Charlie Bruner on Policies for America's Future

Levers for Change

Why Policy Levers for Change? Producing change, particularly in public policies, involves being in the right place, at the right time, AND with the right understanding and capacity. The topic areas here all represent levers for mobilizing public will and establishing policies that can significantly improve child outcomes and equity. They seek to get beyond narrow definitions of what constitute complex problems and challenges, in order to produce needed policy responses.

Health Equity and Young Children. Profound disparities exist in the health of America’s children by race, place, and socio-economic status – and these disparities start early. Shifting the trajectory of children’s healthy development requires attention to the first years of life and to rethinking the role of child health practitioners in ways that go beyond securing health coverage and providing clinical care to being a first and effective response to social determinants of health.

  • With colleagues in the field, Charlie has produced a policy framework paper on transforming young child primary health care practice to better respond to both social and medical conditions that can threaten child health, that also highlights exemplary programs in the field and references a growing array of expert papers describing this as a critical new field of practice.

  • Charlie is working with colleagues at the Child and Family Policy Center on a Health Equity and Young Children Initative that includes a variety of resources for the field. This has resulted in the production of a number of policy papers, webinars, and other resources, many of which are accessible on the Child and Family Policy Center's health equity webpage:

  • One of the challenges exemplary practices face in expanding young child primary care practice to  respond to social determinants is securing financing through the health system for the additional resources this entails. Whiile there is new emphasis in paying for "value" and not "volume," the alternative payment models developed largely have focused upon chronic care populations and are not appropriate for young children. With colleagues Paul Dworkin and Nathaniel Counts, Charlie produced a commentary on the challenges and opportunities to developing altnerative payment models for young child health, based upon a synthesis of responses of leading child health policy and advocacy organizations (including the authors' own) to the Center for Medicare and Medicaid Innovation (CMMI) request for information on this topic.

Child Poverty and Social Justice. Reducing child poverty over the next generation requires that children growing up in poverty today experience realistic and open opportunities to succeed. This involves policies offering economic, educational, health, and social supports that enable individual families to provide their children those opportunities. This also requires community policies, practices, and attitudes to ensure that children and their families are not marginalized or discriminated against because of their economic background, the color of their skin, their family faith and culture, or any special needs they may have. In short, it requires both individual service strategies to foster personal responsibility and community-building strategies to promote social justice.

  • Charlie reviewed current policy efforts to eliminate poverty for the Northwest Area Foundation and found the major emphasis was upon strategies, often based upon fostering personal responsibility and providing economic incentives for employment, to lift individual families out of poverty. At the same time, advocates at the grassroots often took a very different perspective on the causes of poverty, rooted in blocked opportunities and social  injustice. Charlie produced a framework paper that emphasized the need to align the two in order to truly reduce poverty and its impacts upon children.

  • Comprehensive community initiatives have had mixed histories of truly affecting community change and population health, economic well-being, and economic security. As they reviewed the last thirty years of such initiatives, Aspen Roundtable on Comrepehensive Community Change asked different leaders to describe both what we have learned and what we need to find out to address poverty and disadvantage at the community level. Charlie's piece, "Maximum Feasible Self-Reflection," speaks to the importance of taking both "bottom up" and "top down" strategies that bridge differences in perspective, position, and power.

Strengthening Family and Community Voice. Children are a powerful motivator for change, and parents will take extraordinary efforts to give their children opportunities to succeed, even when their own lives present many challenges to succeeding. Professional and public services will not be effective if they seek to make gains to or for or in spite of the children and families being served – they will only achieve durable gains working with those children and families. Both children and adults learn and grow through exerting effort, gaining mastery over new challenges, and then using that mastery to benefit themselves and others. Building upon a parent’s thirst to contribute to their child’s future may, in fact, be the single best driver for improving child outcomes. This involves qualitatively as well as quantitatively different policies and investments.

  • "Why did it take three boy scouts to help the little old lady across the road?" "Because she didn't want to go." Too often, public policies impute what is in the best interests of children and families from a vantage point very different than the lives that those children and families experience. These two essays, one more academic and one more conversational, speak  to truly starting where families are (and not where systems would like them to be) and serving in a facilitative role in enabling them to contribute to their child's and their community's growth.

Village Building and School Readiness. The African proverb, “it takes a village to raise a child,” would not be much quoted if it read, “it takes a multi-disciplinary team of professionals to raise a child.” While health, education, and other professional services are necessary for healthy growth and development, children need supportive neighborhoods and communities to thrive. This, in turn, requires particular attention to community building in developing early childhood systems. Poor neighborhoods are rich in young children, and require additional focus in providing both formal and voluntary supports for young children and their families.

  • Place, as well as poverty and race, impacts child development. Particularly when children are very young, their lives often revolve around their immediate neighborhood. Poor neighborhoods are rich in young children and innate human capital, but lack realized educational, economic, physical, and social capital that promote safe and healthy growth. The paper here updates the first chapter of Village Building and School Readiness with up-to-date census information and the powerpoint presents this and other information (particularly around neighborhood resources for young children) that indicate the need for qualitatively and quantitavely different approaches to early childhood systems buildling in poor neighborhood.

  • With commentaries from over twenty leading national early childhood and health experts and advocates, Village Building and School Readiness provides a framework for achieving school readiness in disinvested neighborhooods through both community-building and individual service strategy approaches.  Chapter Three provides examples of exemplary programs that take such approaches and their common DNA, which involves new relationships between families and staff based upon mutual assistance and commitment to equity.

Electoral Education and Advocacy. For the first time in this country’s history, children face the prospect of growing up less healthy, living less long lives, and being less prepared to compete and lead in a world economy. Unless, as a nation and through public policies, we take action. That action, however, will only occur if children’s issues become part of the national dialogue and debate. At their best, elections offer the time to set priorities going forward. This requires education, advocacy, and mobilization that raises children’s issues to the attention they should command.

  • Polls show voters care deeply about kids and would like more attention to their needs -- across health, safety, edducation, and security -- in public policy, but kids issues generally fail to receive attention in campaigns nor do voters, the press, or candidates themselves knw how to raise them. For the 2016 election, several national child advocacy organizations established a guidebook to outline six key federal policy issues . That, with polling data, responses from some Presdiential candidates, and other resources advocates have developed to raise kids issues, is found at:

Transforming  Pediatric Practice 
​Value-Based Care Commentary
​Synthesis of Responses
NWAF Poverty and Policy
Maximum Feasible Self-Reflection
Thirst to Contribute
Ace, Place, Race, Young Children
Place Webinar