Reprinted with permission of AAP News, April 2005

Chapters vital to 75 years of progress on pediatric issues

This is another in a year-long series of articles leading up to the celebration of the Academy's 75th anniversary in October.

from the AAP Department of Chapter and State Affairs

Despite the hardships brought about by the Great Depression, 1930 was a milestone year for America's children.

President Herbert Hoover had convened the White House Conference on Child Health and Protection. Conference delegates prepared the Children's Charter, a set of 19 principles addressing education, child labor, vocational training, recreation, family welfare, health, and growth and development. The historic charter also contained the first Bill of Rights for the Handicapped Child.

So inspired was one of the delegates, breakfast cereal magnate W.K. Kellogg, that he returned to Michigan and started the W.K. Kellogg Foundation with this simple charge: "Use my money as you please, so long as it promotes the health, happiness and well-being of children."

Elsewhere in Michigan that same year, 35 pediatricians founded the American Academy of Pediatrics. At the organizational meeting, the Academy's founders established a committee to relate to Hoover's White House Conference and its principles. By the following year, another group, the Committee on Relation of the American Academy of Pediatrics to Philanthropic, Welfare and Health and Similar Agencies had filed a report at the AAP annual meeting. Over the next decade, the committee continued to evolve and change names but never lost sight of the Academy's commitment to working with government to improve the health and well-being of children.

Since the bulk of U.S. public health law is under state jurisdiction, AAP chapters have been vital to progress made on pediatric issues over the past 75 years.

1930s and '40s

The state AAP organizations that were established during the 1930s and '40s focused their advocacy efforts on implementation of the principles of the White House Conference on Child Health and Protection, issues related to the maternal and child provisions of the Social Security Act, and on the establishment of standards for hospitalized infants and children. In addition, they were likely to be involved in the state enforcement of the Fair Labor Standards Act outlawing full-time work by children younger than 16 years and in the establishment of "mother's milk bureaus."

1950s

In the 1950s, advocacy efforts were focused on working with state, county and local health departments to help stem the polio epidemic through prevention. In 1955, with the licensing of the polio vaccine, the emphasis was on universal immunization. Since that time, the Academy and state chapters have worked in partnership to develop and maintain strong immunization programs across the country.

There also is evidence of AAP chapter advocacy related to the cost of medical malpractice insurance, the geographic distribution of pediatricians, the establishment of poison control programs, juvenile delinquency and insurance coverage for newborns.

1960s

With the establishment of the Medicaid and Head Start programs by Congress in the 1960s, chapters became more engaged in advocacy work than ever before. The federal-state partnership established by the Medicaid program provided the opportunity for pediatricians and other child health advocates to craft programs to address the health care gaps of children in their respective states. Historic involvement with Medicaid, which continues today, has resulted in Medicaid becoming the largest single insurer of children in the United States.

Also in the 1960s, AAP chapters worked with other groups to enact the first mandatory reporting laws for cases of suspected child abuse and began to raise the issue of the unique health care needs of adolescents and young adults to their legislators.

1970s

A growing number of households with two parents employed outside the home led chapters in the 1970s to explore with state policy-makers concerns over the health and safety of child care centers. In addition, chapter reports indicate that more legislators were seeking the advice of pediatricians on broad topics related to child health care. Insurance regulation, coverage of preventive care and concerns about youth use of tobacco began to take hold.

Advancing technology enabled chapters, together with the March of Dimes, to win the establishment of mandatory newborn screening laws. In Tennessee, Robert Saunders, M.D., FAAP, won passage of the first U.S. child passenger safety law.

1980s

Early in the 1980s, HIV and AIDS were identified. Shortly after, pediatricians recognized that this disease was affecting children and worked with state health departments to address this health crisis.

The 1980s also was the decade of access to care in the states. Increases in eligibility levels in the Medicaid program brought about higher enrollment levels. Concerns related to physician reimbursement began to surface as a result of the growth of the patient population.

A growing willingness on the part of government to play a more active role in injury prevention enabled chapters to win additional seat belt and child safety seat laws and regulation of all-terrain vehicles.

Most chapters had formed state government affairs committees and many had established relationships with lobbyists during the 1980s and '90s.

1990s

Injury prevention continued to be an important state advocacy issue in the 1990s. Bicycle helmet laws were enacted in a number of states, and chapters began to educate the public and legislators about the dangers posed by firearms kept in children's environments. In addition, several chapters were successful in winning bans on corporal punishment in schools.

Perhaps the biggest pediatric advocacy story in the 1990s was the passage of the State Children's Health Insurance Program (SCHIP). Drawing on the success of model state programs that provided coverage for children who did not qualify for Medicaid, the Academy worked with Congress to establish and earmark funds for SCHIP. Once the federal program was established, the Academy provided consultation to chapters as they participated in the development of state programs that best suited the needs of their pediatric population.

Over the past eight years, chapters have worked to enhance SCHIP and protect it from budget cuts. That work continues today.

2000 and beyond

With the new millennium came budget woes for the federal and state governments. AAP chapters have put forth significant efforts to save children's programs from the budget ax, especially Medicaid and SCHIP, while continuing to promote the importance of adequate physician reimbursement.

With most states beginning to climb out of this fiscal crisis, chapters continue to promote the value of the expenditure of state dollars on children's health care coverage.

The terrorist strikes on Sept. 11, 2001, resulted in states focusing on disaster preparedness and bioterrorism. AAP chapters have been engaged since that time in efforts with state health and emergency management agencies to ensure the unique health needs of children are integrated into state preparedness plans.

During the past five years, chapters also have waged important battles to preserve immunization mandates and to ensure that quality care in a medical home is not disrupted by nonphysician clinicians seeking to expand their scope of practice.
Graduated driver licensing systems and booster seat laws have been enacted in many states thanks to the efforts of AAP chapters.

Pediatricians have become so involved in state advocacy that five of them have been elected to state legislatures over the past decade and many others have been appointed to state agencies and regulatory boards. The Academy also established the Chapter Advocacy Summit to help foster the network of advocates in the chapters and states to ensure the advancement of the Academy's goals.

Great progress has been made in the states over the past 75 years, thanks to the dedication of AAP chapters. Those involved in the process would be the first to say, however, that they're just getting started.

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