Hopkins Children’s expert offers five strategies to eliminate health disparities

Health disparities have moved high on the agenda in the national discussion of healthcare reform in the last several years, and hundreds of studies have documented and analyzed gaps in access to healthcare and health outcomes. But one sometimes marginalized group in these discussions is children, according to Tina Cheng, M.D. M.P.H., director of General Pediatrics & Adolescent Medicine at Johns Hopkins Children’s Center, and fellow pediatrician Renee Jenkins, M.D., of Howard University in Washington, D.C.

In a commentary in the June 17th issue of JAMA the pediatricians argue that the time is ripe for changing that paradigm and offer suggestions for how to do so.

The authors note that13 million U.S. children are estimated to be living in poverty, and a recent United Nations report ranked the United States at or near the bottom among 21 nations on five key dimensions of child health and well-being.

Yet according to a landmark 2003 Institute of Medicine report, which reviewed data from 103 studies on health disparities, only five studies focused on children.

“Much more attention has been given to health disparities in adults than health disparities in children,” Cheng says. “But a growing body of research shows that health disparities in childhood often lead to poor health in adulthood.”

The authors argue for an integrated approach to research, one with a life-course perspective that involves collaboration among specialties to study and address health and disease across the distinct stages of life—from obstetrics, to pediatrics, to adult medicine.

Synthesizing extensive research on child health disparities, Cheng and co-author Renee Jenkins, M.D., of Howard University in Washington, D.C., specifically call for:

1. An approach that views an ounce of prevention as worth a pound of treatment: The focus needs to shift toward preemptive investment in wellbeing and skill formation among disadvantaged children in the earliest stages of childhood and away from the current—expensive and ineffective—model of remedial programs and treatment later in life.
2. Guaranteed access to healthcare: The authors applaud the recent reauthorization of SCHIP, the federal program that provides matching funds to states for health insurance of poor families with children. SCHIP has a track record over the years of successfully closing income gaps, improving access to preventive health services and medical care. It has resulted in higher immunization rates, better disease outcomes and overall better quality of life.
3. An inter-generational approach to healthcare and education: The authors call for support and adoption of models like the Harlem Children’s Zone, which provides comprehensive education, health-care and social services to underprivileged children while helping parents become more self-sufficient.
4. Collaboration among medical disciplines and beyond: Physicians must transcend their traditional medical “silos” and collaborate not only with colleagues from other specialties, but also with those from other disciplines, community leaders, public health experts, educators and other key players involved in child development.
5. Top-down transformation: Changing the status quo should start with a strong centralized agenda from the very top, by creating a Presidential commission on children acknowledging that the wellbeing of the nation’s children is a critical investment. The commission must expand and implement recommendations set by the Institute of Medicine and National Research Council in their reports “Unequal Treatment” and “Children’s Health, the Nation’s Wealth.”