Summer is a time for fun and games, and this summer has seen its fair share of discussion surrounding Medicare sustainability, chronic disease prevention and management, and obesity triggers—all of which are key pieces to cutting our health care spending, reforming our health system, and promoting better health outcomes. In all this debate, however, an essential piece of our health care puzzle seems to be missing—babies! And in Detroit, it may be summertime but we learn that for the city's babies, the living sure isn't easy.

Many public health and social science researchers agree that health in the early stages of life sets the foundation for health in adult life (Marmot & Wilkinson, 2006). More specifically, the good health of mothers and children can have beneficial effects on the future health and well being of a country's citizenry. The Detroit Free Press reported today on a study by Kids Count, which puts Detroit at the top of the list for risky births nationwide. (The report covers a 15-year period ending in 2005). Babies in Detroit are coming into the world earlier and less healthy than infants elsewhere in the country.

The study noted that Detroit mothers on average tended to smoke more, were younger, and had little to no prenatal care. Premature births and low birth weights often signal poor prenatal care. City and community officials see social determinants of health (for example: poverty, educational levels, poor housing, environment and health coverage) as allowing this trend to grow. Community members cite the economic collapse of Detroit in the last decade as exacerbating the social determinants, and have stepped in to try to help. The Place Matters Initiative, for instance, brings women of various backgrounds in to educate and counsel young women in many of Detroit's neighborhoods.

With an uninsured rate of roughly 18.3 percent, Detroit is not unlike many parts of the country where access and quality are a social determinant of health. Children (especially on the obesity front) have become players in the national reform debate - but the health policy players need to assess all the pieces of the puzzle. That includes the youngest and most vulnerable. The babies.