Pediatric Annals

Guest Editorial 

This Issue: Public Policy in Children’s Health

Timothy E. Corden, MD

Abstract

I am grateful to have the chance to help bring attention to how policy can influence the health and opportunities of our nation’s children. I thank Dr. Stanford Shulman and the Editorial Advisory Board at Pediatric Annals for giving policy a place in their journal.

As professionals who devote their careers to improving and protecting the health of children, pediatricians have a unique vantage point to see how policies affect the youngest members of our communities. My interest in policy initially stemmed from clinical experience. I have also had the good fortune to spend time with the Robert Wood Johnson (RWJ) Health and Society Scholars Program at the University of Wisconsin. Teams made up of RWJ scholars and pediatric professionals authored the articles in this edition. The authors have produced articles with a broad perspective beyond their individual disciplines that serve as an example of how these types of collaborations can help shape policies effecting health in the future.

David Kindig graciously allowed me to write the first article of the edition with him. The article defines what a “health determinant” is and describes the Evans-Stoddart model of how multiple factors in an individual’s life and across a population get under our skin and influence our biologic health. The model describes how determinants reside within broad categories, such as social economic, physical environment, genetics, individual behavior, and medical care. These are areas that are influenced by policy decisions within society for better or worse. This framework also offers a plausible explanation for why health disparities mirror inequities across several of these broad categories.

The next four articles expand on how determinants and policy interactions within and across the Evans-Stoddart categories affect the health of children; each article also lists recommendations for how policy can be used to improve current and future childhood and adult health.

Conway and Green review the development of immunization policy in our country, describing the partnership between the medical community, industry, government and the public. The policies within this system have evolved to foster scientific advancement, patient safety and, hopefully, the public’s trust. The authors point out how essential that trust is, to ensure individuals and populations benefit from one of the greatest health advancements in history. Their article explains the safety regulations regarding the approval of vaccines and the ongoing monitoring systems currently in use — policies that need to be continued and promoted in a transparent fashion to the general public. The cost/benefit of immunizations are also outlined, reminding us of the value in medical dollars saved and in the individual opportunity preserved by society avoiding devastating illness.

Pediatricians are familiar with the childhood health consequences of ill environmental exposures; exposures that now arise from local and distant global sources. Magzamen et al. discuss the role of policy in protecting children from the ill effects of mercury, lead, and tobacco. Exposures to these agents can cause long-lasting, detrimental effects on developing child physiology and subsequent adult health and productivity.

Johnson and colleagues demonstrate how place, connectedness, socioeconomic factors, and the built environment greatly influence the health within a community. They also introduce a health economic perspective on the vital role policy can play in establishing an atmosphere that makes good/healthy choices easier, as individuals weigh options in their daily lives.

Leininger and Meurer review the success of the Children’s Health Insurance Program (CHIP) and discuss the significant gap that remains in getting universal access for children. The concept of “realized” access demonstrates the value of systems that take into account barriers, such as distance to care, transportation, the challenge to navigate different public and…

I am grateful to have the chance to help bring attention to how policy can influence the health and opportunities of our nation’s children. I thank Dr. Stanford Shulman and the Editorial Advisory Board at Pediatric Annals for giving policy a place in their journal.

As professionals who devote their careers to improving and protecting the health of children, pediatricians have a unique vantage point to see how policies affect the youngest members of our communities. My interest in policy initially stemmed from clinical experience. I have also had the good fortune to spend time with the Robert Wood Johnson (RWJ) Health and Society Scholars Program at the University of Wisconsin. Teams made up of RWJ scholars and pediatric professionals authored the articles in this edition. The authors have produced articles with a broad perspective beyond their individual disciplines that serve as an example of how these types of collaborations can help shape policies effecting health in the future.

David Kindig graciously allowed me to write the first article of the edition with him. The article defines what a “health determinant” is and describes the Evans-Stoddart model of how multiple factors in an individual’s life and across a population get under our skin and influence our biologic health. The model describes how determinants reside within broad categories, such as social economic, physical environment, genetics, individual behavior, and medical care. These are areas that are influenced by policy decisions within society for better or worse. This framework also offers a plausible explanation for why health disparities mirror inequities across several of these broad categories.

The next four articles expand on how determinants and policy interactions within and across the Evans-Stoddart categories affect the health of children; each article also lists recommendations for how policy can be used to improve current and future childhood and adult health.

