It Takes a Village (12 page)

If your children need to lose weight, help them to set a reasonable goal and make a sensible plan for getting there. Parents of teenage girls, who often believe they are overweight even when they are not, should take particular care to prevent their daughters from dieting excessively or obsessing about their weight. As Richard Troiano, one of the epidemiologists who conducted the Centers for Disease Control survey, reminds us, “There is already too much of a culture of thinness leading to eating disorders in this age group.” Their risk of nutritional deficiencies is serious.

I have read advice like Dr. Koop's a thousand times and know that I could do better in my own eating. Since moving into the White House, I have enlisted the ingenuity of chef Walter Scheib in concocting menus for official events and family meals that live up to nutritional guidelines as well as the expectations visitors have for presidential hospitality. For family meals, we moved a table into the second-floor serving kitchen, where we usually (but not always!) dine on vegetables, grains, fruits, lean meats, and fish.

Diet alone does not account for the dramatic increase in weight among Americans, however, especially among children and teenagers. The main culprit is a combination of poor food choices and too little exercise. In many American households, the juvenile couch potato whose only operating muscles appear to be in his jaws, chomping away hour after hour on high-calorie nonfoods, is a familiar sight. A study by the Centers for Disease Control confirmed this picture, showing that physical activity among children and teenagers has declined during the time average weight has gone up.

In a 1990 Youth Risk Behavior Study, only 37 percent of high school students reported getting at least twenty minutes of vigorous exercise three or more times a week, down from more than 60 percent in the 1970s. My home state of Illinois is the last to mandate daily physical education for all students, kindergarten through twelfth grade, although the Illinois legislature recently passed a law allowing local school districts to apply for waivers. In most states, requirements are already left up to local school districts, and the results are not encouraging. Only half of American teenagers are enrolled in physical education classes, and only one in five attend daily. More than one in three, however, report watching three or more hours of television or videos every school day.

I was not always happy to have to take physical education classes every day of my school life, especially when I had to rush to my next class, my hair still dripping from the heavily chlorinated old pool. But I am grateful in retrospect that I learned about different sports, developed some athletic skills, and, most important, exercised my body as well as my mind each day.

I regret the move away from organized physical education and the reduction of recess time for younger kids. All children, especially in today's stressful world, need the joyful release of free play as well as healthful exercise.
Mens sana in corpore sano,
the ancients advised, and it still holds true—a strong mind in a strong body.

How can we achieve that for our children? For starters, turn off the TV, VCR, and computer, get up, and get moving—and get your kids to do the same. Brisk walking, hiking, and bicycling are all good exercise and are great ways to spend time together as well. Put physical education and recess back into the school day. Thirty minutes a day of exercise is recommended for adults or children of average weight, forty-five minutes for overweight people, but it doesn't have to be all at once. You can build shorter periods into your and your kids' regular daily routines. Walk them to the park, school, or store instead of jumping in the car to go two blocks. Take the stairs instead of the elevator. Try to plan vacations and outings around exercise—nature walks, hiking trips, or camping and canoeing in our national parks.

The knowledge that poor nutrition and inactivity are clearly implicated in the high incidence of arthritis and such serious and often fatal illnesses as cancer, heart disease, and diabetes should be enough to get us and our children to shut the refrigerator door and open the front door.

The village can do its part to help. The U.S. Department of Agriculture, which oversees school lunch and breakfast programs, has started Team Nutrition, a partnership between the federal government, states, school districts, farmers, and businesses to promote healthy food choices in homes and schools and in the media. Among other projects, Team Nutrition has recruited volunteer chefs from leading restaurants to concoct recipes for nutritious cafeteria food—lemon chicken, vegetable lasagna, oranges and strawberries in tangerine juice—that kids actually will eat. I tried some rice pilaf with lentils, beans, and chick peas with a group of fifth and sixth graders, who not only ate what was served but said they liked it.

The President's Council on Physical Fitness and Sports is working hard to convince schools both to require physical education for all grades and to give younger students opportunities during the school day to play outside in safe, supervised settings. The goal is to get at least half of all schoolchildren participating in daily physical education. The council emphasizes that classes should include more activities that people can readily pursue over a lifetime, like swimming, bicycling, jogging, and racquet sports.

It also recommends that communities increase the availability and accessibility of facilities for these and other activities. Many churches, like my husband's, Immanuel Baptist in Little Rock, have built family centers that include athletic facilities for exercise classes, basketball games, and jogging or walking. But community recreation centers, especially for teenagers, are nonexistent in many neighborhoods where kids need them most. I can't understand the political opposition to programs like “midnight” basketball and other recreational activities. Providing funds to inner-city neighborhoods to give young people positive outlets for their energies under adult supervision sounds great to me, as a way not only to prevent health problems but to prevent kids from getting into trouble.

 

K
EEPING CHILDREN
healthy in body and mind is the family's and the village's first obligation. But we all know that no matter how conscientious a parent might be or how committed to preventive health a community might be, children will inevitably suffer from disease and injury. Then medical care is required.

Three tales of our era:

A Texas teenager suffered from high blood pressure and recurring stomach pain, but he was uninsured and his family could not afford the tests that would determine the cause of his problems. Then he developed difficulty raising his arms as well. When he needed immediate medical care, he went to the emergency room of the local hospital. His mother applied for Medicaid but was told that the family's income slightly exceeded the state's eligibility level.

