By Donald Gilpin

The photograph on the overhead screen showed a touching image of a loving parent and child, as Dr. Renee D. Boynton-Jarrett, a practicing pediatrician, social epidemiologist, Princeton University graduate, and associate professor at Boston Medical Center and Boston University School of Medicine, asked for responses from the overflow gathering of about 80 in the Princeton University School of Public and International Affairs (SPIA) Robertson Hall lecture room on Friday afternoon, March 1.

“It epitomizes a lot of what I’ve focused my career on,” she said. “How can we create a world where all children are safe and loved, with caregivers and families that feel supported by their environment, and their society provides this nurturing with warmth and safety?”

In a global health colloquium presentation titled “Community-Led Transformation to Advance Child Health Equity and Justice: Global Trends and Emerging Bright Spots,” Boynton-Jarrett, the founding executive director of Boston-based Vital Village Networks, led the audience of mostly University students in an exploration of the above question.

“Especially in this particular moment, we think about how large a challenge it is so that every child can experience that feeling of safety and caring and can fulfill their promise,” she said, asking the audience to “take a moment to consider how overwhelming the challenges that we face are” and citing “significant social and structural forces that need to be addressed.”

But she emphasized how the scene in her opening photo “is also incredibly sensible.” She continued, “There isn’t some magic wand that we need to wave for children to really have what they need to thrive and to have positive experiences in life.”

With a series of PowerPoint graphs, Boynton-Jarrett went on to point out that the infant mortality rate and the maternal mortality rate, widely accepted indicators of population health and well-being, show that a greater proportion of people die from pregnancy and childbirth-related causes in the U.S. than in any other high-income country in the world. The U.S. records about twice as many maternal deaths per 100,000 live births as the high-income country with the next highest mortality rate.

These negative results continue to grow worse, and statistics for Black and Indigenous communities are even bleaker.

Boynton-Jarrett went on to note that the Centers for Disease Control and Prevention (CDC) indicate “that more than 70 percent of the cases of maternal morbidity and mortality are preventable based on the technologies that we have and the preventions that can be provided.”

She cited a number of factors contributing to the negative results, including valuing some types of health care professionals and not others (e.g. midwives), scarcity of health care providers, lack of guaranteed paid maternity leave, and lapses in effective care for emotional distress and chronic disease.

“But if you look at our spending on health care, we top the charts,” she pointed out. “How can this be possible, that we outspend all of the other countries on health care and our outcomes around chronic illness, emotional distress, maternal morbidity, and mortality are so bad? How do you explain that?”

She concluded, “We messed up. We have dropped the ball here. Something is not right.” And she called on the audience to consider: “What actually would make a difference?”

The students’ responses ranged widely as they considered structural change in society to put more of the money spent on health care in the places where it is most needed, “to build trustworthy institutions and advance policies to reimagine systems of care and education to promote child welfare,” and to find “community-led solutions to advance health equity,” in accordance with Boynton-Jarrett’s advice.

Emerging from the ensuing discussion were such proposals as: spending more on preventive care in order to save on treatment care; focusing more on individuals rather than technology and procedures; prioritizing people’s well-being over capital gains; working to resolve a conflict of interest in a system where surgery is always more lucrative for the provider than preventive care; spending more on social care; and eliminating what Boynton-Jarrett called a “systematic discrediting of midwifery” in this country.

There were more questions than answers, a predominantly negative context with the current status of child and maternal health in the U.S., but also many ideas for ways to advance child health equity and justice and a large contingent of emerging university students who seemed committed to pursuing solutions.