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The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community's efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and early childhood development, such as home visiting programs. Efforts to serve children with special behavioral and physical health care needs were discussed as were community-level efforts to bridge service fragmentation and gaps. Site visitors learned about issues faced by community-based organizations serving children and families, including problems with federal funding streams, state and local politics and bureaucracies, and perennial budget challenges.

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