Breaking Through the Social Determinants of Health – for Children’s Sake


No child should have to suffer because of the conditions in which he or she is born or required to live.

I BEGAN MY CAREER IN health care as a nurse at a children’s hospital 35 years ago, and witnessing the firsthand impact of poverty and child abuse left me deeply affected and motivated to do more. Fast-forward to today – the opportunity to lead a hospital like the Children’s Hospital of Philadelphia means I’m in a position to bring real solutions to the table that will benefit children not only in Philadelphia but also around the world.

As the nation’s first children’s hospital and one of Philadelphia’s most enduring historical institutions, CHOP has long played a central role in helping children and families overcome their greatest obstacles. When the hospital opened its doors in 1855, life in Philadelphia and many other growing cities was marked by a high child mortality rate caused by the poor sanitary conditions that were prevalent during the Industrial Revolution.

Poverty and its effect on children remains a huge challenge today in communities across the country – particularly metropolitan regions – with an estimated 43.1 million Americans living in poverty, according to 2016 U.S. census data. The “social determinants of health” – that is, the economic and social conditions that impact the health of a population – are particularly complex issues for any organization to tackle, including a health care institution like CHOP.

[See: 13 Ways Social Determinants Affect Health.]

However, I believe that CHOP is taking steps to lead all children down a healthier path. Our Homeless Health Initiative provides medical screening for children living in Philadelphia’s shelters. Over the years, we’ve expanded it to include health education and wellness programming. Our effort has paid off with a sustainable model that continues to make a difference.

Beyond our commitment to caring for patients, many CHOP employees are deeply involved in their surrounding communities. Child literacy, violence prevention, fighting obesity and injury prevention are just a few of the ways we are working with community-based organizations to promote health and wellness in the community. Our researchers are working to study the impact of blight, hunger and many other issues in an effort to develop evidence-based interventions to keep children safe and healthy. Hunger is as much a health issue as it is a social issue, and healthy food is the best “medicine,” which is why we have started Philadelphia’s first Pediatric Food Pharmacy. With programs like this one, families can access nutritious food without any stigma.

Of course, we don’t have the market cornered on the best ideas to keep communities healthy, and it’s hard to expect that a single government or organization can meet these substantial challenges alone. We are fortunate to work hand-in-hand with a host of public and private sector partners. For example, CHOP has teamed with Penn, Drexel and other anchor institutions in West Philadelphia to invest in University City District’s West Philadelphia Skills Initiative – a workforce development program that connects the un- and under-employed to jobs with local employers. And over the course of four years, over 120 CHOP employees have provided direct mentorship to middle school students through the Spark Philadelphia program, which provides students the opportunity to get firsthand experience with working in a health care setting onsite at CHOP.

[See: 11 Ways Rural Life Is Hazardous to Your Health.]

Beyond the walls of our buildings, we’re exploring placemaking – that is, reinventing public spaces – as a way to improve community health and wellness. For example, we partnered with The Enterprise Center to host and run one of the largest urban farms in Philadelphia, located at our Nicholas and Athena Karabots Pediatric Care Center. This provides more than 1,000 pounds of fresh fruits and vegetables to the children and families of CHOP’s Early Head Start program. The South Philadelphia Community Health and Literacy Center – an innovative collaboration between CHOP, the Philadelphia Free Library and Departments of Health and Parks and Recreation – is a shining example of a shared vision to provide healthcare, literacy and wellness programming for children and adults under one roof.

In the future, CHOP is looking to play a role in housing, another key social determinant. Poor air quality is common in many homes, which leads to more trips to the emergency department or in-patient hospital stays for children with asthma. Through our Community Asthma Prevention Program, which has worked for nearly 20 years to reduce the triggers of asthma in homes, we plan to create public-private partnerships that can help provide safer, healthier homes for children and their families. The result? Reduced visits to the hospital, less workdays missed for parents and lower health care costs.