This issue of Family & Community Health (28.2) centers on a topic that is of great importance to the entire health care community as well as the nation-children's health. Children not only hold the hope for the future of our country, but they are also on the forefront of societal and medical change. At times children have to bear the burden of societal issues such as poverty and hunger more directly than adults. Their numbers reflect the growing diversification of the American population, and emphasize the importance of health care providers' being able to serve people of all nationalities. The health of children also highlights the need to understand and treat chronic diseases as well as illnesses before these youth reach adult status.
The dimensions of child health care have changed significantly over the past few decades. While infectious diseases once occupied the primary focus of pediatric clinical care and training, modern advances in technology and vaccines have considerably reduced this threat. Improvements in diagnosis and treatments, as well as social changes, have led to an increase in children's developmental and mental health issues. The changing epidemiology of illness has resulted in a significant rise in chronic illness as compared to acute illness as the primary cause of child hospitalization and mortality. Child health care is a comprehensive effort that includes both traditional health care and, increasingly, community-based efforts and both prevention and intervention. It includes efforts to help children stay healthy as well as care for both those who are occasionally ill and those with chronic and disabling conditions. In terms of keeping children healthy, social and environmental conditions pose threats. Specifically, current dietary practices that include high calories and limited nutritional values in the food choices and the reduced amount of exercise that some children get are leading to a large youth population who are overweight or obese. Articles in this issue describe the many factors that precipitate inadequate childhood exercise such as lack of safe spaces near their homes where they can be outside, poor role modeling by family and teachers, inadequate amounts of physical education in schools, and a general tendency in our culture to ride rather than to walk. Outside safety is a concern in many neighborhoods due to hazards such as debris, guns, drugs, and the presence of gangs. For many children it is a reality that they could be a bystander in a drive-by shooting. Hence, too many children stay inside for long hours each day. They may be in small places with several people, thereby limiting how active or loud they can be.
Also, many families feel stressed by their personal circumstances and consequently use the television as a form of child care. Rather than reading together, playing games, or engaging in sports or other exercise, children sit unattended in front of the television or playing video games.
Further, the food that children and young people eat increases their health risks. Too often children eat excess refined foods rather than fresh fruits and vegetables, which are so crucial to both weight control and effective growth and development. Food, in many families, is used to reward or entice certain behaviors rather than being treated entirely as a form of nutrition. Another key child health concern is poor dental health among some children, which may be related to health practices as well as to lack of health insurance coverage for dental care. Also the overall issue of lack of health insurance puts many children at risk for health problems since they may get neither preventive care nor timely treatment for injuries or illnesses. Furthermore, the growing field of genetics and gene-environment interactions will lead to new preventive and treatment approaches.
In June of 2003, the Josiah Macy, Jr., Foundation convened a conference on "The Future of Pediatric Education"; this conference centered on the current status of children's health practices as well as education, and the need to make reforms in the coming years. The chairman of the conference, Dr Barry Zuckerman, asserts that pediatrics has yet to incorporate the epidemiology of child health and the changing needs of children as well as their parents; and that to serve today's children-as well as the adults they will become-a redefinition of the field is essential. He states, "Pediatrics in the 21st century must expand to encompass the developmental and mental health needs of the young and the traits and behaviors that may lead to serious health problems in later years. Though pediatrics today appears to be at the cusp of needed transformation, thus far the field has been reluctant to make necessary changes."1
The last article indirectly deals with health of the children. This provocative article describes ways to enlist faith health leaders in intervening in the incidence of HIV/AIDS in their communities and discusses some of the obstacles these health leaders face. Since this health problem affects people of all ages, it is linked to the health of both adults and children.
Child health care involves many participants other than health care providers, including school, social service, community leaders, and law makers. This issue of Family & Community Health describes multiple ways in which the health of children is at risk and also how many and varied approaches and workers are involved. Hopefully, this issue on children's health will serve to introduce readers to some of the growing trends and practices relating to children's health care services and education.
Jeanette Lancaster
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