It Takes a Village

by Hillary Rodham Clinton

  Many people believe that we cannot guarantee health care to all because of cost. In fact, a sensible universal system would, as in other countries, end up costing us less. That’s because most children who become ill or injured are eventually treated somewhere, even if they are given too little, too late, and at a greater cost than they—or we—would have paid if we had made sure their symptoms had been treated earlier. But until we are willing to take a long, hard look at our health care system and commit ourselves to making affordable care available to every American, the village will continue to burn, house by house.

  You can already get a good look at the fallout from our procrastination by visiting the emergency room of any large urban hospital. On display are not just the medical crises for which an emergency room is designed but dozens of children, from infants to teenagers, who don’t appear to have any serious ailment. Why are they there? They have fever, earaches, stomach upsets—the kinds of aches and pains that are better treated by a school nurse or at a doctor’s office or clinic, or, better yet, warded off with good preventive care.

  But most schools no longer have nurses, and doctors cost money—and even people with insurance find that many policies do not cover routine preventive services for children. Most public health clinics are not open at hours that are convenient for working parents. The for-profit clinics sprouting up in shopping malls keep longer hours but require cash or verifiable credit and are not always easily accessible.

  If the number of uninsured Americans continues to rise and the influence of profit-driven medicine continues to grow, many nonprofit hospitals will be forced to close, and ultimately those who cannot afford the cost of expert care will be forced to fall back on low-tech, hands-on solutions. Ironically, less developed nations will be our best models for the home doctoring we will then need to master. If this scenario sounds farfetched, let me tell you that it is already happening. When I visited the International Center for Diarrheal Disease Research in Bangladesh, funded in part with American aid, I met a doctor from Louisiana who was there to learn about low-cost techniques he could use back home to treat some of his state’s more than 240,000 uninsured children.

  I started this chapter with Dr. Lowe’s prescription, and like all the remedies she’s ever prescribed for my child, I’ve found it sound: Commonsense prevention in our homes and schools. A reformed health care system that guarantees all children the medical care they need. Money would be saved from both these approaches instead of the billions of dollars we now spend to fix problems we could have avoided in the first place.

  I’m not sure we will follow Dr. Lowe’s prescription in the short run, but I know we will eventually. One of the reasons I worked so hard on health care reform was that I could not stand the fact that there are millions of children who do not have health insurance and millions more who are dependent on Medicaid, which may not be as available in the future if the current Congress gets its way. Our society will not be able to afford the moral or economic costs of intensively caring for children who should have been, in Dr. Lowe’s words, “treated right in the first place.”

  Security Takes More Than a Blanket

  There’s no place like home…there’s no place like home.

  DOROTHY

  I must have been about eight years old when my mother’s mother took me and my brother Hugh to see The Wizard of Oz. We went downtown to one of Chicago’s grand old movie palaces on a Saturday afternoon. I’d never been in so majestic a theater before.

  On our way there, my grandmother kept warning us that little children sometimes got kidnapped by strangers from city movie houses. When we reached our seats, she sat between us and looped her arms around my brother and me to protect us from harm, real and imagined.

  The scenarios she conjured up were enough to give us goose bumps even before the movie started. By the time those weird-looking winged monkeys flew out of the witch’s castle and Dorothy and Toto were grabbed and taken away, kids were screaming and my brother was trying to climb under his seat to hide. I grabbed hold of my grandmother’s hand for comfort, only to discover that it was as clammy as mine. It was the first time I remember being thoroughly scared.

  Finally the monkey scene ended and the witch melted away. Dorothy and her friends found their way back to the Emerald City. Kids around us stopped crying, and Hugh settled back in his seat. My grandmother even relaxed her grip a little. When Dorothy clicked the heels of her ruby-red slippers, I tapped my sneakered feet together under my seat and repeated along with her, “There’s no place like home…there’s no place like home.”

  When I got home, my mother asked us to tell her about the movie. Before I could open my mouth about the amazing girl who had the same name she did, Hugh was describing the monkeys flying at him and the scary music and the dark forest. My parents reassured us that the story was only make-believe and that they would never let something like that happen to us.

  But it wasn’t only the monkeys that had scared me. What disturbed me more deeply was the realization I’d had, sitting there in the dark, that all the people around me—even the adult who was in charge of me—were also scared. It was a profoundly disconcerting experience. In those days, for most people, it was also a rare experience.

  In my town, kids rode their bikes everywhere—to the library, to the movie theater, to the shops, to restaurants. (My favorite was the Robin Hood, which had scenes of Sherwood Forest on the walls. For years, my friends and I thought we had invented the idea of putting ketchup on french fries there.)

  My brother Hugh, a born adventurer, went off with his buddies on exploits for hours on end. When the neighborhood mothers couldn’t find their boys, they’d call the local police. The first time that happened, the police found them playing among the foundations of the half-built homes in a new development. Hugh, remembering my mother’s firm instructions, refused to get into the patrol car with a stranger, even if he was a policeman. So the police car followed him slowly all the way home, as the other kids sat in the back seat.

