Health is decided long before a child walks through the clinic door
In April 2022, the National Institutes of Health entrusted Nemours Children's Health with $10.9 million to confront a truth medicine has long struggled to act upon: that a child's health is shaped as much by zip code and circumstance as by biology. The five-year COBRE grant will establish the REACH Center, a research hub dedicated to dismantling the social, economic, and environmental barriers that quietly determine which children thrive and which fall behind. It is an acknowledgment that healing must extend beyond the clinic — into communities, systems, and the structures of everyday life.
- Health disparities among children persist not because of medical failure alone, but because poverty, geography, and systemic neglect create barriers that no prescription can address.
- Nemours researchers are already confronting these gaps directly — building technology to reach obese children in rural Delaware and preparing families emotionally for prenatal heart disease diagnoses.
- The REACH Center will anchor two research cores: one to train investigators in rigorous methods, another to ensure communities are partners in research rather than merely its subjects.
- Pilot grants and mentorship pipelines will accelerate early-stage equity-focused projects into larger, sustained investigations across Delaware and beyond.
- This grant — Nemours' second major NIH COBRE award in two years — signals a broader institutional and federal commitment to reframing pediatric health as a systems problem, not an individual one.
Nemours Children's Health received a $10.9 million federal grant in April 2022 to establish the REACH Center — Research Expanding Access to Child Health — a five-year initiative dedicated to understanding why some children face far greater obstacles to care than others. Led by researchers Anne Kazak and Melissa Alderfer, the center will examine the social, economic, behavioral, and environmental forces that drive health disparities in pediatric populations, operating from the conviction that medicine alone cannot repair inequities rooted in the world outside the clinic.
The work is already taking shape in concrete ways. Physician Thao-Ly Phan is developing technology to connect children with obesity in rural Delaware to specialists they cannot easily reach. Clinical psychologist Erica Sood is building tools to help families navigate the emotional and practical weight of a prenatal congenital heart disease diagnosis. These projects reflect a broader philosophy: that research must serve real families moving through systems that were never designed with them in mind.
To sustain and expand this work, Nemours is launching two research cores. The IMPACT Core will train investigators in advanced research methods, while the PROMISE Core will embed community-based participatory approaches into study design — ensuring patients and families help shape the research, not just inform it. Pilot grants and mentorship structures will support emerging investigators in developing their ideas toward larger funding.
This grant follows a $10.5 million NIH COBRE award Nemours received in 2021 for sickle cell disease research. Together, they mark a meaningful shift — toward pediatric research that treats health inequity as a failure of systems and access, and invests in the long work of changing both.
Nemours Children's Health has received a $10.9 million federal grant to establish a research center dedicated to understanding why some children get sicker than others—not because of biology alone, but because of where they live, how much money their families have, and what barriers stand between them and a doctor's office.
The National Institutes of Health awarded the five-year Center of Biomedical Research Excellence grant in April 2022 to Anne Kazak and Melissa Alderfer, researchers at Nemours who lead the organization's healthcare delivery science work. The center, called REACH—Research Expanding Access to Child Health—will investigate the social, economic, behavioral, and environmental factors that create gaps in care and drive health disparities among children. It is a recognition that medicine alone cannot fix health inequity; the barriers exist outside the clinic walls.
Nemours, one of the nation's largest multi-state pediatric health systems, is positioned to serve as a hub for this work. The organization has already begun pilot projects that illustrate the problem and the potential solution. Thao-Ly Phan, a physician in Nemours' weight management clinic, is developing technology to help children with obesity in rural Delaware access care—places where specialists are scarce and travel distances are long. Erica Sood, a clinical psychologist at Nemours, is creating educational tools to help families prepare emotionally and practically when they learn prenatally that their baby will be born with congenital heart disease. These are not abstract research questions; they are about real families navigating systems that were not built with them in mind.
To support this work at scale, Nemours is establishing two research cores. The IMPACT Core, led by Kimberly Canter, will train investigators across Nemours and throughout Delaware in cutting-edge research methods. The PROMISE Core, led by J.J. Cutuli, will ensure that research is done with communities, not just about them—a participatory approach that brings patients, families, and community members into the design and execution of studies. The center will also fund pilot grants for early-stage projects and provide mentoring to help researchers develop their ideas into larger, funded investigations.
This is the second major NIH COBRE award Nemours has received in recent years. In 2021, the organization secured a $10.5 million grant to support the Delaware Comprehensive Sickle Cell Research Program. Together, these investments signal a shift in how pediatric research is being funded and framed—not as a problem of individual patients, but as a problem of systems and access. The work ahead will test whether technology, community partnership, and rigorous research can begin to close the gaps that leave some children healthier than others based on circumstances largely beyond their control.
Citas Notables
The REACH Center will expand Nemours' 'well beyond medicine' strategy, supporting each child's whole health including social, economic, behavioral, and environmental factors.— Mary M. Lee, MD, Nemours Children's Chief Scientific Officer and Physician-in-Chief
La Conversación del Hearth Otra perspectiva de la historia
Why does a children's hospital need a $10.9 million grant to study things outside the hospital?
Because a child's health is decided long before they walk through the door. A kid in rural Delaware with obesity can't see a specialist if there isn't one within an hour's drive. A family getting a prenatal diagnosis of heart disease needs support, not just information. The hospital can treat the disease, but it can't fix the distance or the fear.
So this is about poverty and geography?
It's about that and more. It's about whether a family can afford to take time off work for appointments. Whether they speak the language the clinic uses. Whether they trust the system. Whether the research itself is designed by people who actually live in these communities or just studied them from a distance.
What does the PROMISE Core actually do?
It makes sure researchers aren't just extracting data from communities and leaving. It builds in community members as partners from the beginning—in designing the study, running it, interpreting what it means. That changes what questions get asked and how.
And the pilot projects—are those already working?
They're early. A doctor is building an app to help rural kids with weight management. A psychologist is creating materials for families who just learned their baby has a heart condition. These are small proofs that technology and thoughtful design can meet people where they are.
What happens in five years when the grant ends?
That's the real test. If the research shows that these approaches work, then Nemours and other hospitals have a blueprint. If it doesn't, they've still learned something. Either way, the question shifts from 'Can we do this?' to 'Why aren't we doing this everywhere?'