The American dream is a fundamental ethos of the nation passed from generation to generation. In 1931, James Truslow Adams coined the term as “that dream of a land in which life should be better and richer and fuller for everyone.” Most Americans across all incomes still believe their children and grandchildren will achieve the American dream.1  Yet, in reality, it is out of most children’s reach. The American dream is intrinsically tied to the capacity for upward mobility, whereby children can grow up to surpass their parent’s income level. The groundbreaking work of Harvard Professor of Public Economics Dr Raj Chetty reveals that there is less upward mobility in the United States today than at any other time, likely because of lower overall economic growth and greater inequality in its distribution. Specifically, Chetty et al2  found that, since 1940, the fraction of children who earn more than their parents has fallen from >90% to ∼50%. However, the decline in the American dream is not equally distributed across the United States. Chetty et al3  has revealed great variation in upward mobility, with significant differences even among neighborhoods within the same city. Higher–upward-mobility areas are associated with less residential segregation and income inequality and greater social capital.

As 3 academic pediatricians whose parents came here searching for a better future for their children, we have experienced the American dream firsthand and believe that it is imperative for the field of pediatrics to protect the American dream for all children. This will require action on every level within the field, ranging from pediatricians in practice to pediatric professional organizations. Below, we highlight novel public policies, pediatric-practice recommendations, and promising initiatives in alignment with core pediatric principles that we believe should be enacted and emulated to address key drivers of upward mobility: the elimination of child poverty, the safety and health of immigrant families and children, educational opportunities for young children and families, and collective social capital.

The detrimental effects of poverty in childhood are numerous and extend throughout the life span. Compared with affluent children, by the time poor children reach adulthood they have completed 2 fewer years of schooling, earn less than one-half as much income, and are more than twice as likely to report poor health.4  From a societal standpoint, this is devastating; child poverty costs the United States $1.1 trillion annually, in terms of lost adult productivity.4  In response, the American Academy of Pediatrics (AAP) included child poverty in the AAP Agenda for Children strategic plan and the Academic Pediatric Association convened a poverty task force; these efforts must continue. Last year, the National Academies of Sciences, Engineering, and Medicine issued a report detailing various combinations of policies and programs (eg, increasing the earned income tax credit, raising the minimum wage, and instating a child allowance) that would reduce child poverty by one-half within the next decade.4  We strongly urge pediatric organizations, such as the AAP and Pediatric Policy Council, to legislatively advocate for these policy changes. In addition, within the health care delivery realm and consistent with AAP recommendations, pediatricians should develop systematic ways to address families’ unmet social needs and connect families to available social services. For children to have upward mobility, opportunities must be equitable and accessible; this requires stronger social and economic supports for poor families.

Most families immigrate to the United States in pursuit of the American dream. A total of 1 in 4 children in the United States are from immigrant families, although most are American citizens themselves. Unfortunately, with the current anti-immigration climate, undocumented families live in constant fear of deportation, driving families away from accessing needed government and health services. The National Immigration Law Center is a resource for clinicians to learn how to respond to immigration officials while protecting the rights of children from immigrant families. Pediatricians can maintain a list of immigrant rights Web sites, such as Protecting Immigrant Families, hotlines (if available), and local legal services. The AAP Immigrant Child Health Toolkit also provides practical steps for pediatricians to take to address common issues related to immigrant health, along with information on community resources and available public benefits. Policy changes that dismantle systemic and interpersonal discrimination, reinforce antibullying laws, and ensure that immigrant families can safely access social services are urgently needed. Pediatricians can engage in their local AAP chapters and, collectively, advocate through their professional organizations. By equipping themselves with resources to help children from immigrant families and through advocacy, pediatricians can support immigrant families along their American dream path.

High-quality early education, including universal and free pre-K, and innovative home-visiting programs that provide parents with culturally sensitive parenting skills are important initiatives that promote upward mobility. One example of an educational model that provided integrated support is the Perry Preschool Project. By combining weekly teacher visits to families’ homes for children ages 3 and 4 with daily in-class instruction, the program significantly increased high school graduation, employment, and home ownership.5  Greater federal and state investment in analogous educational programs, home-visiting programs, and literacy initiatives, such as Reach Out and Read, is urgently needed to support children’s development. At all well-child–care visits, pediatricians, in alignment with Bright Futures guidelines, should encourage reading, actively engaging children in play, and enhancing the home learning environment. High-quality early education in conjunction with developmentally appropriate anticipatory guidance and abundantly available learning opportunities are essential in building early-childhood environments in which children can thrive.

Consistent with the concept of community pediatrics, pediatricians can help build social capital in the communities they serve through partnerships with stakeholders, including area residents, organizations, and anchor institutions. Led by pediatrician Dr Renee Boynton-Jarrett, the Vital Village Network (VVN),6  a formalized collaborative network of Boston-area families and organizations, serves as a model for how these partnerships can increase families’ opportunities for upward mobility. Vital Village aims to strengthen services that support children and families by aligning health, education, and social-service sectors and engaging local families to ensure that programs are community driven and build on community and family assets. For example, the VVN developed a service-learning model for caregivers to become peer lactation counselors and facilitate breastfeeding support groups, which expands community capacity, social connections, and enrichment opportunities. The VVN exemplifies a practical way for pediatricians to address structural inequities through a community pediatric based approach: by working in tandem with cross-sector coalitions to build sustainable capacity at the community level to promote positive change.7 

The United States has long been considered the land of opportunity and hope, and many pediatricians, including the authors, have achieved the American dream. Nevertheless, there are fewer upward–economic-mobility opportunities for today’s children. Expanding public policies that support vulnerable families and children is necessary to reverse this downward trend. Pediatricians must mitigate the impact of poverty and immigration status on upward mobility and augment social capital within their communities through advocacy and by addressing families’ unmet social needs, delivering context-specific, anticipatory guidance, supporting the home environment, and partnering with community services. By enacting these upward mobility initiatives, the American dream can become more equitably attainable for all children.

We thank Ms Mikayla Gordon Wexler for her assistance and technical support.

Dr Garg conceptualized and drafted the manuscript and reviewed and revised the edited manuscript; Drs Lopez and Raphael edited the initial manuscript draft and reviewed and revised the edited manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: No external funding.

     
  • AAP

    American Academy of Pediatrics

  •  
  • VVN

    Vital Village Network

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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no conflicts potential of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.