A six-year-old Kansas girl developed a severe infection that required mastoid surgery. When she was released from the hospital, physicians prescribed antibiotics to be administered by IV at home, but the family's insurance policy refused to cover the cost. Without the antibiotics, she developed seizures and inflammation of the brain, and ultimately lost many fine motor and cognitive skills, including the ability to speak. She now requires complicated therapy and nursing care to manage her condition.

A Virginia woman was unable to afford health insurance for her son, who suffered from severe asthma. When he had an asthma attack, she would take him to the emergency room, where doctors would treat him and prescribe medication for him to continue at home. But his mother could not afford to have the prescriptions filled, and even when the doctors gave her a free dose to take home she held off giving it to him until the last possible minute, knowing she could not afford more.

I could tell you many other stories that end in the same question: Is this the kind of health care system our children deserve?

Today there are more than ten million children, most with working parents, who do not have health insurance; that number has been rising by about a half million a year. The rate will accelerate even more if Congress's proposed cutbacks in Medicaid, which provides government insurance for poor children, are enacted. That would channel even more children into overworked emergency rooms for basic care, where overworked staffs will eventually be forced to turn them away.

When I look into the eyes of parents whose children's illnesses are not only taking an emotional toll but exacting a cruel financial cost because they could not afford insurance, I think, There but for the grace of God go I and everyone I love. The number of Americans who will face these heartbreaks is growing.

Some families who can afford to pay for private insurance are unable to find coverage. In Cleveland, Ohio, I met a couple who have two daughters with cystic fibrosis and a healthy older son. The father, a self-employed professional, provided health insurance to his employees and their families. The family could afford private insurance for themselves and their son and would have bought it for their daughters but could find no one willing to sell them a policy because of the girls' conditions. They repeated to me the words of one insurance agent—words I will never forget as long as I live. “What you don't understand,” the agent told them, “is that we don't insure burning houses.”

I find this attitude deplorable. What kind of message does it send to hardworking people who love their children but cannot protect them? And if we are willing to write off these children, whose will be next? That is a question for all of us to ponder, because as research in genetics continues to advance, scientists will soon be able to tell us which of our genes predispose us to cancer or diabetes or many other serious diseases. Will those of us who carry such genes and the children we pass them on to eventually be denied insurance too?

When I met seven-year-old Ryan Moore of South Sioux City, Nebraska, I knew I had encountered a young person of heroic disposition. Ryan was born with a congenital syndrome that produces multiple birth defects. His father, Brian, was able to provide his family with good health insurance until Ryan was a year old, when the company Brian worked for went out of business. Brian searched for work but was unable to find a job because companies were wary of his son's health care needs. “It's like they looked right through me and only saw my son,” said Brian. “I have a lot to contribute, and I couldn't even get work as a janitor.”

Seven-year-old Ryan, however, did find work. He has become a local celebrity, mainly by being himself—hopeful, happy, and resilient in the midst of all his troubles. Ryan has been working with the Children's Miracle Network and raising money to support his high medical and travel costs. This brave little boy loves to quote Piglet from
Winnie-the-Pooh:
“It is hard to be brave when you are such a small animal.”

Another small, brave soul I met was four-year-old Mike Bebout, who came to the White House for a children's health event. He has suffered all his life from short bowel syndrome, which prevents his body from absorbing the nutrients it needs. His parents could not get private insurance to cover his treatments. His older brother, another Ryan, told me that he thought every kid should get the health care he needs, and he had come up with an acronym for the cause—MIKE—Medical Insurance for Kids Everywhere.

The lack of adequate health care for many Americans forces us into an emergency situation on every level. People use emergency wards as clinics, overburdening hospitals' resources and often receiving, in turn, inadequate preventive or follow-up care. Infants and children end up with serious conditions requiring expensive care because we don't invest in prevention. Toddlers don't get their immunizations on time. School-age children don't get the nourishment or exercise they need to feed their growing minds and bodies.

Many people believe that we cannot guarantee health care to all because of cost. In fact, a sensible universal system would, as in other countries, end up costing us less. That's because most children who become ill or injured are eventually treated somewhere, even if they are given too little, too late, and at a greater cost than they—or we—would have paid if we had made sure their symptoms had been treated earlier. But until we are willing to take a long, hard look at our health care system and commit ourselves to making affordable care available to every American, the village will continue to burn, house by house.

You can already get a good look at the fallout from our procrastination by visiting the emergency room of any large urban hospital. On display are not just the medical crises for which an emergency room is designed but dozens of children, from infants to teenagers, who don't appear to have any serious ailment. Why are they there? They have fever, earaches, stomach upsets—the kinds of aches and pains that are better treated by a school nurse or at a doctor's office or clinic, or, better yet, warded off with good preventive care.

But most schools no longer have nurses, and doctors cost money—and even people with insurance find that many policies do not cover routine preventive services for children. Most public health clinics are not open at hours that are convenient for working parents. The for-profit clinics sprouting up in shopping malls keep longer hours but require cash or verifiable credit and are not always easily accessible.

If the number of uninsured Americans continues to rise and the influence of profit-driven medicine continues to grow, many nonprofit hospitals will be forced to close, and ultimately those who cannot afford the cost of expert care will be forced to fall back on low-tech, hands-on solutions. Ironically, less developed nations will be our best models for the home doctoring we will then need to master. If this scenario sounds farfetched, let me tell you that it is already happening. When I visited the International Center for Diarrheal Disease Research in Bangladesh, funded in part with American aid, I met a doctor from Louisiana who was there to learn about low-cost techniques he could use back home to treat some of his state's more than 240,000 uninsured children.