In September 2000, 50 pediatricians from the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH) met in the United Kingdom to establish a sustainable international program to improve child health outcomes in our respective countries. This was the first such joint endeavor for the AAP and the RCPCH and the first organized effort by the societies to recognize the global dimension of health inequities and disparities and the challenges that confront us all as pediatricians.
From its inception, the meeting was meant to go beyond a biomedical model of health to define the social, economic, political, and environmental determinants of child health. It was hoped the meeting could contribute to the political resolve in both nations to develop public policy and generate sustainable resources to tackle these health determinants and disparities. Within this context, the following 4 conference objectives were pursued:
To establish consensus on a set of priority determinants and indicators of child health in the United Kingdom and in the United States that can be addressed successfully by the RCPCH and the AAP
To develop a mutual understanding of our respective national health systems and the structural and functional changes that could positively impact critical determinants of child health
To define potentially successful strategies and the roles of community pediatricians and the RCPCH and the AAP to improve child health in the United Kingdom and in the United States
To establish an agenda for the future and strategies to sustain and eventually expand this international endeavor
The meeting engaged participants in a variety of learning environments. Articles from participants in the United Kingdom and in the United States were organized into 6 critical focus areas: 1) the social, economic, and political determinants of child health; 2) health systems; 3) child health policy; 4) community pediatrics; 5) academic medicine and research; and 6) children’s rights. Small working groups then took the perspectives and information generated through the sessions to focus on roles and functions of community pediatrics as they relate to: 1) child advocacy, 2) the care of marginalized children and children with special needs (the term “marginalized” is used throughout the proceedings to describe populations of children with limited access to the social, economic, and environmental prerequisites and resources for optimal growth and development), 3) child mental health, 4) medical education, and 5) child health practice. The results of these discussions were presented and prioritized during the final session as recommendations for further action by the AAP and the RCPCH.
A mission, goal, and 4 “Implementation Groups” have been established to begin the process of translating these recommendations into practice as the Equity Project. The mission of this joint AAP-RCPCH initiative is to reduce health disparities among populations of children in the United States and in the United Kingdom, in particular among children living in poverty and other groups of marginalized children. The goal of the Equity Project is to sustain and expand the commitment and activities of the RCPCH and the AAP to ensure that equity in health outcomes remains a fundamental tenet and task of the respective societies.
Four Implementation Groups are the venues in which the priorities established during the meeting will be developed and implemented as the Equity Project.
Education and Training. To ensure all pediatricians and child health professionals of child health services understand the issues and experience of marginalized children, the impact of social determinants on health, and the health implications of inequities, and have the knowledge, attitude, and skills to deal with health disparities among all children.
Practice and Advocacy. To enable pediatricians to work toward societal equity in child health and improve health outcomes of marginalized children through health service and child advocacy.
Research and Public Policy. To improve our understanding of the genesis of health disparities and ways to resolve them through research and the development of evidence-based public policy.
Children’s Rights. To implement a children’s rights paradigm as a framework and strategy to reduce child health disparities.
Pediatricians can do much to improve child health outcomes by understanding and mitigating the effects of social determinants on individual children and families. Research, knowledge, and experience have been accrued over the last decade to provide pediatricians options for intervention. By jointly working on these issues and engaging community pediatricians and other public and private sector partners, the RCPCH and the AAP can develop and advocate for programs that will improve the health of all of our children.
The Equity Project is the inheritor of the knowledge and experience of many past and current AAP and RCPCH initiatives. It will provide a venue for the AAP and the RCPCH to work together to ensure pediatrics and pediatricians remain relevant to the current and future determinants of the global health of children. Toward this end, the following articles and framework for action are presented to engage all pediatricians and those so committed to this endeavor and these outcomes.
Child poverty is increasing in the United Kingdom and in the United States. Given the known impact of social, economic, environmental, and other nonmedical determinants on child health, an impact that continues through adulthood, it is incumbent on pediatrics and pediatricians to focus their efforts on dealing with the root causes of these social injustices. The Royal College of Paediatrics and Child Health and the American Academy of Pediatrics, through this joint Equity Project, should establish the education, practice, and research framework to integrate these issues into the corpus of pediatrics. Much is available to be learned from our mutual experience, but also from the efforts of other countries. Advocacy and political resolve will be necessary for success. Recommendations include:
Economic and demographic trends indicate that rates of child poverty and deprivation are not declining, but actually are worsening in many parts of the United States and the United Kingdom,
Poverty and the culture surrounding it have a significant and pervasive impact on the health and development of children,
Evidence of clinical effectiveness, or clear evidence of lack of effectiveness, should have an impact on commissioning and delivering care,
The RCPCH and the AAP should engage in a joint initiative to apply medical effectiveness and evidence-based medicine methods to better define what works in community pediatrics,
There is a direct relationship between poverty and ill health in childhood in the United Kingdom and in the United States,
Partnerships among families, health care professionals, and communities will play an increasingly important role in our response to these social determinants of health,
Pediatricians need to be more active in communities and educational systems,
Pediatricians need to learn how to interact with policy and lawmakers,
Equity and advocacy need to be put on the pediatric training agenda and institutionalized in the core structure of curricula and the assessment of curricula and student competencies,
The AAP and the RCPCH should work together to define the core competencies of community pediatrics and strategies for assessment of process and outcome measurements of these competencies,
The RCPCH-AAP Equity Project should consider development of a joint research program in social epidemiology,
The definition and introduction of new indicators and measures for assessing child health should be used to structure future child health endeavors and define the success of current and future programs.