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The 2024 Joseph W. St. Geme, Jr Leadership Award Address: To Create a Better World for Children and Families

2024; American Academy of Pediatrics; Volume: 154; Issue: 5 Linguagem: Inglês

10.1542/peds.2024-068085

1098-4275

Benard P. Dreyer,

Parental Involvement in Education

The following is an address given by the author in receipt of the Joseph W. St. Geme, Jr Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies Meeting in Toronto, Ontario, Canada, on May 3, 2024.=====================I stand before you honored in so many ways. First and foremost, to receive a leadership award with Joseph W. St. Geme, Jr's name on it is the thrill of a lifetime. As the consummate pediatrician, he captured the hearts and souls of other pediatricians, and his death at a young age was a tragic loss to children, to the profession of pediatrics, and, of course, most especially to his own family. I never met Joseph W. St. Geme, Jr, but I do know his son Joseph W. St. Geme, III and asked him about his father. One thing he said particularly stood out. He told me that when he and his brothers and sisters were growing up, perhaps even as adults, they often would say, when faced with a conundrum: What would dad say or do?I think I know one possible answer to that question: to create a better world for children and families. And although I am standing in his long shadow, that has been my life's work as well. I was lucky enough, from my medical school days at New York University and Bellevue and for the rest of my career to have had the privilege of partnering with poor families, often immigrants, often people of color, to care for, and help them parent their children. They educated me about the impact of poverty in our nation, the richest country of the world, and were role-models for me of resolve, resilience, and rectitude. I owe them everything, and I sit at their feet in admiration. They are standing at this lectern here with me today. The families I see at Bellevue come from more than 70 countries, from every continent in the world. One of the things these families taught me was the power of cultural pluralism and importance of cultural humility.I have heard many great addresses for this leadership award, but one I especially remember was F. Bruder Stapleton's 2019 discussion of Ubuntu,1 a South African philosophy meaning shared humanity, or perhaps human kindness. I think every culture has some form of the value of shared humanity. In my own upbringing, my parents imbued me with the Jewish concept of "chesed,"2 which means lovingkindness. They inculcated chesed in me through my witnessing their loving and kind actions with everyone they met, or knew, or helped. I am sure that Joseph St. Geme, Jr also treated everyone with lovingkindness, with chesed, so we can take this as a lesson from him as we celebrate him once more this year.I am also extremely honored to have been chosen for this award by my colleagues and friends in all 7 of the Federation of Pediatric Organizations. How meaningful it is to be selected for this great honor by my pediatric family! I am definitely feeling the love, and I reflect that love back to you all.What a privilege it is to be a pediatrician! Often, I feel that I make a positive difference in the lives of children living in poverty; frequently I feel I am helping them on their pathway to success; once in a great while, I have saved a child's life with my own hands. Or [I] stayed with them when they needed someone to care about them, or comforted them in times near the end of their lives, or mourned for them with their families. Those times are burned in my memory and my soul. They are marked by my own personal expression of lovingkindness.Dr St. Geme, Jr was also a researcher, and when I give lectures on advocacy, I always remark that research can be a kind of advocacy as well as a quest for new knowledge. My own research was based on what I saw as the problems of the families I cared for: poverty, homelessness, lack of school success. We devised interventions in pediatric primary care to improve early relational health, early childhood literacy, school readiness, patient medication safety, plain language communication, and to prevent early excessive weight gain. One of our signature programs is PlayReadVIP, where VIP stands for Video Interaction Project.3 The intervention includes real-time videotaping with a guided review of a parent reading and playing with their child by a developmental specialist, giving toys and books to the family to take home, and a written plan that the parent creates for activities to do when they get home. The Video Interaction Project has a significant evidence base, including sustained improvements in early literacy skills and social emotional development.4–7 It is implemented in more than 10 sites in New York City, in several other states, and several countries worldwide. I want to give a shout out to all my research collaborators.I became an advocate early in my career. I first focused on designing a health care program at Bellevue that gave poor children health care as good as or better than experienced in a highly skilled and compassionate private pediatric practice. Very soon, I realized that advocacy was needed outside of health care and an upsurge in family homelessness in the mid-1980s started me on a journey, from the problems of family homelessness, to the problems of family poverty, from regional organizations, to national organizations, such as the APA (Academic Pediatric Association) and the AAP (American Academy of Pediatrics), and from membership to mid-level leadership roles in those organizations to eventually becoming the President of the APA and the President of the AAP. When I am asked about how I charted this career, I frequently say that my guiding principle, my so-called north star, was to get to a position where I could create a better world for children and families. I tried to focus pediatricians and pediatrics on child poverty and solutions not only to poverty but to ameliorating the toxic influences of poverty on children and their futures. I got involved in child and family immigrant health at a national level through the AAP, in partnership with many of my personal heroes in immigrant health, as well as the brave physicians in south Texas. Of course, this was natural for me since I have cared for immigrant families all my career, and my parents were immigrants as well. My mother came here as an unaccompanied minor at the age of 11 all by herself, traveling alone across Europe and the Atlantic. She told me that she cried herself to sleep each night on that voyage in steerage across the ocean. So, the plight of immigrant children tugs at my heartstrings and makes me want to defend them. In reaction to anti-immigrant animus and the continuing drumbeat of hatred for immigrants, I have become a fierce advocate against this hatred. I used to say I am nonpartisan but prochildren. Of course I am still prochildren, but I am not sure being nonpartisan is really moral and ethical in today's United States. I would love to hear what you think about that!In New York