Conway and Green review the development of immunization policy in our country, describing the partnership between the medical community, industry, government and the public. The policies within this system have evolved to foster scientific advancement, patient safety and, hopefully, the public’s trust. The authors point out how essential that trust is, to ensure individuals and populations benefit from one of the greatest health advancements in history. Their article explains the safety regulations regarding the approval of vaccines and the ongoing monitoring systems currently in use — policies that need to be continued and promoted in a transparent fashion to the general public. The cost/benefit of immunizations are also outlined, reminding us of the value in medical dollars saved and in the individual opportunity preserved by society avoiding devastating illness.

Pediatricians are familiar with the childhood health consequences of ill environmental exposures; exposures that now arise from local and distant global sources. Magzamen et al. discuss the role of policy in protecting children from the ill effects of mercury, lead, and tobacco. Exposures to these agents can cause long-lasting, detrimental effects on developing child physiology and subsequent adult health and productivity.

Johnson and colleagues demonstrate how place, connectedness, socioeconomic factors, and the built environment greatly influence the health within a community. They also introduce a health economic perspective on the vital role policy can play in establishing an atmosphere that makes good/healthy choices easier, as individuals weigh options in their daily lives.

Leininger and Meurer review the success of the Children’s Health Insurance Program (CHIP) and discuss the significant gap that remains in getting universal access for children. The concept of “realized” access demonstrates the value of systems that take into account barriers, such as distance to care, transportation, the challenge to navigate different public and private options and the importance of health literacy, including appropriate cultural and language elements that support patient compliance. The authors illustrate the merits of care coordination through a medical home approach and describe the success of Community Health Centers as an example. The differences in the types of care emphasized by public and private insurance options are also interesting. Public options stress prevention services, while private options often stress less extensive prevention coverage, although allowing for greater reimbursement to the health care system. Hopefully, this difference provides a chance for the two approaches to influence each other rather than becoming a justification for future cuts in public programs.

As a critical care physician, my clinical encounters have reinforced the simple concept that good health and support for chronically ill and special needs children are essential for individuals and families to reach their full potential, while the converse, ill health, leads to limiting a child’s and family’s future choices. Because pediatricians directly see the results of how broad determinants affect children, they have much to bring to the policy process.

The health determinants model and articles in this edition demonstrate the role policy can play in influencing a child’s biologic health. The articles also highlight the potential for policy to reduce the growing health disparities in our country. These articles come at a time when decision makers are grappling with budgetary issues at the state and national levels. Although we must be fiscally responsible to future generations, their prosperity, health equity, and our nation’s future competitiveness is also dependent on how we invest in policies that influence health. My hope is that the concepts presented within this edition and the views of pediatricians are part of the debate.


Authors

About the Guest Editor

Timothy E. Corden, MD, is Associate Professor of Pediatrics at the Medical College of Wisconsin (MCW) and Associate Director of the Pediatric Critical Care Unit at Children’s Hospital of Wisconsin in Milwaukee. He also serves as Co-Director of the Policy Core of the Injury Research Center at MCW.

Dr. Corden received his undergraduate degree in chemistry at Wake Forest University in Winston-Salem, NC, in 1982, and his MD from Wayne State University, in his hometown of Detroit, Michigan in 1986. He was a resident and chief resident in pediatrics at Children’s Memorial Hospital from 1986 to 1990 and a critical care fellow at the University of California at San Francisco from 1990–1993. He also was a guest faculty member to the Robert Wood Johnson (RWJ) Health and Society program at the University of Wisconsin from 2006 to 2010. He served as the American Academy of Pediatrics (AAP) representative to the Joint Commission’s Hospital Professional and Technical Advisory Committee and consultant to the AAP Committee on Hospital Care from 2002 to 2007. The AAP sponsored Dr. Corden as a Department of Health and Human Services, Primary Health Care Policy Fellow in 2005.

Dr. Corden has conducted and published knowledge transfer research on how policy can be used to prevent childhood injuries. He has also served as an academic partner to several grant-funded community projects exploring topics, such as the use of WIC (Women, Infants and Children) offices to help coordinate child passenger safety education and device distribution; connecting free and/or reduced-price lunch eligible children to public health insurance; and expanding the Child Death Review (CDR) system in Wisconsin and use of CDR data to drive evidence-based policy.

As chair of the legislative committee for the Wisconsin chapter of the AAP, he has testified at multiple state regulatory and legislative hearings regarding policies affecting child health and partnered with legislators to develop Wisconsin’s current child passenger safety laws. He is also extensively involved in teaching future and current physicians about the effects of policy on childhood well-being and the unique talents and experiences physicians can bring to the policy process.

10.3928/00904481-20110224-02

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