Florida Department of Health County Directors -- Miami
The text of a speech given by David Lawrence Jr., president of The Early Childhood Initiative Foundation, on May 20, 2004 before the Florida Department of Health County directors in Miami.
Ladies and gentlemen, it is a privilege to be in your midst today. I admire deeply the difference you make.
I am proud of the leadership of Dr. John Agwunobi in behalf of the state. I am proud of the leadership of Lillian Rivera and her team in my own community. And I want to say that while I am sure that Annie Neasman’s retirement is wonderful news for her, I sure hate to lose her (as I know you do, too). Annie Neasman is a class act, and we are all the better for her. But I take great comfort in knowing that Nancy Humbert is ready, willing and able to take on her new assignment. Please know, too, of my deep respect for all of your work with Healthy Start, with WIC, with KidCare, school health, dental health, immunizations, and the list goes on and on. I feel fortunate to work alongside you.
Let the obvious be said up front: What I am able to talk about this noontime is not grounded in any special knowledge of health or medicine. That has made me a bit nervous for weeks now as to what I might share with you that would be useful and interesting. But since I do know something about history, I do have the wherewithal to frame my observations in the context of the past going forward.
And that leads me to read you a brief excerpt from a book I read a couple years back. I quote:
“Little Antanas was not smiling just now, being a mass of fiery red pimples. He had had all the diseases that babies are heir to, in quick succession, scarlet fever, mumps, and whooping cough in the first year, and now he was down with the measles. There was no one to attend him but Kotrina; there was no doctor to help him, because they were too poor, and children did not die of the measles -- at least not often. Now and then Kotrina would find time to sob over his woes, but for the greater part of the time he had to be left alone, barricaded upon the bed. The floor was full of draughts, and if he caught cold he would die. At night he was tied down, lest he should kick the covers off him, while the family lay in their stupor of exhaustion. He would lie and scream for hours, almost in convulsions; and then, when he was worn out, he would lie, whimpering and wailing in his torment. He was burning up a fever, and his eyes were running sores; in the daytime he was…a plaster of pimples and sweat, a great purple lump of misery.” That book is called “The Jungle,” and it was written a century ago by Upton Sinclair. The setting is Chicago, but it could have been anywhere in America.
Life back then, to quote a recent New York Times magazine cover story by Senator Hillary Clinton, bespoke of “crowded living conditions, dangerous workplaces, inadequate sanitation and infrastructure in cities and pollution and infectious disease like typhoid fever and cholera that exacted a huge toll on the oldest and youngest in society. Since then, a century’s worth of advances (have) yielded remarkable results. Antibiotics were developed. Anesthesia was improved. Public health programs like mosquito control and childhood immunizations succeeded in reducing or even eradicating diseases like malaria and polio in this country. Congress passed legislation regulating the quality of food and drugs and assuring that safety and science guided medical developments. Workplace and product-safety standards resulted in fewer deaths and injuries from accidents. Effective campaigns cut tobacco use and alcohol abuse. Employers began providing some workers with health care coverage, primarily for hospitalization costs. And to aid some of those left out, President Lyndon B. Johnson persuaded Congress to establish Medicare and Medicaid to address the poorest, sickest, oldest and highest-risk patients in our society. As a result of these accumulated gains, life expectancy grew from 47 years in 1900 to 77 years for those born in 2000.”
Yet for all those gains, how do we remain a nation now of almost 300 million people that fails to fulfill this country’s promise (and our decency) to millions of our neighbors? For just one example, how could 44 million Americans, among them almost 3 million Floridians, be without health insurance? (Even though 80 percent of the adults have jobs?) How can this be in the richest, most powerful country in the history of the world? What we truly need is “a systemic overhaul,” in the phrasing of a recent Miami Herald editorial.
Now you will recall that the person I quoted a few moments ago was Democratic stalwart Hillary Clinton. Lest you get any impression I think this is a one-party cause, I quote a most certain Republican, Newt Gingrich, who earlier this month had this to say: “Politicians like to say that the United States has the best health care system in the world. Actually, what we have right now is the best medical talent, technology and facilities in the world – but the system that delivers our care is badly broken.”
How could the system for health care in so great a country as ours be so badly broken? Moreover, while I’m at it, how is it possible that among the world’s most industrialized nations, the United States is No. 1 in gross national product, in the number of millionaires and billionaires, in military and health technology, yet this very same country -- our country -- is 10th in eighth grade science scores, 16th in the living standards among the poorest one-fifth of our children, 17th in low birthweight rates, 18th in the gap between rich and poor children, 21st in eighth grade math scores, 22nd in infant mortality and dead last -- literally -- in protecting our children against gun violence?
Are we not a better people than this? Could we not have a vision that embraces all?
That, my friends, is at the core of what I want to talk about today.
