Fall 2025
The Kids Are Not Alright
By Shelby Crosier
Illustration by Tonya Engel
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Are we on the path to making our children healthier, or is more harm yet to come?
The Kids Are Not Alright
It is hard to be a kid in the U.S. today. Childhood now means navigating a complex societal landscape: from the aftermath of the COVID-19 pandemic and all that meant for children’s learning and development; to the ever-growing presence of screens and social media; to rising rates of anxiety and depression; to increasingly prevalent school safety concerns. All of this is making kids sicker.
Over the past roughly 20 years, rates of mental health conditions, behavioral disorders, obesity, and chronic conditions like asthma have gone up for kids in the U.S. Children in this country have also consistently experienced higher mortality rates than kids in other high-income countries, especially from things like guns, car crashes, and substance use.
This, of course, is not going unnoticed. A recent poll from Rollins School of Public Health found that gun violence, mental health, drug and alcohol use, and healthy eating are all top concerns for parents across Georgia—regardless of their political stance.
"Kids are a quarter of our population, and it should be incumbent upon us all to help them thrive and be successful. But we have just not done that.”
Stephen Patrick, MD
Getting to the bottom of what is causing the decline in children’s health is a pillar of the federal government’s Make America Healthy Again Commission, but this summer’s spending bill is also making cuts to programs that support the health of children and families across the country.
Without proper support, children’s well-being will continue to suffer.
“There is a sort of social contract we all have to make to ensure that kids are thriving in our communities,” says Stephen Patrick, MD, O. Wayne Rollins Distinguished Professor and Chair of the Department of Health Policy and Management at Rollins. “That's about them not going hungry, about having a reasonable school down the street. Kids are a quarter of our population, and it should be incumbent upon us all to help them thrive and be successful. But we have just not done that.”
Access to Insurance, Access to Health
Across the U.S., tens of millions of people rely on Medicaid for health insurance, including 41% of kids. In states like Georgia, Alabama, and Texas, over two-thirds of Medicaid enrollees are children.
When Medicaid expansions happen, like they did under the Affordable Care Act (ACA), it tends to have a “welcome mat” effect—meaning that children who were previously eligible for coverage but not receiving it enroll in Medicaid alongside their now-eligible parents. But the opposite can also happen. Changes to state Medicaid policies in Kentucky, for example, caused entire families to lose their insurance coverage, even if their children were still Medicaid eligible.
Now, this “unwelcome mat” effect could happen on a national scale due to Medicaid changes passed in the federal spending bill in July. Work requirements, changes to ACA plan enrollment periods, and more frequent eligibility checks will all make it harder for people to become and remain insured, as experience has shown us.
Georgia launched a work requirement for their state Medicaid in July 2023 and has since only enrolled about 3% of eligible Georgians. In 2018, Arkansas implemented a similar policy which resulted in Arkansans losing health insurance, with no increase in employment rates.
“We know that work requirements don't work, they just create barriers,” says Patrick. “We saw something similar during the COVID-19 pandemic. States could not kick people off Medicaid. So, when the public health emergency ended, states had to determine if people were still eligible. What we saw were a lot of procedural red tape issues, and a lot of people lost coverage purely because of those issues.”
The result of these changes is that an estimated 10 million Americans could lose health insurance, including 20% of children currently enrolled in Medicaid.
Patrick worries about how other Medicaid funding changes, like limits to provider taxes that allow hospitals (particularly in rural areas) access to more federal dollars, will impact access to health care for kids.
“We are cutting an already lean system,” he says. “It becomes a real challenge—certainly for rural communities that rely on Medicaid, but also for pediatricians and other providers. Medicaid pays for almost half of all births in the U.S. This is a cascade of events that is really challenging.
“As someone who has always worked in children's hospitals, most of my patients have been on Medicaid. Today, I work in the newborn intensive care unit at Children’s Healthcare of Atlanta, and more than half of those patients are on Medicaid,” he adds. “Medicaid is a critical safety net for some of the sickest kids in the world.”
Mental Health Challenges on the Rise
Mental health diagnoses are on the rise for both publicly insured and privately insured children in the U.S., with about one in five kids having ever been diagnosed with a mental, behavioral, or emotional health condition.
Depression and anxiety are common, especially among teens. In 2023, 8.7% of kids ages 12 to 17 in the U.S. had a depression diagnosis, and 16% had an anxiety diagnosis. While the reasons for these spiking diagnoses are still not completely understood, experts think that the after-effects of the COVID-19 pandemic, social media, perceived safety at school, and anxieties about society at large all play a role.
“General societal anxiety is an important factor— when the level of trauma or a feeling of anxiety has increased for a whole group of people,” says M. Daniele Fallin, PhD, James W. Curran Dean of Public Health. “The pandemic is a good example of that. We have also seen that in conflict situations or post-disaster situations in the U.S. It tends to also correlate with elections.”
For Fallin and others, like Janet Cummings, PhD, professor of health policy and management, screen time and social media use are top concerns when it comes to children’s mental health. Almost 100% of American teens use the internet daily, and almost half say they are online nearly constantly. That level of exposure means we urgently need more research into how it is affecting our kids, according to Cummings.
“We really need more rigorous research on these topics to better understand the connections between how kids are engaging in the virtual world and the implications for their mental health and well-being,” she says. “That depends heavily on having federal funding and also on the cooperation of companies like Meta.”
It is not just social media that is a concern. Screen time—including things like playing video games, messaging with friends and family, and using a computer to complete school assignments—makes kids more likely to develop emotional and behavioral issues like anxiety, depression, and aggression.
