"Across all of them, there are way too many kids who are obese and overweight - about a third of the kids in the region," said Colleen McCauley, health policy director for the advocacy group Public Citizens for Children and Youth (PCCY), which is releasing the reports Wednesday.
In addition, the proportion of obese and overweight children increased dramatically in Bucks, Chester and Montgomery Counties over five years. It decreased in less-affluent Delaware County, as it has in lower-income Philadelphia.
The city, where PCCY has long focused its efforts, was not included in the four county reports, although many of the findings were drawn from publicly available data. The nonprofit group hopes that it will "start a conversation" with advocates and others involved with youths "so that together we can work to improve children's well-being," said McCauley, author of the reports.
All the recommendations are addressed to county leaders, although many would require them to lobby or form coalitions with other levels of government. Probably the most controversial is ultimately aimed at the state lawmakers who set limits for the Children's Health Insurance Program.
CHIP is available to all residents - higher-income families pay premiums, while those with lower incomes pay less or nothing - with one exception: undocumented children. The reports urge Pennsylvania to join New York, California, and Illinois in allowing them to enroll in CHIP. (Federal law excludes them from Medicaid.)
The reports also suggest that the state bring parity to its data collection by gathering statistics on behavioral health conditions, as it does with physical health. Children's "behavioral health importantly impacts their overall health," the reports note, and say that without that information, a more complete picture of "children's health status is not possible."
Because there were few reliable measures for comparison, for example, the reports did not deal with substance abuse.
"We know that young people are experimenting and using drugs, particularly prescription drugs and opioids, at earlier ages than ever," said Beverly Haberle, executive director of the Council of Southeast Pennsylvania, a prevention and recovery organization that was not involved with the reports.
In Delaware County alone, the Medical Examiner's Office said Tuesday, 26 people 20 and younger died of drug and alcohol poisoning over the last four years, including preliminary 2013 numbers.
Overall, the PCCY reports found that children's health in the more affluent counties was good and getting better. Teen birthrates dropped by double digits in all four counties over five years. Infant mortality was down in all except Bucks, but the relatively small numbers fluctuate from year to year.
Less affluent Delaware County had worse indicators on several measures but was improving.
Obesity is a tough one.
"As the father of three girls, I know," said Bucks County Health Director David Damsker, that the challenge involves "TV and screen time on computers, parents being afraid to let their children run around outside, more and more processed food. . . . Kids want to eat chips and Pop-Tarts instead of eggs for breakfast."
The four reports will be posted Wednesday, alongside previous examinations of public education and family economic security, at www.pccy.org.