Pediatric chronic disease poses future health and welfare challenges

The increased incidence of chronic conditions among American children predicts serious strains on health care and social welfare systems in the future, caution investigators from Massachusetts General Hospital (MGH) and Harvard School of Public Health (HSPH).

In a commentary in the June 27 Journal of the American Medical Association an issue devoted to pediatric chronic disease the authors explain how rates of obesity, asthma and attention-deficit hyperactivity disorder (ADHD) have increased over the past three decades, review factors that may underlie those increases and examine future implications.

These new epidemics in chronic health conditions among children and youth will translate into major demands on public health and welfare in upcoming decades, explains James Perrin, MD, of the Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, one of the authors of the report.Active prevention efforts likely offer the best hope of reversing these trends.

The authors reviewed data from many sources and numerous studies in scientific journals to document their observation that more children have chronic health conditions today. They found that rates of obesity in children and adolescents have more than tripled from 5 percent in the 1970s to 18 percent today. The incidence of asthma has more than doubled to almost 9 percent, and the diagnosis of ADHD has also increased in past decades to include about 6 percent of school aged children. Overall, from 15 to 18 percent of children and adolescents have some sort of chronic health condition, nearly half of whom could be considered disabled.

While all three of these disorders probably have some genetic basis, the most probable explanation for the recent steep increases is rapid change in social and environmental factors. These include modern stresses on parents that reduce the time and energy they can devote to their children; increased time children spend watching television or in other indoor sedentary activities; reduced opportunities for physical activity; and dietary changes that include more fast foods and sugar-sweetened beverages, and overall increases in calorie consumption.

The food, physical activity and media environments of children have changed dramatically in recent decades, and primary prevention efforts can begin by working to improve those environments, says study co-author Steven Gortmaker, PhD, of the HSPH Department of Society, Human Development, and Health.We know that major health conditions continue into adulthood; so if these trends continue, we will see increased health care costs and decreased quality of life, as many of these young people find their opportunities limited. He is a professor of the Practice of Health Sociology at HSPH, and Perrin is a professor of Pediatrics at Harvard Medical School.

The authors also including Sheila Bloom, MS, of MGH list potential outcomes if the current trends continue. Obesity is known to increase incidence of type 2 diabetes, already being seen in young people, hypertension and cardiovascular disease. Asthma persists into adulthood in at least 25 percent of children, many of whom will risk disability. ADHD is also known to continue into adulthood at least half the time, putting affected individuals at increased risk of other mental health problems and potentially limiting educational and employment success.

In their summary, the authors note that current health and welfare programs are unprepared for the demands presented by this situation. Planning for increased expenditures to meet these needs will be critical, and further investigation of factors underlying these conditions and the implementation of preventive strategies will be essential.