PEDIATRICS Vol. 103 No. 6 June 1999, pp. 1304-1306

AMERICAN ACADEMY OF PEDIATRICS:
The Pediatrician's Role in Community Pediatrics

Committee on Community Health Services

	ABSTRACT

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This policy statement offers pediatricians a concise definition of community pediatrics and provides a set of specific recommendations that underscore the critical nature of this important dimension of the profession.

Today's children and families live in a period of rapid social change. The economic organization of the health care and social service systems in the United States is undergoing profound changes. Pediatric training programs are searching for the optimal blend of knowledge, skill, and experience to prepare tomorrow's pediatricians for the new challenges and morbidities they will face.^1-3 As clinicians and educators encounter new demands on their commitments and resources, it is important to reaffirm a vital and long-standing role of pediatricians: promoting the health and well-being of all children in the communities they serve.

	DEFINITION OF COMMUNITY PEDIATRICS

The American Academy of Pediatrics offers this definition of community pediatrics to remind all pediatriciansgeneralists and specialists alikeof the profound importance of the community dimension in pediatric practice. Community pediatrics is all of the following:

• A perspective that enlarges the pediatrician's focus from one child to all children in the community
• A recognition that family, educational, social, cultural, spiritual, economic, environmental, and political forces act favorably or unfavorably, but always significantly, on the health and functioning of children
• A synthesis of clinical practice and public health principles directed toward providing health care to a given child and promoting the health of all children within the context of the family, school, and the community⁴
• A commitment to use a community's resources in collaboration with other professionals, agencies, and parents to achieve optimal accessibility, appropriateness, and quality of services⁵ for all children, and to advocate especially for those who lack access to care because of social or economic conditions or their special health care needs
• An integral part of the professional role and duty of the pediatrician

For many pediatricians, efforts to promote the health of children have been directed at attending to the needs of particular children in a practice setting, on an individual basis, and providing them with a medical home. This approach, in combination with pediatricians' own personal community interests and commitments, has been dramatically successful. Increasingly, however, the major threats to the health of America's childrenthe new morbidity⁶arise from problems that cannot be adequately addressed by the practice model alone.⁷ These problems include unacceptably high infant mortality rates in certain communities, extraordinary levels of intentional and unintentional injuries, chemical dependency, behavioral and developmental consequences of inappropriate care and experience, family dysfunction, sexually transmitted diseases, unplanned pregnancies and out-of-wedlock births, and lack of a medical home.⁸ "We must become partners with others, or we will become increasingly irrelevant to the health of children."⁹

Pediatricians remain instrumental in efforts to create, organize, and implement changes in communities, efforts that can substantially improve the health of children. Starting with Abraham Jacobi, MD, (1830-1919), a leading child advocate of his time and a founder of the discipline of pediatrics, pediatricians have recognized that children are best understood, and their needs attended to, within interlinking contexts of biology, family, and community.¹⁰ More recently, Robert J. Haggerty, MD, FAAP, identified the unique contribution and focus of community pediatrics:

Community pediatrics [has sought] to provide a far more realistic and complete clinical picture by taking responsibility for all children in a community, providing preventive and curative services, and understanding the determinants and consequences of child health and illness, as well as the effectiveness of services provided. Thus, the unique feature of community pediatrics is its concern for all of the populationthose who remain well but need preventive services, those who have symptoms but do not receive effective care, and those who do seek medical care either in a physician's office or in a hospital.¹¹

With the sweeping changes occurring in the world of medicine and other human services, it is especially important now for pediatricians to reexamine and reaffirm their role as professionals in the communityas community pediatriciansand prepare themselves for it, just as diligently as they prepare for traditional clinical roles.

	RECOMMENDATIONS

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1. Pediatricians should use community data (epidemiologic, demographic, and economic) to increase their understanding of the health and social risks for children and of the opportunities for successful collaboration with other child advocates.
2. Pediatricians should interact with other members of the community to improve all settings and organizations where children spend time (eg, child care facilities, schools, youth programs).
3. Pediatricians should strive to bring community and school resources to bear on the problems that children face.
4. Pediatricians should work collaboratively with public health departments and colleagues in related professions to identify and mitigate hindrances to the health and well-being of children in the communities they serve.¹² In many cases, vitally needed services already exist in the community. Pediatricians can play an extremely important role coordinating and focusing services to realize maximum benefit for all children.^13,14
5. Pediatricians should seek to improve the effectiveness and efficiency of health care for all children and strive to ensure a medical home for every child in the community.
6. Pediatricians are encouraged to become involved in the education of residents and medical students in community settings. Community pediatricians have the unique opportunity to model roles outside the traditional clinical roles students and residents usually encounter. Pediatric academicians should use resources from the American Academy of Pediatrics and the Ambulatory Pediatric Association to engage the community pediatrician as an educator, both in the care of individual patients in community-based practice and in roles related to promotion of the well-being of all children in the community.^3,15
7. American Academy of Pediatrics' chapters and their members should provide leadership for furthering the understanding of community pediatrics and encourage participation in creative, community-based, integrated models such as those supported through the Community Access To Child Health (CATCH) Program and the Healthy Tomorrows Partnership for Children Program.
8. American Academy of Pediatrics' chapters should provide leadership, support, and recognition for pediatricians involved in advocacy efforts at the local, state, and national level to ensure access to care for all children and to foster integration of these activities as an integral part of the professional role and duty of the pediatrician.

