Pediatrician George Askew has created a way for children’s doctors to actively promote policies and practices that will improve the health and development of infants and young children across the United States, taking the practice of medicine beyond clinic walls.
The New Idea
George Askew is taking medical doctors from the sidelines and putting them in front of policy-makers to secure greater social justice for children zero to five years old. His “Docs For Tots” doctors reaffirm their Hippocratic Oaths by giving expert, non-partisan, scientific public testimony on the medical and developmental consequences of pending poverty, hunger, and environmental policies. Many medical doctors, like other professionals who swear an oath, become frustrated when their sworn duty is reduced to a measure of billable hours rather than of lasting change. George gives these caring professionals a way to honor their oaths and to prevent the conditions that they would otherwise just treat in emergency rooms and free clinics. His more than 400 medical doctors are a powerful and previously untapped resource for creating sound social policy and redefining what it means to be a caring physician.
Pediatrician George Askew founded Docs For Tots to solve two related categories of systemic failure. The first is a failure in public policy to create a society wherein all children are given “a fair shot at a good start in life.” The second is a failure of trusted public servants to use their voice in solving the first problem.
In regards to the first problem, medical researchers agree that the prenatal to first 5 years of childhood development represent the period of greatest opportunity and vulnerability for social, mental, physical and emotional development. Poverty presents significant and well-documented risks to this development. Yet 42 percent of all infants, toddlers, and preschool children in the United States of America live in poverty, putting them at risk of malnutrition, maternal substance abuse or depression, environmental toxins and physical traumas. This has a domino effect of contributing to social agitation, learning disabilities, and other social afflictions. In Illinois the government even uses fourth grade literacy rates as a key indicator of how many prison beds will be needed in 10 years. Docs For Tots therefore recognizes the creation of “nurturing environments for children” as the key to reducing multiple social afflictions and they believe that doctors, as trusted and non- political authorities, can offer quantifiable medical testimony for governmental officials and others who make and influence important policy decisions.
So why hasn’t this been done before? This is the second problem. As a pediatrician, Dr. Askew—like thousands of other medical doctors across the country—repeatedly saw the same low-income patients returning to the hospitals, emergency rooms, and clinics to treat conditions that were brought on by poverty, preventable health conditions, and early educational development failures. This is a great source of frustration for many doctors, lawyers, and judges who swear an oath to serve society as part of their professional commitment. To many physicians, being a doctor is a vocation that is reduced to a mere occupation when they concede that they can only treat medical symptoms rather than actually heal the afflictions of their child patients. Yet the time demands on a doctor are such that they are very unlikely to educate themselves and become adequately involved in addressing the public policies that cause preventable, expensive-to-treat and deadly afflictions such as lead poisoning, low birth weight, high infant mortality rates, Type II diabetes, and chronic malnutrition.
The only membership organizations that most doctors belong to are those dealing with their specific discipline or the American Medical Association (AMA). These trade associations simply do not have an incentive to champion public policy even though a doctor like George Askew was in high demand when he began speaking publicly on social issues.
In only two years of operation, Docs For Tots has grown from George Askew to over 400 participating doctors in 49 states. George and his staff make it easy for the doctors to get briefed on the issues that matter to them and to connect to child advocacy agencies that hold legislative forums or that have the ear of elected officials.
Docs For Tots has had six guiding goals in these first two years:1. Building a nationwide network of doctors who feel they could do more advocacy work if given the right support.2. Providing doctors with the information and resources they need to become comfortable and confident advocates in areas not traditionally, or directly, tied to health or where the connection needs further reinforcing, such as poverty, quality child care, and paid family leave.3. Offering doctors easy access to quality supportand guidance.4. Supplying easy entry into the advocacy arena.5. Recognizing and highlighting doctors making an effort to be advocates.6. Making the initial work of becoming an advocate for young children and their families simple.
George’s distinction as a medical doctor helped him establish Docs For Tots. He is a Harvard graduate; an AMA International Health Fellow to Kumasi Ghana, and a Soros Open Society Institute Medicine as a Profession Advocacy Fellow. Docs For Tots began when George contacted his circle of friends and colleagues and encouraged them to participate in a legislative forum in Massachusetts. Their testimony was compelling and successful. This and similar work led to numerous invitations for George to speak at child advocacy events.
George then began building a network of doctors. In the first 20 months, through word-of-mouth, his Web site, and articles in medical journals, he signed on more than 300 doctors and dozens of advocacy organizations that needed them. When doctors sign on, they list issues of interest to them, from foster care to literacy. The advocacy groups share information with Docs For Tots that is researched and organized into easy to use fact points and presentations. The medical doctors can then download and use these presentations or their own material when called upon by Docs For Tots to participate in a legislative session or consulting event.
Though Docs For Tots is still very young, George has made a commitment to finding local doctors to speak at the state and county level. While national policy issues that affect everyone, he recognizes that “all politics are (still) local.” So when there is a decision to be made on low-income multi-family housing in DeKalb County, Georgia, a doctor who knows the local history and issues from that county—or at least from that state—is more credible than one flown in from Washington, D.C.
Ease of use is paramount in this model because none of the doctors become full-time advocates, nor do they typically want to join a “membership organization.” Docs For Tots acts as an agent to link the information, the opportunities and the policy makers with the doctors. Normally it is the child advocacy groups that handle the logistics of an event.
Dr. Askew started Docs For Tots because as an urban-based pediatrician, he was continually frustrated by factors beyond his clinical practice walls that had far greater impact on his patient’s well-being than anything he could “treat” in the office. These include: poverty, lack of access to social services, inadequate early care and education, unsafe environments, racism, and more.
George believes he is called to improve the lives of very young children. When he looks into the face of a small child, he is overwhelmed by his sense of hope, joy, and innocence. Unfortunately, he is too often confronted with the face of a child representing despair, sadness, and guilt. These young children will throughout their lives endure one obstacle after another to receive the basic requisites for a quality life. Often these are poor and/or minority children. George believes that as a pediatrician and experienced child advocate, he is uniquely positioned and is obligated to help remove some of their obstacles.
One encounter firmly planted the seed for Docs For Tots. During a routine health care visit with a mother and her two sons, ages 3 and 5, she offhandedly said she thought her 5-year-old “needed therapy.” George asked why, and she said he had been killing mice. To a pediatrician, a young child killing animals is an indicator of potentially serious present or future mental health problems. He asked, “How does he find the mice?” The mother responded that they were all over his room and that they run across his bed. “Oh, and by the way,” she added, “he gives the dead mice to his little brother to throw away.” On that occasion, and many others since, he could treat the specific health consequences of such a situation but he wanted to do more beyond his clinical practice to prevent such a situation from occurring in the first place.
George decided to address the social circumstances that will tolerate a single mother and her two young children living in dilapidated, mouse-infested housing whose only option seems to be requesting therapy for a five-year-old who kills mice.
Whenever he is asked to think about mentors who have influenced his current work, he names Barry Zuckerman, Chairman of Pediatrics at Boston Medical Center. Barry always advised him to try and have his advocacy work develop out of what he experienced in his clinical work with children and families. George says that Barry is the person who told him that “sometimes it is better to approach a problem ‘fire, ready, aim,’ than ‘ready, aim, fire.’” This sense of urgency has caused Docs For Tots to grow tremendously, expanding from only George to over 400 doctors in the first two years.