Pediatricians must look beyond the walls of the examining room and into their own communities to understand and confront the socioeconomic and environmental threats to the health of children and adolescents, such as poor nutrition, exposure to violence, and substance abuse.
That was the recommendation of a special supplement of the journal Pediatrics released today by the American Academy of Pediatrics, the nation's largest professional organization of pediatricians.
The supplement's lead editors and contributors included several University of Rochester Medical Center pediatricians and many of the recommendations and conclusions in the study are based on the pioneering work done by Rochester-based practitioners in the field of pediatric community health.
"In the past, pediatricians focused solely on the patient and the treatment of disease," said Jeffrey Kaczorowski, M.D., a pediatrician at URMC, co-director of the Pediatric Links to the Community program, and one of the supplement's editors and contributors. "The health problems that we are confronting in kids today, such as obesity, mental health concerns, drug use and violence, are the result of the conditions in their communities."
The supplement focuses on socioeconomic, environmental, and lifestyle impacts on the health of children and the need for pediatricians to partner with community-based organizations, state and local government, schools, churches and families to improve the delivery of health care.
Pediatricians are becoming more sensitive to the direct relationship between socioeconomic status and child health. Economically disadvantaged youths are more susceptible to teen pregnancy, violence and injury, sexually transmitted diseases, and mental health problems. Racial and economic disparities are particularly glaring. Black and Hispanic children are more likely to be under immunized, become overweight, develop diabetes, become pregnant as teens, and suffer from asthma than their white counterparts. The mortality rate for black infants is twice that of white infants.
"Factors such as race, poverty, and education are among the most important determinants of the future health of an individual," said Andy Aligne, M.D., a URMC pediatrician and co-editor and contributor to the supplement. "These factors have their roots outside what has traditionally been considered the realm of pediatric care. But in order to have a meaningful impact on health, we have to engage with the community to confront these problems."
The supplement details several models for community-based approaches to improving the health of children, including the groundbreaking efforts at URMC. Building on an already strong institutional commitment to community health, in 1996, the Pediatric Links to the Community (PLC) program was created at URMC to further the study of the unique health challenges for economically disadvantaged children and adolescents in the Rochester area and develop partnerships with community-based organizations to improve the delivery of care. The program has received national recognition and in 2001 received the Ambulatory Pediatric Association's Outstanding Teaching Award, the American Academy of Pediatrics Professional Education Award, and a $2.5 million grant from the Dyson Foundation.