  There were real dangers. A local murder or kidnapping made headlines from time to time. We encountered the occasional stranger who exposed himself to us in the parks or tried to get one of us to go for a ride or, as happened to my friends and me once, pulled out a butcher knife to scare us when we were exploring a building site. Perils existed, but they seemed manageable if we followed the basic rules of safety our parents taught us.

  Once, while I was still in grade school, an older boy who was visiting in the area chased me, threw me to the ground, and kissed me until I kicked and hit him hard enough to extricate myself and scramble home. I ran to the kitchen sink and washed my face over and over again, while screaming to my mother about what had happened. She calmed me down and, after making sure that I was not hurt, talked with me about how I could avoid that boy and take better care of myself in the future.

  With fewer guns around, a stranger’s desperation or a family member’s sudden burst of anger was less likely to have lethal consequences than today. Children’s disagreements generally ended with no injury more serious than hurt feelings or, at worst, bruises from a fistfight. Friends of my generation who grew up in inner cities or isolated rural areas recall moments of fear or danger, but nothing like the pervasive anxiety about safety that has seeped into every corner of our country’s psyche.

  One warm spring afternoon when Chelsea was about nine years old, she and a friend, who had been riding their bikes around the fountain in front of the governor’s mansion, came inside to ask if they could bike to the public library ten blocks away. I remembered all the trips I’d made to my local library at their age, unaccompanied and unafraid. Tears welled up in my eyes as I told her no. I put aside what I was doing and drove the girls to the library instead.

  My reaction may have been disproportionate to the actual risk involved, but it was symptomatic of the general anxiety about children’s safety that grips every parent I know. Jennifer Allen, a mother and writer who traveled around
the country for Life magazine to talk with parents about the dangers facing children today, emphasizes that household accidents and unintentional injuries are more common threats to their well-being. Yet, she observes, “we can’t stop worrying about the other things, the less dangerous, less likely things like strangers abducting our children.”

  There is no place like home in children’s lives. Brain research teaches us that feeling “safe and protected” is essential to healthy neurological development. But home should provide an emotional as well as a physical haven. Children have an uncanny ability to detect adults’ feelings of powerlessness. It is impossible for them to feel safe when they sense that we are uncertain we can protect them.

  SECURITY DOESN’T end with the physical environment, but it begins there. Safety-minded parents keep household poisons, plastic bags, and matches out of reach. Landlords and public housing authorities install screens to prevent accidents, fix dripping hot-water faucets so children don’t scald their hands, and repaint peeling walls so that children don’t ingest lead, which can harm their developing brains.

  Ann Brown, whom I like to think of as the Pied Piper of child safety—she chairs the Consumer Product Safety Commission—has pulled together a wealth of information on “childproofing” homes. Recently, she invited me to accompany her to the Mazique Parent-Child Center in Washington, D.C., as she teamed up with Gerber Products and the Food Marketing Institute to unveil the Baby Safety Shower How-To Kit. Brown suggested that baby showers with a safety theme are a great way to help new and expectant mothers childproof every room in their homes. I was so impressed by the shower idea that I gave safety items at a White House shower I hosted for a friend who had just adopted a baby.

  I watched as Ann performed a test that all new parents should know about: If a can of soda held upright fits through the slats on the side of a baby’s crib, the space between them is too wide and babies can get their heads caught. Baby mattresses should be firm and flat; mattresses that are too soft can smother babies as they sleep. Inexpensive plugs for electrical outlets and safety gates to block stairways can avoid other serious mishaps.

  Three times as many children die each year from preventable household accidents as from murder. By definition, accidents are unpredictable. Beyond a certain extent, then, they cannot be avoided, but serious injuries from them most often can be. My mother remembers the time when, as a toddler, I spotted a Coke bottle that painters in our apartment building had filled with turpentine. I began drinking it before anyone knew what I was doing. The adults around me reacted quickly to prevent serious consequences. The experience cured me of ingesting anything I wasn’t sure about (except for the fermented mare’s milk I sampled as the honored guest of a nomadic family in Mongolia). But as I grew up, even with watchful adults hovering close by, I still had more than my share of accidents: an arm scalded with boiling water, gashed ankles, knees, and eyebrows; falling down stairs.

  Parents should be willing to go toe-to-toe with their kids over taking certain precautions, like wearing helmets to bicycle, ride a motorcycle, skateboard, or Rollerblade. I remember once, on a trip to San Diego, telling Chelsea and a friend that they didn’t need to wear helmets to accompany me on a short bike ride, and I didn’t either. Imagine my horror when Chelsea’s friend ran into the door of a truck that opened suddenly in her path. Thankfully, she was not hurt, and I got off with a good scare and deep embarrassment when articles about the incident ran in local newspapers. But wearing helmets could help protect some of the more than forty thousand children who receive head injuries each year. Car safety seats and seat belts, used properly, could help prevent another forty-nine thousand injuries in car accidents.

