Transformed and revitalized a national survey on children’s physical, emotional and developmental health, providing timely and insightful data to state and federal policymakers.

Reem M. Ghandour, DrPH

When a major national report on children’s health was released in 2020, it not only shared a crucial statistic — that 15.5% of U.S. youth ages 10-17 are obese — but it also shed light on racial, ethnic and income disparities of those children and provided specific state-by-state snapshots. 

This critical information just scratches the surface of the voluminous data supplied by the National Survey of Children’s Health. Led by Reem Ghandour of the Health Resources and Services Administration. The annual federal survey is widely used by local, state and federal officials to shape policies relating to the physical and mental health of children throughout the United States. 

“The impact Reem has had with the survey has been both wide and deep,” said Michael Kogan, director of the Office of Epidemiology and Research at the Health Resources and Services Administration. “She has really pushed us to look at the totality of children’s lives to see the influences on their health.” 

The survey, which examines a wide range of issues including access to quality health care and aspects of family life, neighborhoods and schools, has been radically transformed under Ghandour’s guidance during the last several years. 

When Ghandour took over the survey in 2013, for example, it was conducted every four years, the scope was narrow and the rate of reporting—conducted mostly by telephone at that point— was falling. She increased response rates by introducing a mail- and web-based reporting system, and working to publish the survey annually starting in 2016. She also regularly added new information to shed greater light on the health and well-being of the nation’s children. 

“When you only have milestone data every four years, it is not particularly helpful, but Reem really led the push to change that,” said Michael Warren, an associate administrator at the Health Resources and Services Administration. “It is really remarkable to have this kind of data every year, and not only representative at the national level, but at the state level.” 

Ghandour is now breaking new ground by using the survey to examine several areas— behavior, social-emotional interactions and gross motor development—to assess whether children are generally on track for kindergarten. 

“There had been no consensus among countries, academics or federal agencies on how to measure this important concept, yet Reem decided to take on the task,” Kogan said. “She arranged meetings with international and national authorities, other federal agencies and stakeholders at various levels. She helped create and test an entire section devoted to school readiness. It is a remarkable achievement to move a whole field of scientific work forward.” 

For the 2021 survey, Ghandour added five new questions related to the pandemic that she said “will allow us to track some of the impact on kids and families from COVID-19.”  

Conducting the survey annually enables users to examine fresh data on topics of interest and produce more reliable results by aggregating survey samples across multiple years. Since the information is free and accessible online, the survey is used by a wide range of groups and people.  

Maternal and child health programs in every state use the survey to measure their performance against national standards, develop needs assessments and provide state legislatures with critical data. Eight states have also received funding from the Centers for Medicare and Medicaid Services to use the survey to assess their performance and impact on various health indicators.  

A number of states have also begun using new data added under Ghandour’s guidance that demonstrates the effects of adverse childhood experiences, such as exposure to violence and abuse, and household dysfunction. 

Ohio used data on adverse childhood experiences to expand a statewide trauma-informed initiative, and many state health departments, including those in Texas and Hawaii, have worked with their legislatures to address these issues. California drew on the survey for an initiative that required screening, resilience and protective factors for children who have suffered from adverse experiences.  

Private companies have also made use of the information from the survey. In 2018, Starbucks Corp. used certain data to improve its child care policies. After noting that 2 million working parents quit their jobs in 2016 because of child care, the company expanded its U.S. employee benefits package to include 10 subsidized backup care days. 

Laura Kavanaugh, a deputy associate administrator of the Health Resources and Services Administration, described Ghandour as “a tireless, visionary leader who has developed this powerful tool to analyze the health of America’s children.” 

Ghandour said she views the survey as an important way to inform the public and policymakers about the physical and mental health of our nation’s children. 

“It’s a tool to make sure that all little kids have the best opportunity to thrive and be healthy,” Ghandour said. “This is something I hold true to my heart. I see my job as making sure that federal investments in maternal and child health work efficiently and effectively for all mothers, infants and children.”