Caring, compassionate, and knowledgeable pediatricians must address the needs of their patients and all children in the context of the community.

COMMITTEE ON COMMUNITY HEALTH SERVICES, 1998-1999
Paul Melinkovich, MD, Chairperson
Wyndolyn C. Bell, MD
Denice Cora-Bramble, MD
Helen M. DuPlessis, MD, MPH
Stanley I. Fisch, MD
Robert E. Holmberg, Jr, MD
Arthur Lavin, MD
Carolyn J. McKay, MD, MPH
Yvette L. Piovanetti, MD
Denia A. Varrasso, MD
David L. Wood, MD, MPH

LIAISON REPRESENTATIVES
William Bithoney, MD Ambulatory Pediatric Association
Anne E. Dyson, MD AAP Partnership for Children
Lindsey K. Grossman, MD Section on Community Pediatrics
Cheryll A. Jones, ARNP, CPNP National Association of Pediatric Nurse Associates and Practitioners
Alice Lenihan, MPH, RD National Association of WIC Directors
Jennie A. McLaurin, MD, MPH Migrant Clinicians Network
Charles Poland III, DDS American Academy of Pediatric Dentistry

CONSULTANT
Donna O'Hare, MD

FORMER COMMITTEE MEMBERS
R. Larry Meuli, MD, MPH
Michael Weitzman, MD

	FOOTNOTES

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

	ABBREVIATIONS

CATCH, Community Access To Child Health.

	REFERENCES

Top Abstract Recommendation References

1. Alpert JJ Primary care: the future for pediatric education. Pediatrics. 1990; 86:653-659 [Abstract/Free Full Text]
2. American Academy of Pediatrics, Task Force on the Future Role of the Pediatrician in the Delivery of Health Care Report on the future role of the pediatrician in the delivery of health care. Pediatrics. 1991; 87:401-409 [Abstract/Free Full Text]
3. DeWitt TG, Roberts KB, eds. Pediatric Education in Community Settings: A Manual. Arlington, VA: National Center for Education in Maternal and Child Health; 1996
4. Haggerty RJ Community pediatrics. N Engl J Med. 1968; 278:15-21
5. Bergman DA Thriving in the 21st century: outcome assessment, practice parameters, and accountability. Pediatrics 1995; 96:831-835 [Abstract/Free Full Text]
6. American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health The pediatrician and the "new morbidity." Pediatrics 1993; 92:731-733 [Abstract/Free Full Text]
7. Nazarian LF A look at the private practice of the future. Pediatrics 1995; 96:812-816 [Abstract/Free Full Text]
8. Sia CJ The medical home: pediatric practice and child advocacy in the 1990s. Pediatrics. 1992; 90:419-423 [Abstract/Free Full Text]
9. Haggerty RJ Child health 2000: new pediatrics in the changing environment of children's needs in the 21st century. Pediatrics 1995; 96:804-812 [Abstract/Free Full Text]
10. Jacobi A The best means of combating infant mortality. JAMA. 1912; 58:1735-1744
11. Haggerty RJ Community pediatrics: past and present. Pediatr Ann. 1994; 23:657 [Medline]
12. Zuckerman B, Parker S Preventive pediatricsnew models of providing needed health services. Pediatrics. 1995; 95:758-762 [Abstract/Free Full Text]
13. Mullan F Community-oriented primary care: an agenda for the `80s. N Engl J Med 1982; 307:1076-1078 [Medline]
14. American Academy of Pediatrics, Task Force on Integrated School Health Services Integrated school health services. Pediatrics. 1994; 94:400-402 [Abstract/Free Full Text]
15. Bithoney WG, McCarthy P, McGravey A, et al. Training Residents to Serve the Underserved: A Resident Education Curriculum. McClean, VA: Ambulatory Pediatric Association; 1993

	SUGGESTED READING

1. Cone TE. History of American Pediatrics. Boston, MA: Little, Brown and Company; 1979
2. Green M, ed. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Arlington, VA: National Center for Education in Maternal and Child Health; 1994
3. Haggerty RJ, Roghmann KJ, Pless IB. Child Health and the Community. New Brunswick, NJ: Transaction Publishers; 1993
4. Kark SL, Kark E An alternative strategy in community health care: community-oriented primary health care. Isr J Med Sci. 1983; 19:707-713 [Medline]
5. Lairson DR, Schulmeier G, Begley CE, Managed care and community-oriented care: conflict or complement? J Health Care Poor Underserved 1997; 8:36-55 [Medline]
6. Landis SE, James CL The Claxton Elementary School health program: merging perceptions and behavior to identify problems. J School Health 1995; 65:250-254 [Medline]
7. Nevin JE, Gohel MM Community-oriented primary care. Clin Off Pract 1996; 23:1-15
8. Starr P. The Social Transformation of American Medicine. New York, NY: Basic Books; 1982