Editorials |
Child public health and child (health)care: too far apart?
Sijmen A. ReijneveldProfessor of Public health, University Medical Center Groningen The Netherlands; Member of the Editorial Board of EJPH
Correspondence: Sijmen A. Reijneveld, Professor of Public health, University Medical Center Groningen, The Netherlands, e-mail: s.a.reijneveld{at}med.umcg.nl
Child public health denotes both the health of the young population and the societal efforts to improve this health. Measured by for instance the contents of the Journal or the number of lectures at the annual meetings of Eupha, it constitutes a substantial part of European public health.
In the current issue of the Journal, again several publications provide information on child public health in Europe. Koupil et al.1 studied inequalities in infant mortality in Estonia. Efforts to lower infant mortality have been in the roots of public since long ago. Interestingly their study shows a large decrease in infant mortality since 1991, the year in which Estonia regained independence. Relative differences in mortality by socioeconomic position remained rather stable though, similar to the trend in other countries.
Health-related behaviours in children and adolescents have received attention more recently. In the current issue of the Journal, a study of Niclasen and co-authors shows the dramatic increase in overweight and obesity at school entry.2 Their study concerns the Greenland population from 1972 to 2001 but is likely to reflect developments in other countries.
Hagquist studied self-reported health and health-related behaviour among Swedish adolescents.3 This study shows a higher prevalence of adverse health outcomes among adolescents with lowly educated parents. Not unexpected, differences are even larger by the type of education, an adolescent follows. In contrast, Andersen et al.4 do not find important socioeconomic differences in the occurrence of drunkenness among Danish adolescents. They do find higher rates of school-related risk factors for this among adolescents with parents of low occupational level, though. Different mechanisms thus seem to contribute to drunkenness, depending on adolescents' socioeconomic position.
In short, this issue of the journal provides interesting data on trends in child public health, but also poses new questions. What should routine child healthcare and primary care do with the results as presented? Should providers use these findings in their provision of care, and could they help to solve or prevent problems as identified? Koupil and co-workers explicitly call for better perinatal care for deprived groups. And Niclasen and co-workers derived their data from routine child health examinations. But further activities from child (health)care services are not called for. Why not explicitly invite primary care to participate in case-finding and advice? Or take notice that after-school services offer an excellent route to influence health habits of school-aged children, in particular regarding nutrition and physical exercise? And may providers of specialized care like pediatricians not offer strong alliances to draw public attention to the effects of morbid obesity and of extreme drunkenness among adolescents? Sometimes, such alliances occur. For instance, recently a Dutch pediatrician asked for public attention because of an increasing number of children under 16 years who entered emergency care unconsciously because of extreme alcohol abuse.5 Attention to this may add to campaigns to ban sales of alcohol to adolescents.
Crossing the bridge from public health to child (health)care may thus provide valuable means to improve and protect child health. If ignoring that, opportunities are missed to embed preventive efforts in the regular care for children. It is my impression that this gap between public health and (other) healthcare is in most European countries also only incidentally crossed from the other side, by healthcare services that take a child public health perspective. Interestingly, a good example regarding the opportunities for specialized child health care to achieve this can be derived from the USA. In that country, pediatricians seem to take a somewhat more active approach including a lot of public health problems.6 Of course one may argue that the child health problems urge them more to do so too, and that public health is better developed in several European countries. But anyhow, it may be helpful to assess whether such a social pediatrics approach, including explicit advocacy for child public health, might reinforce European child public health and might be transferred to other types of child health services. I see a lot of opportunities to improve child public health and despite some interesting initiatives, still a lot to do.
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1 Koupil I, Rahu K, Rahu M, Karro H, Vågerö D. (2006) Major improvements, but persisting inequalities in infant survival in Estonia 1992–2002. Eur J Pub Health 17:8–16.
2 Niclasen BV, Petzold MG, Schnohr C. (2006) Overweight and obesity at school entry as predictor of overweight in adolescence in an Arctic child population. Eur J Pub Health 17:17–20.[Medline]
3 Hagquist CE. (2006) Health inequalities among adolescents—the impact of academic orientation and parents' education. Eur J Pub Health 17:21–26.
4 Andersen A, Holstein BE, Due P. (2006) School-related risk factors for drunkenness among adolescents: risk factors differ between socio-economic groups. Eur J Pub Health 17:27–32.[Medline]
5 Parents should follow courses to learn more on the risks of alcohol. [in Dutch] Trouw. 27 October 2006.
6 Satcher D, Kaczorowski J, Topa D. (2005) The expanding role of the pediatrician in improving child health in the 21st century. Pediatrics 115:Suppl. 4, 1124–8.
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