Amid the “Healthy Holly” book scandal shaking the political foundations of Baltimore is another scandal of a deeper, but more important, order. And that scandal involves the lack of resources we dedicate to early literacy for our youngest Baltimoreans. Early literacy refers to the love of reading, the love of books, and the number and quality of words that infants and young preschool age children are exposed to in these formative years. There is a large amount of research that shows children as young as six months begin to identify phonetic sounds, associations with reading and positive feelings/bonding when being read to. These positive effects of books are life long and carry over into other domains of the child’s life.

The Reach Out and Read program is a national program that has distributed millions of books through pediatricians’ offices to young children since 1989 and encouraged parents to read to their infants and toddlers as one of the best ways to cultivate a healthy, whole child. My pediatric office in South Baltimore has been distributing books to kids since 2001; now we are out of books. We have distributed zero books in the past four months due to lack of funds and lack of public health financing. My office is obviously not the only Reach out and Read site affected. Throughout Baltimore and the country as public health funding has dried up, so has the funding for great early childhood programs, like ROR. This is a public health crisis.

It is ironic that as research continues to reveal the roots of health as deeper and broader than we ever realized, what is possible to achieve in our current health care system becomes less and less. There is an amazing body of research called Life Course Health Development that shows the basis of health, in its broadest possible sense, is largely determined in the first five years of life. This is health conceived in the broadest possible sense, that is, social, emotional, physical and economic health. This foundation is laid down in the first few years — for life. After these early years, the course of health will follow an almost predictable trajectory. There are risk factors that can push the trajectory down — poverty, illiteracy, stress, poor access to quality health care, etc. — and positive factors that raise the trajectory: secure access to food, housing, books and quality health care, etc. The point is that the whole trajectory over the life span is lowered or raised based on the early life factors, even to the end of life.

In 1995, university professors Betty Hart and Todd Risley published an important paper called “The Early Catastrophe,” which showed the exposure to words, both spoken and written, varied widely by socio-economic class. As you would expect, kids from lower-income families were exposed to fewer words and therefore could say fewer words in these formative preschool years. In what has come to be called “the 30 Million Word Gap,” these children from the lower-socioeconomic families had been exposed to 30 million fewer words by age 4. This leads to an achievement gap in later years. There is obviously more to a fulfilled childhood than exposure to words, but subsequent research has borne out these meaningful differences in early childhood experience and revealed that these first years of life are not just a vulnerability, but also an opportunity. It is a maxim of medicine that it is better and cheaper to prevent than to treat. And we are talking about pennies on the dollar and, more importantly, about the flourishing of human life.

We can do better, much better. Amid all of the focus on Baltimore’s woes and finger-pointing about who is to blame we neglect to notice the more than 40 years of public-sector divestment – lack of funding for public health (broadly conceived), public parks, public transportation and public education. It is the children of Baltimore who bear the brunt of this and are lost in the wake of privatizing and the financialization of every realm of life.

Children don’t vote, they don’t have any power and they don’t have any money. But we can see them as our wealth that we are saving for the future. It is the future of Baltimore.

Dr. John F. Irwin (John.Irwin@Medstar.net) is a pediatrician in Baltimore.