The Medical Model of Health
As the pace of social change quickens, children are faced with new social and environmental risks to their growth and development. Of these changes, childhood poverty poses the greatest threat to children 's well-being. One in four American children under the age of 3 years lives in poverty; (Haggerty 1999) a higher percentage of children live in poverty than any other age group. As pediatricians, we know that children in poverty experience a double jeopardy. First, they are more frequently exposed to risks to their health and development (such as lead poisoning, malnutrition, and family dysfunction). Second, children suffer more negative consequences (such as developmental delay and school dysfunction) from such exposure than do children with more advantaged socioeconomic circumstances. (Barry 2000)
Although recognition of and sensitivity to these risks have increased, primary preventive efforts, the cornerstones of pediatric practice, have failed to keep pace with changing circumstances. On the contrary, the pediatric primary-care clinician is asked to shoulder an ever greater burden in reducing the effects of social disadvantage on children--a trend that continues to increase as the social safety net for children has become increasingly porous. The primary-care clinician is enjoined to provide anticipatory guidance, to perform developmental surveillance, to prevent unintentional injuries, to recognize and address parental substance use and depression, to solve issues of child abuse and family violence, to advocate with the school system and other social agencies, to manage behavioral and family issues, etc--all in the context of a 20-minute health supervision visit. Clearly there is a limit to a clinician 's ability to address such a daunting agenda, and that limit has long since been exceeded, even for families without social disadvantages.
Perhaps the problem lies neither in the primary-care pediatrician 's abilities or motivation nor in the multitude of
Although recognition of and sensitivity to these risks have increased, primary preventive efforts, the cornerstones of pediatric practice, have failed to keep pace with changing circumstances. On the contrary, the pediatric primary-care clinician is asked to shoulder an ever greater burden in reducing the effects of social disadvantage on children--a trend that continues to increase as the social safety net for children has become increasingly porous. The primary-care clinician is enjoined to provide anticipatory guidance, to perform developmental surveillance, to prevent unintentional injuries, to recognize and address parental substance use and depression, to solve issues of child abuse and family violence, to advocate with the school system and other social agencies, to manage behavioral and family issues, etc--all in the context of a 20-minute health supervision visit. Clearly there is a limit to a clinician 's ability to address such a daunting agenda, and that limit has long since been exceeded, even for families without social disadvantages.
Perhaps the problem lies neither in the primary-care pediatrician 's abilities or motivation nor in the multitude of
References: Atpert JJ, Robertson LS, Kosa J, Heagarty MC, Haggerty RJ. Delivery of health care for children: report of an experiment. Pediatrics. 1996;57: 917-930 Barry, A, M & Yuill, C (2000)Understanding Health. A sociological Introduction. Sage London Frank D, Napoleone M, Meyers A, et al. A heat or eat effect? Seasonal changes in weight for age in a pediatric emergency room. Presented the Annual Meeting of the American Public Health Association, Atlanta, GA, 1991 Greenspan S. Monitoring social and emotional development of young children. In: Parker S, Zuckerman B, eds. Behavioral and Developmental Pediatrics: A Handbook for Primary Care. Boston: Little Brown; 1995 Haggerty RJ, Rogghman KJ, Pless IB. Child Health and the Community. New York: John Wiley and Sons; 1999 Meyers A, Rubin D, Napoleone M, Nichols K. Public housing subsidies may improve poor children 's nutrition (letter). Am J Public Health. 1993;83:115 Needlman R, Fried LE, Morley DS, Taylor S, Zuckerman B. Clinic-based intervention to promote literacy. Am J Dis Child. 1991;145:881-884 Nettleton, S (2001) The sociology of Health and Illness Polity Press, Cambridge. Senior, M& Vivieash, B (1998) Health and Illness. Palgrave, Basingstoke & New York