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What about Bob?

Bob was 8 years old and weighed nearly 200 pounds when I met him in 2005. He already had signs of metabolic syndrome (“pre-diabetes”) consistent with his obesity. His mother had been bringing Bob to see me in the weight management clinic for 3 months to try and effectively manage his weight to give him the best opportunity for good health. I was running a few minutes late in clinic when I opened the door to Bob’s exam room, and was utterly dismayed to see Bob eating chips and drinking a soda when I walked in. I couldn’t reconcile what I was seeing with what I knew about Bob and his mother. His mom was very invested in helping Bob achieve a healthy weight – she had attended every appointment with me, as well as with the nutritionist and physical therapist who supported the weight management program. She had adjusted her work schedule so that she could walk to school with Bob, ensuring he got some physical activity each day. And, she had absorbed each bit of information and advice regarding healthy food options and ways to incorporate physical activity into Bob’s daily routine.

Why then, was Bob engaging in those very behaviors which would – over time – condemn him to chronic illness, and risk a shorter lifespan and lower quality of life?

Bob and his mother lived in an economically challenged neighborhood, which did not have a grocery store within 3 miles, making it difficult for Bob’s mother to prepare more nutritious meals. The neighborhood lacked safe, open spaces for children and young adults to play, so Bob spent a great deal of time in sedentary activities. The family did not own a car, and relied on public transportation to get around. Thus, a one-hour appointment with our weight management team actually took Bob’s mom away from her job for 2.5 hours, including bus transfers. Since Bob’s mother worked in an hourly job, any time away from work meant a lower paycheck for the family. And, since I was running late to his appointment, Bob was hungry and his mother got him a snack from the most convenient location – the vending machines in the lobby of our clinic.

For any clinician serving families facing economic hardship, Bob’s is a familiar story.

It also was the reason I pursued a policy position. As a pediatrician, I had spent countless hours supporting families like Bob’s in trying to thrive in conditions which seem to convey the message that their only possible outcome was poor health. However, as a policy-maker, I could develop informed policies which would change the circumstances in which children like Bob live, learn, play and grow.

Well-informed policies shape the world in which our children live. Do children have the healthiest start possible to life because their mothers had ready access to high quality preconception and prenatal care? Can parents ensure their children’s brains receive healthy, positive stimulation in high-quality child care settings? Do children have access to affordable, healthy foods and safe physical environments?

Each of the circumstances faced by Bob’s family could be directly influenced by policies – health, economic development, education, and housing policies, among others. As we approach the last few days before election day on November 6th, consider asking candidates in your area about the following.

Economic development – Policies that support economic vitality of families have long been associated with improved outcomes. The Earned Income Tax Credit is associated with improvements in health-related behaviors such as smoking, and increases in the minimum wage are associated with improved birth outcomes and reduced infant mortality. What policies will you support that improve the economic outlook for our children and families?

Education – What is your understanding of the impact of early experiences on brain development? Do you recognize the benefits of high-quality early childhood programs such as high-quality, center-based child care and educational programs such as early head start and head start? How will you support these opportunities for your constituents?

Housing – Children growing up in unhealthy housing are at greater risk of poor outcomes due to both environmental factors and safety. The issue of housing is complex, with policies addressing quality, safety, stability, and affordability often at odds with one another – e.g. creating higher quality homes that are no longer affordable for the general population. How will you work to ensure our children have access to healthy, safe and stable housing?

Nutrition – Having access to healthy foods is integral to learning and academic success, as well as for positive health outcomes. WIC provides access to nutritious foods for pregnant and postpartum Women, Infants and young Children, and has demonstrated improvements in infant birth weight and maternal breastfeeding. Will you ensure continued access to high-quality nutrition programs like WIC and school-based meals, and minimize barriers to children receiving healthy foods?

Health Impact Assessment - Tools such as health impact assessments (HIA) help policy makers assess potential impacts of their policies on health outcomes. HIAs are not yet widely used, and there is an opportunity to refine these tools even further to examine the unique impacts of policies on children. How will you use data and tools such as HIAs to ensure your proposed policies have the expected impact on child health and well-being?

When exercising your right to vote this election cycle, think about Bob and the 74 million children in the United States who are counting on us to use well-informed, child-focused policies to shape a world in which they can thrive. Kids can’t vote. It’s up to us to be their voice.

Genesis Health Consulting has deep experience navigating the intersection of health and policy. Learn more about our experience analyzing and developing policies for public and private institutions by contacting us at

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