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May 2, 2023
View from Here
State Health Policy Leadership Health Equity
Christopher F. Koller
Apr 11, 2023
Jan 24, 2023
Jan 19, 2023
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Creating distractions is a time-tested political strategy to divert people’s attention from what you don’t want them to see.
In the Rhode Island Office of the Health Insurance Commissioner, in honor of our lawyer’s dog, we called this the “Look, Daisy! A squirrel!” maneuver. We were not above pointing to a squirrel — an alleged insurer misbehavior, some juicy data — to distract people from a more damaging reality, such as a mistake we had made or a potentially controversial policy that we wanted to slip past scrutiny.
And when it worked, as the public sniffed around for the skittish rodent and we skirted the controversy, we would congratulate ourselves on our cleverness.
That dynamic is playing out now in our state legislatures, where waves of coordinated, nationally generated legislation purported to protect children are distracting legislators and the rest of us from much greater threats to kids and to our democracy.
This year alone 10 states have passed legislation to ban or significantly limit for people under 18 the use of puberty blockers, cross-sex hormones, and transition surgery– known collectively as gender-affirming care. In another seven states, bans have passed at least one legislative body. These bills are linked to larger concerns around alleged threats to “parents’ rights,” which are to be defended with bans on certain books and curriculum about racism.
The rise of this legislation is not accidental. Rebuked by broad support for marriage equality, supporters of more traditionally conservative cultural values went fishing for issues where fissures remained. They found it by targeting the estimated 300,000 kids (and 1.3 million adults) who identify as transgender. Groups like the American Principles Project have generated over 150 bills in this legislative season alone to regulate the lives of transgender kids.
“It’s a sense of urgency,” said Matt Sharp, the senior counsel with the Alliance Defending Freedom, an organization that has provided strategic and legal counsel to state lawmakers as they push through legislation on transgender rights. “What can we do to protect the children?”
Mr. Sharp asks an important question. The answer is that we can indeed do lot more than we have been doing recently to protect the children. Although they can raise challenging questions about long-held cultural mores, a few gender-questioning kids are not the true threat to the country’s youth right now.
Research from the indefatigable Steven Woolf and colleagues documents grim news for those truly concerned about protecting our children. After years of steady decline, mortality rates for individuals under age 19 in the United States are increasing. The cause is driven by all categories of injuries, especially among males.
Categorizing the types of childhood injuries on the rise amounts to a list of indictments of our society: transport and poisoning deaths speak to neglect; suicides point to stress, social isolation, and a lack of access to mental health services; and homicides indicate abuse and access to firearms. In fact, firearms are now the leading cause of death for children under 19 and were responsible for almost 50% of the increase in children’s mortality from 2010 to 2020. The increases in death rates associated with injuries started before the pandemic, but it’s possible COVID and its associated conditions accelerated them, Woolf notes.
Particularly in the case of homicide, rates varied by race and ethnicity. In 2021, the homicide rate among non-Hispanic Black youths aged 10 to 19 years was six times that of Hispanic youths, and more than 20 times that of Asian/Pacific Islander non-Hispanic youths and White youths.
The risks also vary based on where a kid is born. Data from the Centers for Disease Control and Prevention (CDC) complied by the Kaiser Family Foundation indicate that a child under 14 in Mississippi was almost five times as likely to die in 2020 as one born in Massachusetts (Figure 1). While some state policies are clearly more protective of kids, the upward mortality trend seems widespread. Informal inspection of the preliminary CDC source data appears to indicate the 2021 trends observed by Woolf have occurred in most states.
Source: State Health Facts. Kaiser Family Foundation. Accessed April 27, 2023. Data: 2014 – 2020: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on April 5, 2022.
Summarizing their evidence, Woolf and colleagues state flatly: “Research and policy efforts to address the underlying causes — e.g., depression, suicidality, opioid use, systemic racism, widening inequities, societal conflict — are urgently needed, as is system redesign to provide help for people affected by these conditions.”
They point particularly to the toll of gun violence: “Current efforts to understand gun violence, overcome political gridlock, and enact sensible firearm policies are not progressing with the speed that pediatric suicides and homicides require.” Recent mass killings in Nashville and Louisville, and well-publicized shootings in Kansas City and upstate New York by socially isolated old white men, underscore the dangers of easy access to and misuse of dangerous weapons.
The increase in the country’s children’s mortality rate documented by Woolf and colleagues means that about 3,500 more children a year are dying now in US than were 10 years ago. This is an indictment of our society and its policies. It is happening on our watch, and we know how to prevent it. Sham legislation that targets vulnerable groups of kids in the name of helping all of them is a dangerous distraction.
But perhaps that is the point. In battling over kids and their rights and protections, our attention is being diverted both from what is truly threatening them and from broader efforts to acquire and maintain political power to advance an agenda that serves the interests of those who finance them.
To the extent that efforts by powerful people to preserve the status quo threaten what we value – population health and health equity, and elections and public governance where all are treated without fear or favor – we cannot be distracted. We must focus both on our children’s health and our country’s.
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