Prescription for a healthier nation: Support our most vulnerable (foster) kids

It’s midnight, and a tired and hungry fourteen-year-old girl walks down the street alone and scared. Where will she sleep tonight? How will she survive on her own? She knows that leaving home was her only choice, since staying with the abuse was not an option.

That fourteen-year-old girl was me. I made my way from those streets to medical school, where I trained as an infectious disease physician and HIV/AIDS researcher. Today I am honored to serve as president of the Albert and Mary Lasker Foundation, dedicated to promoting medical research.

I was lucky.  I had foster parents who cared for me and teachers who mentored me. But I saw others who were not so fortunate.  Kids who society “threw away” and who gave up hope as the adults in their lives failed them.

Over half a million U.S. children interact with the foster care system. Every year, 30,000 foster care youth age-out of the foster care system when they turn 18 or 21 (depending on the state)—with limited options for their future.  An alarming number--one out of three--experience at least one episode of homelessness by the time they turn 26. In California, 40% of people living in homeless shelters are former foster children. Over half are unemployed. Less than 3% go on to college as I did.  A disproportionate percentage of the nation’s prison population is comprised of former foster youth. These facts highlight the reality of our failed foster care system – including devastating personal and societal consequences for unemployment, incarceration and homelessness.

One shameful outcome particularly disturbing to me as a physician is that foster children have poorer overall health, increased chances of developing mental health issues and greater risks of chronic medical conditions. Despite this, 30% of foster children sampled in a comprehensive study by the Administration for Children and Families did not receive required health screenings – no regular visits to doctors or dentists or optometrists.

But lack of access to health care services is only the tip of the iceberg: The social determinants of health – many of which impact negatively for foster kids – play a more serious threat to their health and chances for healthy development and long-term well-being. These determinants include things like race, income, education, job opportunities, access to healthy foods, safe neighborhoods, and social integration—i.e., all of the conditions in which one works, lives, and plays. I have dedicated my life to serving patients as a physician, but I know that the clinical services delivered by health care workers in clinics and hospitals determine only a small part of health status—about 10-20%.  The social determinants of health are much more powerful predictors of health.  The links between health and drivers such as income, education, safety and feeling that one has a valued place in society are strong and well-documented.

Addressing the underlying conditions that contribute to the poor health of foster children is  a responsibility that must be addressed by professionals across many disciplines – teachers, urban planners, criminal justice specialists and social policymakers, just to name a few.

The courts have been an important avenue for children’s advocacy groups to challenge pervasive problems with the foster care system. For example, Children’s Rights, a New York-based nonprofit, has mounted legal challenges in 20 states to expose flawed policies and put forward criteria for serious reform. Just this week in Oklahoma, a settlement was reached in a lawsuit against the Oklahoma Department of Human Services’ foster care system, and as a result, Oklahoma’s Pinnacle Plan will guide improvements mandated by 2017.

At a community level, concerned citizens can play a significant role in helping address the adverse effects of social determinants on the health and well-being of young people in foster care.

So, for example, since moving from one foster home to another in the middle of a school year can drastically impact a child’s educational performance, we need to ensure that foster kids have a safety net. Teachers can be attuned to the child’s special needs and enlist classmates to assist in helping him or her catch up on assignments. School-age families can include foster kids in homework sessions, a baseball game, movie outing or trip to the ice-cream store. Business owners can prioritize foster kids when hiring or filling internships. Skilled workers and professionals can informally mentor foster teens by teaching them the ropes and helping them explore their career passions. And all of us can celebrate and support those young people who make it into college by contributing to social service programs such as the Guardian Scholars, which provide practical support (e.g., dorm room supplies) along with the mentorship and guidance which would otherwise be provided by parents.

By becoming more familiar with local organizations that work with foster children, we can become better community partners. We can volunteer to include foster children in local sporting, religious and community events.  And as we become more sensitive to the needs of young people living on the margins of our communities, we will likely become more adept at offering support. A recent news report described a 19-year-old Denver girl who had just “aged-out” of foster care and posted a plaintive ad on Craigslist. She offered to “rent a family” for $8-an-hour so that she wouldn’t have to spend her birthday alone. She received thousands of replies, demonstrating the reservoir of support available. This much needed social support can decrease young people’s feelings of social marginalization: A classmate’s family reaching out with an invitation to a holiday gathering or to celebrate a birthday, for example, can change a young person’s life.

In many ways, foster care youth are “the canaries in the coal mine” when it comes to assessing the impact of the many social determinants of health and social well-being.  Everyone has a part to play in altering the way we create a healthier, socially integrated nation, and we must prioritize support for the most vulnerable among us.  It is time for each of us to say that we will not “throw away” foster children— first by opening our eyes to their often heartbreaking predicament, and then by letting them know that we will be there to support their health and development as fellow citizens.  In so doing, we will define a better future for us all.