  Among the most tragic accidents are those involving guns. Each year, about five thousand people under the age of twenty die because of firearms. One in ten of these deaths is said to be accidental, many of them caused by children who find loaded guns in their homes. Nearly half of all American households have guns, and often, instead of being locked up, they are just hidden or even left in a drawer, filled with ammunition. Accidental gun injuries have become so prevalent that the American Medical Association advises doctors to make a point of talking with patients who are gun owners about using safety locks on their guns and storing ammunition separately.

  A safety lock is no substitute for the most essential form of child protection, however: the attentiveness of parents and other adults, and of the village at large.

  Last summer, during one of the worst heat waves here in our nation’s capital, four-year-old Iesha Elmore and her two-year-old brother, Clendon, wandered away from their house and climbed into an unlocked car in a nearby parking lot. A couple of hours later, both children were found dead of suffocation.

  The headline on a follow-up story in the Washington Post read “No Place to Play.” A neighbor of the children’s family was quoted as cautioning those who don’t live in the neighborhood not to judge the children’s mother too harshly. Pointing past a blue plastic pool in the run-down housing project, which has no playground, she said, “What is there to do around here? Where is there to play?”

  Stories like this sadden me for the senseless loss of young life. But they also anger me, because no one will take responsibility. Although the parents—both mother and apparently absent father—were primarily responsible for these children, it is too easy, as the neighbor suggests, to blame only them.

  The residents are justified in pointing to the larger community’s neglect. For years, they had tried in vain to get local authorities to install a playground and a speed bump that would slow down the cars careening through their streets. But the neighbors themselves deserve some of the blame. Why didn’t they organize themselves to meet their children’s needs or to demand that they be met? Why didn’t they take turns watching the kids, pitch in to clean up the project’s yard, chip in to buy a few outdoor toys that all the children could share?

  Parents can’t police kids twenty-four hours a day. They need to be able to rely on other adults for help, the way my mother and father could. In the neighborhood where I grew up, if a child fell from a tree or a fight broke out between kids, someone else’s parent was likely to run out of the nearest house to help. Partly this was because more mothers were at home during the day, and other relatives frequently lived nearby. People also welcomed their neighbors’ intervention, rather than seeing it as a criticism of their parenting.

  A woman who is raising children of her own remembers that when she was growing up, she had to be careful about what she did because her grandmother would find out about her behavior even before she got home. Her grandmother welcomed reports from neighbors, even when it was bad news, like the day she tried smoking for the first time.

  Some communities are so besieged by issues of survival that children’s needs get pushed aside. But here and there, neighborhoods are working to rebuild a sense of trust and mutual responsibility.

  In Morningside Gardens, a racially mixed cooperative housing complex in Harlem that is home to almost a thousand families, neighbors make a point of getting to know one another. The complex includes a senior citizen center, a combination day care center and nursery school, a bank, and a grocery store. The complex has its own security patrol and a newspaper that spreads word of births, deaths, and other community news. Residents place a special emphasis on giving young people a stake in the life of the community. There are recreation and tutoring programs, and children and teens are recruited for cleanup projects and other neighborhood activities.

  Residents attribute the health of their village to a strict resident selection process and their grassroots approach to problem solving. They also emphasize a third factor, which is increasingly on citizens’ minds these days: public safety.

  ONE EVENING during the 1992 presidential campaign, Bill and I were being escorted to a dinner through a hotel kitchen. A waiter reached out to shake Bill’s hand. He said he had immigrated to this country from Greece and was now a citizen. “G
overnor,” he said, “my boy is ten years old. He studies politics in school. He says you should be President. Since I trust my boy, I will vote for you.” Bill smiled and said how honored he’d be to receive the vote. “But I have something to ask you,” the man continued. “Where I came from, we were poor, but at least we felt free. Here in America, my family is no longer free. When my boy cannot walk across the street to play in the park in our neighborhood unless I am with him, he is not free. If I do what my boy asks and vote for you, will you make him free?”

  On April 29, 1994, James Darby, Jr., a boy just a year younger than that waiter’s son, wrote to my husband from his home in New Orleans. “Dear Mr. Clinton,” he began, “I want you to stop the killing in the city. People is dead and I think that somebody might kill me. So would you please stop the people from deading. I’m asking you nicely to stop it. I know you can do it. Do it. I know you could.” He signed the note, “Your friend, James.”

  Reprinted with special permission of King Features Syndicate.

  Nine days later, James Darby, Jr., was fatally shot in the head during a drive-by shooting in his neighborhood.

  The freedom James and the waiter asked for is the kind Bill and I experienced when we were young. It existed because adults in our communities offered us both formal and informal means of protection when we ventured out. A number of efforts are under way to re-create that sense of freedom.