City, we have had an influx of over 180 000 migrants over the last year or 2. Many of them are sheltered in hotels within walking distance from Bellevue, so I have been privileged to care for these children and families and work with city leaders to treat them justly.8,9 I want to state here, that advocacy, like research, is a team sport. Everything I have accomplished in combatting child poverty or in furthering immigrant health, or more recently in promoting an antiracism agenda, was accomplished with a band of brothers and sisters. In promoting an antiracism agenda, I have partnered with many great colleagues and leaders, among them Renee Jenkins, who introduced me for this award.In 2019, the APA invited me to give the George Armstrong lecture at the PAS (Pediatric Academic Societies) meeting. I focused my remarks on racist and hateful rhetoric.10 As in that address, I feel I should issue a disclaimer: Nothing I am saying has been sanctioned by the AAP, the APA, the APS (American Pediatric Society), or the other 4 organizations that comprise the Federation of Pediatric Organizations. I know well that the Internal Revenue Service warns not-for-profits not to stray from the nonpartisan path. But, oh, how I wish you could speak out about the racist, misogynist, anti-immigrant, anti-lesbian, gay, bisexual, transgender, queer or questioning plus, anti-Latinx, anti-Semitic, and anti-Muslim rhetoric that is spewing forth from the mouths of some.At the end of the George Armstrong lecture, many pediatricians in the audience came up to me to say that they wanted to work together on antiracism and against hate. We called this group of pediatricians Pediatricians Against Racism and Trauma. There are now almost 100 members of this informal group. Last year, we gathered at PAS to take stock and Michael DeBaun, the APS President, announced that he is leading an effort focused on health care for incarcerated youth. The APS Presidential Plenary at this PAS meeting in 2024 addressed this important issue.So where do we go from here…What would I suggest we do about child poverty? In 2019, the National Academy of Science, Engineering, and Medicine published The Roadmap to Reducing Child Poverty."11 I was honored to be part of the group that wrote that report. We came up with a variety of existing government programs that, if strengthened, would cut child poverty in half. The most significant was a child allowance, also called a reformed child tax credit. It was reformed because it gave each family $3000 a year for each of their children. Furthermore, the families did not need to have any taxable income or any income at all. We estimated that if enacted, that reformed child tax credit would cut child poverty by almost 50%. In the spring of 2021, the Biden administration enacted this child tax credit and by the end of 2021, child poverty rates were indeed reduced by almost 50%.12 Advocates, including myself, and families with children, were overjoyed. However, in January 2022, when the political parties controlling the House of Representatives changed, it was not refunded and child poverty rates bounced back up. So, that should be our major advocacy for reducing child poverty: fight the good fight for reinstating the reformed child tax credit and battle on for as long as it takes! In the end, we must succeed for the sake of children!What about immigrant health? When I was President of the AAP, a group of AAP leaders visited the Texas border and bore witness to the conditions in the Customs and Border Patrol detention centers. The AAP has been visiting the border ever since. So, please consider joining visits to the Texas border. Also, care for migrant families if you are in a city that is receiving busloads of migrants. These families need all the health care and lovingkindness you can provide. Finally, if you are a citizen of one of the states pictured in white in Fig 1 that still make recent documented child immigrants wait 5 years before qualifying for public health insurance, advocate for a change of those rules.13 Better yet, advocate for all children, regardless of their documentation status, to be covered by public health insurance, as is possible in all the states in the northeast but 1, as well as in Illinois, California, Oregon, Washington State, Utah, and the District of Columbia, all shown in dark green.In the wake of the murder of George Floyd, many universities, including my own, started DEI (Diversity, Equity and Inclusion) programs. And we in Pediatricians Against Racism and Trauma wrote a commentary published in Pediatrics entitled "The Death of George Floyd: Bending the Arc of History Toward Justice for Generations of Children."14 We listed a number of policies for effective change in that commentary, most focused appropriately on policing. It is now almost 4 years later, and we still have a long journey ahead of us.There is now a backlash against DEI programs at universities across the country. The Supreme Court also curtailed affirmative action in colleges and graduate schools. One path you can take is to be active in protecting those efforts in your own pediatric department, children's hospital, and/or medical school. I am the Vice Chair for DEI in my department as well as cochair of a committee of all the Vice Chairs of DEI from departments across my medical school, and we are now grappling with how to maintain these programs locally. The pediatric voice needs to be heard in these deliberations, so please speak out!I want to end on a very personal note. My beloved Constance, the love of my life, died of cancer in the summer of 2015, when I was President-Elect of the AAP. Her support, partnership, and great love were why I ran for that position and won that race. I was depending on her continued love and wisdom, but alas that was not to be. When she was diagnosed that February, that first night, when we were still reeling from the likely fatal diagnosis she had been given, she turned to me and said: "Promise me you will not let this stop your efforts to help children and lead change. Promise me!" And I promised her and kept my promise. I miss her every day of my life and think of her many times each day. Oh, how I wish she could be here with me today. This award is dedicated to you, Constance, with my everlasting love.To keep my promise to Constance, I want to urge us to lead needed change for children. We need to act and advocate for children NOW. President Obama said, "We are the ones we've been waiting for. We are the change that we seek." I say, don't wait for someone else to lead change or wait for some other time to act. Act NOW! Lead change NOW! If not NOW, WHEN?I think these challenges hold for all of us gathered here at PAS. Together we can accomplish many great things. Together, WE CAN CREATE A BETTER WORLD FOR CHILDREN AND FAMILIES!Thank you all again from the bottom of my heart for this great honor.Thanks to Renee Jenkins for her longstanding friendship and collaboration and for the wonderful introduction of my address; and a special thank you and endless gratitude to all the children and families who educated me and allowed me to partner with them for my entire career.