Tuesday, August 09, 2005
CINCINNATI - Despite a large and growing investment in health care in the United States, few advances have been made in reversing disparities in children's health, researchers say.
Even though the health of Americans has improved overall, large disparities persist among racial, ethnic, socioeconomic and geographic groups, according to Edward Donovan, MD, a physician at Cincinnati Children's Hospital Medical Center, and Barbara Rose, MPH, a researcher at Cincinnati Children's. Donovan and Rose are authors of the editorial in the July / August issue of Public Health Reports. This issue of the journal is entirely dedicated to disparities in health and health care for children and was produced by Dr. Donovan and Ms. Rose.
It's been known that large disparities in health and access to health services exist between children with and without health insurance. Immunization rates are lower, pediatric emergency department wait times are longer; and, lead exposure and under-nutrition are more common among certain racial / ethnic and socioeconomic groups. "It is important that the findings described in this issue be disseminated to policymakers," said Dr. Donovan, director of the Child Policy Research Center at Cincinnati Children's.
How does one explain child health disparities? The authors refer to a triangle consisting of consumers, public health providers and traditional health care providers. They say this triangle may reflect a society in which health is viewed as a commodity, rather than a public good, where all three sides of the triangle are mutually responsible. Poorly functioning interrelationships may lead to feelings of uncertainty among the three parties, the authors say.
The authors say that research has not fully clarified or explained the causes of the health and health care disparities in children in the United States. "Policy makers and the research community should consider the evidence available, and its quality, in evaluating future investments to improve child health. Both public and private investments should be based on the best available evidence to determine what works. Investigators should partner with investors to prioritize relevant questions, develop a common language and understanding of valid evidence, and develop strategies for evaluating untested interventions," the authors wrote.
The authors highlighted programs that are designed to reverse the troubling trend in health disparities among children in the United States. For example, prevention has proven to be effective in improving health conditions in some populations, still in others, access to preventive interventions remains an issue.
Other related issues featured in the journal include an increasing diversity of language used by children and families, access to primary care, mental health, dental care and intergenerational issues.
Reducing disparities in women's health may not only address the unmet health needs of women, but may also reduce disparities in their children's health, according to a study by Robert Kahn, MD, a physician at Cincinnati Children's. The study appears in the current issue of Public Health Reports.
The study found that maternal smoking, depression and alcohol play important roles in explaining the association between lower parental income and education and children's behavioral problems.
"We found that the affects of low income and education on child behavioral problems decreased 26 to 49 percent when smoking, depression and alcohol use were factored in.
"Maternal smoking, and depression and alcohol use persisted over the child's early years and were associated with the mother's own childhood socioeconomic status. The traditional focus has been on ensuring that all women have access to prenatal care, but prenatal care alone is insufficient. Improved health services and insurance for disadvantaged mothers before, during and after pregnancy may be critical to breaking the link between low socioeconomic status and substandard child health," Dr. Kahn said.
The current issue of Public Health Reports also includes a photo essay, "Health Disparities in Children: A Lasting Legacy," by Cincinnati photographer Jim Callaway with text by Barbara Rose, MPH, of Cincinnati Children's. "Many health problems that begin in childhood have a lifelong impact. Disparities in health and health care contribute to lasting effects on the populations well-being," Ms. Rose said.
Public Health Reports is published by the U.S. Public Health Service and the Association of Schools of Public Health.
Cincinnati Children's is a 423-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health.