being diagnosed with the condition continues to rise.

This poses a dire threat to the American people and our way of life. Seventy-seven percent of young adults do not qualify for the military based in large part on their health scores. Ninety percent of the Nation’s $4.5 trillion in annual healthcare expenditures is for people with chronic and mental health conditions. In short, Americans of all ages are becoming sicker, beset by illnesses that our medical system is not addressing effectively. These trends harm us, our economy, and our security.

To fully address the growing health crisis in America, we must re-direct our national focus, in the public and private sectors, toward understanding and drastically lowering chronic disease rates and ending childhood chronic disease. This includes fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety. We must restore the integrity of the scientific process by protecting expert recommendations from inappropriate influence and increasing transparency regarding existing data. We must ensure our healthcare system promotes health rather than just managing disease.

Sec. 2. Policy. It shall be the policy of the Federal Government to aggressively combat the critical health challenges facing our citizens, including the rising rates of mental health disorders, obesity, diabetes, and other chronic diseases. To do so, executive departments and agencies (agencies) that address health or healthcare must focus on reversing chronic disease. Under this policy:

(a) all federally funded health research should empower Americans through transparency and open-source data, and should avoid or eliminate conflicts of interest that skew outcomes and perpetuate distrust;

(b) the National Institutes of Health and other health-related research funded by the Federal Government should prioritize gold-standard research on the root causes of why Americans are getting sick;

(c) agencies shall work with farmers to ensure that United States food is the healthiest, most abundant, and most affordable in the world; and

(d) agencies shall ensure the availability of expanded treatment options and the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.

Sec. 3. Establishment and Composition of the President’s Make America Healthy Again Commission. (a) There is hereby established the President’s Make America Healthy Again Commission (Commission), chaired by the Secretary of Health and Human Services (Chair), with the Assistant to the President for Domestic Policy serving as Executive Director (Executive Director).

(b) In addition to the Chair and the Executive Director, the Commission shall include the following officials, or their designees:

(i) the Secretary of Agriculture;

(ii) the Secretary of Housing and Urban Development;

(iii) the Secretary of Education;

(iv) the Secretary of Veterans Affairs;

(v) the Administrator of the Environmental Protection Agency;

(vi) the Director of the Office of Management and Budget;

(vii) the Assistant to the President and Deputy Chief of Staff for Policy;

(viii) the Director of the National Economic Council;

(ix) the Chairman of the Council of Economic Advisers;

(x) the Director of the Office of Science and Technology Policy;

(xi) the Commissioner of Food and Drugs;

(xii) the Director for the Centers for Disease Control and Prevention;

(xiii) the Director of the National Institutes of Health; and

(xiv) other members of my Administration invited to participate, at the discretion of the Chair and the Executive Director.

Sec. 4. Fighting Childhood Chronic Disease. The initial mission of the Commission shall be to advise and assist the President on how best to exercise his authority to address the childhood chronic disease crisis. Therefore, the Commission shall:

(a) study the scope of the childhood chronic disease crisis and any potential contributing causes, including the American diet, absorption of toxic material, medical treatments, lifestyle, environmental factors, Government policies, food production techniques, electromagnetic radiation, and corporate influence or cronyism;

(b) advise and assist the President on informing the American people regarding the childhood chronic disease crisis, using transparent and clear facts; and

(c) provide to the President Government-wide recommendations on policy and strategy related to addressing the identified contributing causes of and ending the childhood chronic disease crisis.

Sec. 5. Initial Assessment and Strategy from the Make America Healthy Again Commission. (a) Make our Children Healthy Again Assessment. Within 100 days of the date of this order, the Commission shall submit to the President, through the Chair and the Executive Director, the Make Our Children Healthy Again Assessment, which shall:

(i) identify and describe childhood chronic disease in America compared to other countries;

(ii) assess the threat that potential over-utilization of medication, certain food ingredients, certain chemicals, and certain other exposures pose to children with respect to chronic inflammation or other established mechanisms of disease, using rigorous and transparent data, including international comparisons;

(iii) assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs;

(iv) identify and report on best practices for preventing childhood health issues, including through proper nutrition and the promotion of healthy lifestyles;

(v) evaluate the effectiveness of existing educational programs with regard to nutrition, physical activity, and mental health for children;

(vi) identify and evaluate existing Federal programs and funding intended to prevent and treat childhood health issues for their scope and effectiveness;

(vii) ensure transparency of all current data and unpublished analyses related to the childhood chronic disease crisis, consistent with applicable law;

(viii) evaluate the effectiveness of current Federal Government childhood health data and metrics, including those from the Federal Interagency Forum on Child and Family Statistics and the National Survey of Children’s Health;

(ix) restore the integrity of science, including by eliminating undue industry influence, releasing findings and underlying data to the maximum extent permitted under applicable law, and increasing methodological rigor; and

(x) establish a framework for transparency and ethics review in industry-funded projects.

(b) Make our Children Healthy Again Strategy. Within 180 days of the date of this order, the Commission shall submit to the President, through the Chair and the Executive Director, a Make Our Children Healthy Again Strategy (Strategy), based on the findings from the Make Our Children Healthy Again Assessment described in subsection (a) of this section. The Strategy shall address appropriately restructuring the Federal Government’s response to the childhood chronic disease crisis, including by ending Federal practices that exacerbate the health crisis or unsuccessfully attempt to address it, and by adding powerful new solutions that will end childhood chronic disease.

(c) The Chair may hold public hearings, meetings, roundtables, and similar events, as appropriate, and may receive expert input from leaders in public health and Government accountability.

Sec. 6. Additional Reports. (a) Following the submission to the President of the Strategy, and any final strategy reports thereafter, the Chair and the Executive Director shall recommend to the President updates to the Commission’s mission, including desired reports.

(b) The Commission shall not reconvene, following submission of the Strategy, until an updated mission is submitted to the President through the Executive Director.

Sec. 7. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

THE WHITE HOUSE,

February 13, 2025.