Screening Children for Structural Drivers of Health

Nearly half of all US children—40 million kids—were insured by Medicaid or children’s health insurance programs in mid-2025. In 2024, the Centers for Medicare and Medicaid Services added a requirement that all hospitalized Medicaid patients be screened by a qualified clinician for structural drivers of health (SDoH). One justification for this requirement is that health outcomes, particularly for children of color, are widely documented as compromised by social, historical, and fiscal neglect of parental leave and other US policies that support children. Regardless of whether screening for SDoH is federally required, pediatricians’ understandings of factors that situate health outcomes for all US children, regardless of their insurance status, are key to caring well for children. Yet, despite the value of SDoH screening in improving US children’s health outcomes, one problem is that even when such screening is feasible, it’s not always clear which follow-up actions should be integrated into children’s care plans, based on what screening reveals. This theme issue investigates clinical, ethical, and policy-level questions about how SDoH screening of children should be implemented and administered.

Background image by Sara Gironi Carnevale.