“Total amount of screen time does appear to be correlated with psychological distress in adolescents,” says Fallin. “Unfortunately, right now we aren’t doing much at a policy level to regulate this, so we are asking a lot of parents, and that's challenging.”
As mental health concerns in children and youth increase, cuts to Medicaid and other programs that support their health will only serve to limit health care access and exacerbate the issue. Already, about half of U.S. kids with a mental health diagnosis are not receiving mental health treatment, and that is even higher in some states. In Georgia, almost two-thirds of kids are not getting needed mental health services.
“It’s alarming that there have been major federal cuts to systems that serve children at a time when our nation is experiencing a child mental health crisis, and now more cuts are on the way,” says Cummings.
Substance Use and Overdose Prevention
Cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA) will impact both access to mental health services for youth and substance use and overdose prevention. This year, the agency has lost half of its staff, and the proposed federal budget for next year would cut over $1 billion from its operating budget.
“SAMHSA is responsible for reducing the impact of mental health and substance use in our communities and supporting our mental health and substance use treatment systems,” says Cummings. “With federal funding cuts at these levels, state governments are going to have to look at what resources have been lost and where they would be willing to make up the difference.”
This comes at a time when teen opioid use and overdose is a national concern.
“Because the adolescent years are a critical period for brain development, substance use during this period can have both immediate and long-lasting effects, including increased risk of developing a substance use disorder later in life,” says Kelli Komro, PhD, professor of behavioral, social, and health education sciences.
Overdose deaths in teens rose sharply during the COVID-19 pandemic, finally decreasing in 2023. This mirrors overall trends in the country. However, federal funding cuts to substance use prevention programs could put this progress in jeopardy.
“We need continued support from federal and state governments to fund effective prevention efforts,” says Komro.
Komro and colleagues at Rollins and Cherokee Nation Behavioral Health have proven the value of prevention with their school-based Connect for Prevention program, born of a 15-year collaborative partnership. The innovative program combines a personalized intervention given to every student in a school to help them reflect on their choices and goals with take-home kits to help strengthen family relationships.
Teens in rural Oklahoma who went through this program had lower alcohol and cannabis use, binge drinking, and opioid misuse than their peers who did not.
“We found that the program significantly reduced substance use among high school students by nearly 50%,” says Komro. “Prevention is key to reducing teen substance use and all the negative outcomes from that. If we invest in prevention today, we not only save precious young lives, we promote lifelong well-being.”
“If we invest in prevention today, we not only save precious young lives, we promote lifelong well-being.”
Kelli Komro, PhD
Feeding America’s Kids
Beyond Medicaid, some of the biggest federal budget changes affecting children’s well-being are coming to the Supplemental Nutrition Assistance Program (SNAP). SNAP helps over 41 million Americans, or 12.3% of the country, supplement their grocery budgets and feed their families each month.
Programs like SNAP are vital to children’s health. One in five children in the country live in food insecure households. The numbers look even worse in states like Georgia, where food insecurity goes up to one in three.
“I think food access and hunger will be the most acute challenges that we see after the spending bill,” says Patrick. Experts like Megan Winkler, PhD, assistant professor of behavioral, social, and health education sciences, agree.
“The bill cut the SNAP program down dramatically, and in multiple ways. So, we will have less benefits and less people able to enroll,” she says.
One major change coming to SNAP is work requirements, something that never previously existed in the program for anyone with dependents under 18 years old. Now, families with a child 14 or older will be required to work 80 hours every month. This could put more than 5 million people at risk of losing their benefits.
The bill also changes long-standing funding procedures by requiring states to pay a portion of benefits (which were previously 100% federally funded) and a greater share of the administrative costs.
“This might result in states changing their eligibility criteria,” says Winkler. “Currently, there's a fair amount of consistency across states, but this could result in states changing their eligibility to reduce their SNAP beneficiary pool and thus the cost to the state.”
Americans losing benefits that help them feed their families will result in hungrier, less healthy kids.
“Hunger affects everything from mental health to physical health,” says Winkler. “Even marginal food security, which is not typically viewed as being food insecure, is enough to see childhood effects.”
Where Do We Go From Here?
Healthy kids are vital to a healthy future. It is critical that we support children’s health and well-being, and that can start at the community level, especially when it comes to mental health.
“We often don't give a lot of agency to youth and adolescents, and what we’re often seeing, particularly in this political climate that we've been in, is that they don’t feel like what they're doing matters,” says Fallin. “So, it is important to figure out ways to give purpose. What can you get involved in? What kinds of things can you work on so that you are part of the solution and not just recognizing that there is a problem? If we give youth agency to be a part of those solutions, it is actually a solution itself.”
Communities can also step up to support food insecure families when systems fail.
“We already have a strong charitable food system,” says Winkler. “Here in Atlanta, we have the Atlanta Community Food Bank. There’s also Helping Hands Ending Hunger, which is a school-based pantry program that runs all year, where they send home these weekend food bags for families. Now is the time that, as community members, we will need to double-down on those types of efforts.”
But the burden of protecting and uplifting children’s health should not fall entirely on communities or individuals. To truly ensure healthy kids and a healthy society for years to come, policy must work to protect them.
“We have no cohesive policy strategy for kids. We do not have that nationally, and we do not have it locally, and that is one of our problems,” says Patrick. “Programs for kids and more broadly for maternal child health have always been a little bit uncoordinated. They have been poorly funded. And so, in some cases we see big gaps, and in some cases, we see duplication of services. What we need is a strategy.”
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Rollins Magazine is published twice a year by the Rollins School of Public Health, a component of the Woodruff Health Sciences Center of Emory University, for alumni and friends of the school.