Executive Summary:

A growing recognition that socioeconomic factors affect health outcomes in significant ways is fueling new community investments and change in health care delivery systems. Often referred to as “social determinants of health” (SDOH), these factors refer to “the structural conditions in which people are born, grow, live, work and age” that have profound implications for an individual’s overall well-being. Addressing SDOH needs for children and their families is particularly important in light of the strong evidence that investments in the earliest years can have a potent impact on children’s development and their ability to thrive and grow to be healthier adults. Yet children have largely been left behind with respect to SDOH investments in part because the financing for these initiatives has relied heavily on the potential for a relatively short-term return on investment (ROI) for the health sector. SDOH interventions focused on children will produce health-related financial returns but typically on a longer time horizon, and they often will result in savings outside the health care sector (for example, to the child welfare system), giving rise to what is known as the “wrong pockets” problem. Given the extraordinary impact that the COVID-19 pandemic is having on the well-being of children, and most notably children of color, the urgency to act could not be more apparent.

A Children’s Health and Wellness Fund is a way to galvanize efforts focused on SDOH investments for children. On the most basic level, a Fund offers a mechanism to address the wrong pockets problem by facilitating a shared financing approach that reflects the shared interest and benefits of the many sectors that serve children—including health care, education, child welfare, and juvenile justice. A Fund can attract, collect, and administer funding derived from different sources that can help finance “whole child” care. Sources of funding can be diverse, including public and private funds that build on investments that ought to be made through Medicaid and the Children’s Health Insurance Program (CHIP). But a Fund can be more than a bank account that facilitates multisector investments and spending; by bringing together diverse actors, all with a strong interest in children, a Children’s Health and Wellness Fund can focus attention on children’s needs and spur action on their behalf.

This brief describes a pathway to ensure that children and their families benefit from SDOH investments. It reviews options for designing and implementing a Children’s Health and Wellness Fund with respect to each of the issues identified below, highlighting different models that can address the core components of a Fund. Critically, all these decisions require leadership from and close collaboration with the community to be served and a consistent and focused attention on promoting equity.

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