For Kids, More Than an Apple a Day

When you think about ways to improve children’s health, creating affordable housing or lowering the cost of energy are not at the top of the list — if they make the list at all. They should, says pediatrician Lauren Smith. An associate professor at the School of Medicine and a clinician at Boston Medical Center, she’s been at the forefront of an effort to show how seemingly disparate public policy measures can significantly help — or hurt — children’s health.

Take the issue of housing. “It is the single largest portion of anyone’s budget, especially low-income folks, who spend up to 50 percent of their income on housing,” Smith says. “Families are forced to make trade-offs between food and transportation and health care because they spend such a huge percentage of their budget on housing. It’s those trade-offs that have health implications.”

Smith leads the Child Health Impact Assessment Working Group, which focuses on the impact of public policy on child health and well-being and includes representatives from seven Boston-area hospitals and universities. The group issued a report detailing the health impacts of the lack of affordable housing, especially food insecurity and housing instability. “We presented it to the state legislature, in testimony before the joint committee on housing, and certainly were an unusual voice to be talking about affordable housing,” she says. The testimony was covered in the press, which captured the attention of lawmakers.
   
The group last fall issued a second report on the impact of higher energy costs on children’s health. “You land yourself in the same budget trade-off — ‘heat or eat’ — that’s a reality for low-income families,” she says. “Usually people don’t think of heating policy as a health issue, but that’s our point — actually it is a health issue.”
   
Smith, who teaches pediatric medicine at MED and regularly goes on rounds at BMC, has been extending her involvement in public policy by working two days a week at the State House, in House Speaker Salvatore DiMasi’s office. Funded by a grant from the William T. Grant Foundation, she focuses on health-care issues, specifically on implementation of the Massachusetts health-care reform passed in 2006.
   
The Grant Foundation program enables policy professionals and researchers to work in one another’s worlds, allowing them “to understand better the intersection of policy and practice,” according to the foundation. Smith notes that it “allows researchers like me to have a better understanding of the kind of work that might be useful or helpful in a policy-making setting. It’s been a good experience.”
   
Smith is no newcomer to policy issues. As an undergraduate with medical school in mind, she majored in biology, but courses in economics and politics soon “opened my eyes to another way of seeing how the world worked,” she says. “That started me on this idea of working at the intersection of policy and health care.” Out of college she did public policy research work for the federal Department of Health and Human Services before heading off to medical school.
   
She was chief resident at Children’s Hospital in Boston, then came to BMC on a fellowship in 1997 and stayed, joining the MED faculty two years later. Working at BMC, seeing patients and their families, helped solidify the connection between policy research and advocacy work. “It really stems from my clinical experiences and hearing the patients and their families talk about the struggles they are facing,” she says.
   
Smith has taken these efforts even further as medical director of the Medical-Legal Partnership for Children at BMC, a national program that pairs lawyers with pediatricians to advocate for children’s nonbiologic health needs — food, housing, education, and safety. 
   
She has been active in other research as well. She’s investigated disparities in funding for sickle cell anemia compared to other single-gene diseases and led a project assessing the impact of welfare reform on children with chronic illnesses.
   
With her desire to work in that intersection of health care and policy, Smith knows that she’s in the right place. At MED and BMC, she says, “there is a clear understanding of the connection between these issues. It’s part of the ethos of the pediatrics department that these are important issues.”

Taylor McNeil can be reached at tmcneil@bu.edu.