We in the United States do not have a health care system; rather, we have a health care non-system. The non-system is complex, composed of isolated elements (including practitioners, hospitals, insurers, and public health entities) lacking connection or communication. Compared with other nations, our health outcomes are poor and our cost is high. Worst of all, our uncoordinated non-system results in consequences that are harmful to our most vulnerable – our children – and this harm has long-term implications throughout one’s life.

While there is certainly no magic bullet, constructing a system that keeps in mind the needs of families and children will prove crucial to the integrity of the system as a whole. Improvement will certainly require simultaneous efforts on a number of fronts, but building a system around the needs of our children will create health care that embodies our values, delivers effectively, and eventually lowers cost.

Our nation would be well served by a primary focus on improving health and health care of children as part of greater health reform. This investment would be an economic and a health stimulus, amplified many times over by improving family health, economic growth, and establishing health behaviors with long lasting implications. Maintaining a focus on children and rebalancing our health investment with proportionately greater resources in community prevention and a greater emphasis on redesigned primary care should, over time, have a significant impact on the health of all Americans.

Any real system must put a priority on primary care and preventive medicine built around the family and child. With childhood obesity threatening to shorten the lifespan of our nation’s next generation and asthma prevalence continuing to grow, primary care and preventive medicine are a lynchpin in curbing these epidemics. In practical terms, this means, among other elements, a significant reinvestment in primary care – not simply in the existing models but in new, multidisciplinary models: the medical model and the health home model. These models include creation of resources shared across multiple organizations such as care coordination, health information technology, and quality improvement capabilities. Moreover, it will require a focus on improving population health outcomes as well as improving individual clinical care as reflected by traditional metrics of quality. There is a significant public role in promoting these capabilities, such as through national and state resource centers.

A focus on child health care quality includes ensuring that adequate care is paid to community-based prevention – initiatives that cast wide nets, redeveloping neighborhoods and households around a healthier model of living. Rebuilding our communities will require broad use of health impact assessments, incentives for greater availability of healthy foods, tobacco taxes, public transportation, and safe parks. Public health and personal health services will need to be closely linked.

Health information systems can play a crucial role in linking improved primary care systems with community health and prevention. Immunization registries not only help practitioners identify which of their patients require specific immunizations but also inform public health professionals about levels of coverage in a community. Similarly, tracking the population of children over the 95th percentile of BMI for age and gender – which defines those considered obese – is useful for the practitioner to identify which children need more intensive counseling or clinical evaluation. At the community level, such information allows for identifying community priorities or tracking the results of broad, community-wide interventions.

The overall recommendations here all assume universal health insurance coverage as a core tenet underlying health system improvement. The barriers to implementation of these changes are substantial, inertia being primary and the vast scope of our health system another. These barriers can be overcome by political will and national leadership as well as by a commitment to continuously improve whatever system we develop. Either way, our current non-system does not work and our outcomes are untenable.

A new day is upon us, and our focus in rebuilding our system must be on our future: our children.

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