{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:52:19Z","timestamp":1791636739546,"version":"4.3.4"},"reference-count":107,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>From 2011\u20102023, US children's health deteriorated across &gt;170 indicators. Chronic conditions rose from 25.8% to 31%, risk of anxiety tripled, and autism and learning disability more than doubled.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Policies based on biomedical models have failed to address these trends. Life course models regard health as a developmental process, with mismatches between children's physical, nutritional, and relational environments and the ones they are evolutionarily calibrated to expect as likely drivers of declining health.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>State policies can help to overcome mismatches and optimize developmental ecosystems. New Mexico is pioneering and testing an approach linking early childhood policy innovation with population\u2010level developmental measurement.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>The health of US children has deteriorated significantly across multiple indicators with trends accelerating since 2007. From 2011\u20102023, the prevalence of chronic conditions among 3\u201019\u2010year\u2010olds rose from 25.8 to 31%, obesity rose from 17 to 20%, and autism and learning disabilities more than doubled. Rates of anxiety, loneliness, depression, early onset of menstruation and trouble sleeping all increased. Biomedically driven policy and practice have improved treatment of certain established medical conditions (e.g., childhood cancers and congenital heart disease), but failed to stem increasing mental health challenges, and neurodevelopmental disorders. Life course models point to fundamental changes in the early developmental ecosystem resulting in profound mismatches between the conditions children are evolutionarily primed and historically calibrated to expect and those they currently experience as primary drivers of these changes. The Industrial Revolution accelerated changes in children's physical, relational, and nutritional environments; temporal rhythms; and cognitive demands. The Digital Revolution further accelerated the speed and degree of change, potentially outpacing children's capacity for adaptive developmental responses. These multiple environmental changes do not act in isolation but interact in multilevel, dynamic, and complex ways to form the developmental ecosystems shaping children's developmental trajectories. In this paper we suggest a reorientation of child health policy and resulting interventions\u2014expanding the focus beyond isolated social risks and behavioral deficits to address ecosystem\u2010level influences and shift population outcomes by altering health development trajectories. We also suggest a suite of actionable state\u2010level policy solutions geared to improve the configuration of these developmental ecosystems. We highlight state policy innovations such as New Mexico's comprehensive portfolio of early childhood policy changes and infrastructure upgrades\u00a0along with ongoing population\u2010level measurement of children's health development to monitor policy impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70135","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:01:00Z","timestamp":1791633660000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Child Health Challenges, Ecosystem Mismatches, and the Case for State\u2010Level Policy Innovation"],"prefix":"10.1111","author":[{"given":"NEAL","family":"HALFON","sequence":"first","affiliation":[{"name":"Center for Healthier Children, Families and Communities University of California  Los Angeles"},{"name":"David Geffen School of Medicine University of California  Los Angeles"},{"name":"Fielding School of Public Health University of California  Los Angeles"},{"name":"Luskin School of Public Affairs University of California  Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SHIRLEY","family":"RUSS","sequence":"additional","affiliation":[{"name":"Center for Healthier Children, Families and Communities University of California  Los Angeles"},{"name":"David Geffen School of Medicine University of California  Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_2_17_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.9855"},{"key":"e_1_2_17_3_1","doi-asserted-by":"publisher","DOI":"10.1353\/foc.2012.0004"},{"key":"e_1_2_17_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014\u20100594"},{"key":"e_1_2_17_5_1","unstructured":"FryarC CarrollM AffulJ.Prevalence of overweight obesity and severe obesity among children and adolescents aged 2\u201019 years: United States 1963\u20131965 through 2017\u20132018.NCHS Health E\u2010Stats; published 2020.https:\/\/www.cdc.gov\/nchs\/data\/hestat\/obesity\u2010child\u201017\u201018\/obesity\u2010child.htm. 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