It is timely in the current environment to examine the intersection of health care and public health as it pertains to children. Major threats to children’s health, such as chronic conditions, obesity, injury and communicable diseases, cannot be managed solely in the pediatric office. Clinical practice should be integrated with public health activities so that prevention can be accomplished at multiple levels (e.g., the child, family and community).
The new AAP policy statement Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation’s Childrenidentifies opportunities for collaboration. The statement, from the Council on Community Pediatrics and Section on Epidemiology, Public Health and Evidence, is available at https://doi.org/10.1542/peds.2017-3848 and will be published in the February issue of Pediatrics. It builds on a 2013 policy about medicine, public health and the social determinants of children’s health (http://bit.ly/2qrY7CR).
Impact of population-level conditions
National statistics indicate that our children are not thriving. For example, 20% of children live under the federal poverty level; 20% of children 9-17 years have a diagnosable mental health condition; over 30% of children have overweight or obesity; and more than 4,000 children were killed by firearms in 2014.
Social, economic and environmental factors are critical determinants of child health. In many ways, the general pediatrician is a front-line public health provider, able to identify emerging issues facing children at the local population level. Public health professionals should partner with pediatricians to better allocate resources to address the child health issues most pertinent in the local community.
In recent years, significant population-level conditions have affected the health of children, including the Disneyland measles outbreak, the Flint water crisis and the emergence of Zika virus infections.
After the measles outbreak in 2014-’15, California state Sen. Richard J. Pan, M.D., M.P.H., FAAP, co-authored a bill (SB 277) mandating that all public school children be vaccinated on school entry. Hundreds of pediatricians and thousands of non-pediatric physicians across the state educated legislators on the importance of this bill, which was signed into law and took effect in 2016.
Contamination of the water supply in Flint, Mich., led to an increase in the number of children with elevated blood lead concentrations, which was identified by Mona Hanna-Attisha, M.D., M.P.H., FAAP, by examining hospital records. Because of her data and efforts by environmental advocates, the state and federal governments authorized aid toward resolving the crisis.
When Zika virus infection emerged in late 2015 as a potential source of significant birth defects, the Centers for Disease Control and Prevention (CDC) issued several reports cautioning pregnant women against travel to Zika-infested areas of the world and methods of protection from mosquito bites. The CDC and the Academy partnered to develop guidelines for pediatricians on the management of infants born to Zika-exposed mothers.
Calls to action
Although these examples may seem beyond the purview of a practicing pediatrician, the following are among recommendations in the policy for how pediatricians can work with public health professionals to improve the health of children in their communities.
For individual pediatricians:
- Keep abreast of reporting requirements for diseases, outbreaks and vaccine adverse events to public health agencies.
- Use resources and recommendations from public health agencies and access local and state public health data to identify population health needs and trends.
- Identify opportunities to collaborate with public health entities on community disease prevention and health promotion programs. Consider advocating for population-health approaches within health care institutions and systems.
- Those training residents should include public health and population health curricula into training.
For collaboration between pediatricians, public health professionals:
- Share data and information on children’s health issues.
- Partner on prevention and health promotion projects that address chronic disease and disability.
- Collaborate with families to advocate for healthy environments for children, including considerations in disaster planning, particularly for those with special needs.
- Partner to advocate for investments in public health systems and infrastructure at all levels, including efforts to promote healthy community development.
For the Academy and chapters:
- Include pediatrician members serving in public health departments, facilities and agencies in AAP communications and activities.
- Develop working relationships with state and local health departments so important matters of joint interest are effectively communicated and when a crisis occurs, they can work together.
- Consider making continuing medical education opportunities in public health practice and priorities available to all members.
Most important is the recognition that pediatricians and their public health colleagues are key in addressing the social determinants of health that have major consequences on children’s health and well-being. Current federal stances on children’s health insurance coverage and deportations of immigrants and refugees will have a negative impact on children’s health for years to come. Greater communication, collaboration and partnership between pediatricians and the public health sector have the potential to protect children and improve individual and population-level child health outcomes.