In the 115 years since the Health Department was formed in Florida, we came to beat back epidemics of yellow fever and tuberculosis, and make all sorts of other medical advances, yet that could never be satisfaction enough for the parents of the more than 800,000 children in Florida who lack health insurance today.
It is not as though the heart of the problem is skimping on the dollars. Indeed, we pay far more per capita for health care than any other industrialized country in the world. A new RAND study reminds us that we spend $1.3 trillion a year in this country on health, and get “fairly dismal results” for that investment. Meantime, as I read recently, the United States ranks “behind 47 other countries in life expectancy” and we’re No. 42 in infant mortality. Of those 44 million Americans without health insurance, almost a quarter of those are children. How can this be?
I do not bring you simple solutions. We do not live in simple times. But I am here to tell you that unless we can share a vision, we have no chance to make a real difference in the lives and futures of the children of Florida. And unless that vision embraces all, we are doomed to nibble on the margins of progress. This is not socialism, ladies and gentlemen; nor is it radicalism or revolution. Rather, this is a matter of vision and basic American fairness.
Now, let me back up for a few minutes, and tell you how I got to this place in my mind and heart.
You have before you the father of five -- ages 19 to 39 -- and the grandfather of one who is hoping to be the grandfather of many. Until just a few years ago, I had no idea how important my present-day mission of “school readiness” is. (Health is most certainly a fundamentally crucial element in that.) Anyhow, until a few years ago, I would have told you, without hesitation, that "school readiness" begins in kindergarten or first grade. How little I knew. How wrong I was.
I simply did not realize that greatness has by far its best chance to emerge from classrooms whose students get off to a strong start in the early years. I came to learn that if we were ever to make the necessary investments in “school readiness” – that is, the wisest blend of health and education and nurturing -- we would have made the greatest possible contribution to “public education reform” in America. I came to believe this country’s very future depends on “school readiness” with the sure knowledge that all children need stimulating early care and education experiences.
Over these past few years, I have had much to “unlearn,” including any sense that this was about children learning to read, say, by age 3. I read a great deal, visited places like France and Italy to learn more, came to know the research, and continue to follow it closely. I give you just two examples: (1) A national study that told us that if 50 first graders have problems reading, then 44 of them still have problems reading in the fourth grade, and (2) The research over four decades telling us that if we were ever wise enough to invest a dollar up front in children's lives we would save maybe seven dollars or more later on in money we would not need to spend on police, prosecution, prison and remediation of all sorts.
Armed with such research, I came to believe the tragedy of early childhood unpreparedness was preventable. I came to believe that however well intended we might be, we would never make more than incremental change unless we could create real "public will" for real change (most particularly the public awareness on the part of parents for what their children really needed). And I came to believe that you and I must move on a great many fronts because children need all the basics in these early years. No one thing will make the difference. Everything must be available, affordable and accessible and, moreover, of high quality because only real quality leads to making a real difference in children’s futures. That means high-quality parent skill-building, high-quality child care. That means high-quality pre-kindergarten available for all. And, yes, it means health insurance for all children.
My approach was -- and is -- non-partisan and bipartisan. My journey began at the invitation of Gov. Lawton Chiles, a Democrat, but I have in more recent times worked with Republican Jeb Bush. Both men have been governors and leaders of integrity. It is in that spirit that I remind myself, and you, that children do not belong to political parties. They and their cause belong to us all.
I have come to believe that we must build a “movement” in behalf of everyone’s child and everyone’s family. But most times here is what happens: Well-intended people focus their resources on children in neighborhoods encompassing the most deeply disadvantaged. There is a logic of decency and generosity in that approach. But there also a downside to this: Others then tend to observe what is being done – almost invariably in a non-holistic and disconnected way – and conclude, "Oh, I see it is about those children." In fact, however, all children need all the basics. This movement is not about “other people’s children,” but about “everyone’s children.” The same principles that raise my five children, or yours, are the same principles needed for everyone’s children. Moreover, and contrary to what some might think, the children with "readiness" challenges are not infrequently children who do not come from poor and distinctly disadvantaged homes and families and neighborhoods. Increasingly in our country -- state by state, community by community -- good and wise people are building an early childhood movement and seeking to embrace every child.
When I talk about building a “movement,” I most frequently use kindergarten in illustration. While kindergarten was "invented" in 1837, and came in this country a century and a half ago, it took more than a century to be genuinely widespread, kindergarten was frequently fought as unnecessary and, even, "anti-family." For decades, kindergarten was seen as mostly for society's worst off and society's best off. Only when it became a "movement" in behalf of everyone's child did it become a full reality. Today, a high-quality kindergarten experience for all children has become an expectation on the part of every parent of every 5 year old. Kindergarten isn't mandatory in Florida – or for that matter in 34 other states -- but I have yet to meet the parent of a 5 year old who wants anything less than a high-quality kindergarten-like experience for that child. A movement for everyone’s child is basic American fairness. The American dream embraces all children. Building a movement depends on our ability to build genuine private-public partnerships. Collaboration must build from a shared vision.
We in Miami and Florida have elected no “children’s czar,” nor will any community. Instead, any power we have builds from: (1) that shared vision, (2) the ability to convene, and (3) the commitment to act. We work with health people, education people, business people, civic and political people, child care people, people from the faith community, and the list goes on and on. If you came to visit us, you would learn soon enough about The Early Childhood Initiative Foundation, The Children’s Trust, the Miami-Dade School Readiness Coalition, the Family Learning Partnership, the Healthy Start Coalition, United Way Success By 6, and all sorts of other institutions and agencies. But, more important, you would come to know a record of momentum that includes this progress:
Led the campaign to pass a statewide constitutional amendment to provide parents the opportunity, beginning in the 2005 school year, of a high-quality pre-kindergarten experience for their 4 year olds. Led the campaign in our community that will mean more than $60 million a year for early intervention and prevention. Dramatically increased the number of high-quality child care facilities -- from 17 to 200. Began using social, emotional and cognitive assessments with thousands of Miami-Dade 3 and 4 year olds. Created the best local early childhood website in the country, and accompanied by 24-hour phone lines – and everything in three languages. Built partnerships for new-parent packets with 13 birthing hospitals and nine midwifery centers. Send a high-quality parent skill-building newsletter to more than 19,000 homes each month. Embarked on a major study, in 162 child care centers, as to what early learning curricula -- Spanish and English -- work best. Launched, with W.K. Kellogg Foundation support, a readiness project working with 1,600 before-school children in 68 child care centers and eight elementary schools.
I am not bragging. We have so far to go. But I am illustrating what is possible, and already underway, in Miami-Dade and many other places in Florida. Our mutual cause is a moral one...a just one...and, most assuredly, a practical one.
My friends, could we not be wise enough to come together to “own” a portrait of what we would want for every child? Can we not see this as a matter of wise investment in their future and our own? Is it not basic American fairness that every child have a real chance to succeed? Can we not have the strength and compassion to embrace and include every child?
Is there not a way for the public and private sectors to “own” a mutual vision and make a mutual commitment? That is, for only one example, could we not agree that no child should be without a “medical home”? Is it really impossible for us to make this happen? I would despair if you told me, “Yes.” To arrive at a “medical home” for all, let us not be asphyxiated by the one-size-fits-all national thinking of a decade ago. Rather, could we not agree on a vision, a strategic plan and a combination of public and private incentives and investments to get us there? The sort of step taken just recently in Florida with the Governor’s vision for Health Savings Accounts, and all the other so- needed-to-come steps toward a “medical home” for everyone. Ladies and gentlemen, I weary of a world where “fairness” is judged by what level of “poverty” or “near poverty” that people find themselves. I weary of government’s present prisms of 150 or 185 or 200 percent of poverty. Are we not a good enough people to figure out how to make sure no one is left out of society’s fair share. This already is – as it should be – a major issue in this year’s presidential campaign.
Most of us in this room today have children, and we raise them with a pediatrician among our most treasured family allies in ensuring our children grown up healthy and well. But hundreds of thousands of our neighbors in Florida live in a world of hospital emergency rooms as fundamental medical care. That is simply not right…not what could, or should, happen in America. Your very mission, I note, speaks to “promot(ing) the health and safety of all people in Florida.”
Are we good enough, wise enough, tough enough, to embrace all children, all families?
I am not suggesting it will be easy. Suffrage wasn’t easy. Social Security wasn’t easy. Diminishing racial barriers was not easy. Medicare wasn’t easy. But they were right, as the American people came to understand.
This is a great moral cause. The very imperative of justice and fairness impel us to do what is right by all Americans. But it is a most powerful practical cause, too.
“We know what an unhealthy early childhood does to a growing human being,” writes David Shipler in his new book, ‘The Working Poor.’ “”Neuroscience and other areas of research have taught us about the intricate relationships between the biological and the cognitive, between early nurturing and later functioning. Our understanding of the problems is ahead of the skills we have acquired to solve them, and the skills are ahead of our will to act.”
And it is, ladies and gentlemen, most profoundly a matter of “will.” We have known for a long time what we really have to do. Socrates asked us 2 ½ millennia ago, “Fellow citizens, why do you turn and scrape every stone to gather wealth, and take so little care of your children, to whom one day you must relinquish it all?”
So this becomes our burden and our opportunity, and we could, of course, fail in this. It is for that reason that I remind you of the words of the great psychiatrist Karl Menninger, who told us a half-century ago: “What we do to children, they will do to society.”
Let us remember that…and remember that you and I hold the key to the future of our communities. The children we help – and their families, too -- will do much for a better world…if only we do right by them -- and their parents -- in their first few years.
Thank you for caring. Thank you for doing. And God bless you in your important work.