- AAP —
- American Academy of Pediatrics
“How wonderful it is that nobody need wait a single moment before starting to improve the world.”
— Anne Frank
The health status of children worldwide, and within individual communities, varies so widely that pediatricians should be prepared to care for children from diverse social, economic, cultural, and economic backgrounds. Dr Arnold makes the case, in an era of global travel, migration, and economic interdependence, we can no longer think in just local terms. Conditions in different parts of the world create impacts that can influence the health care needs of children in all countries. Child advocacy knows no geographic boundaries, and pediatricians can improve the entire world by looking after and speaking out on behalf of our most precious resource, children everywhere.—Jay E. Berkelhamer, MD, FAAPEditor, Global Health Monthly Feature
Many of us have been asked why we care for children in other countries, when there are so many needy children in our own communities. It is unclear why people think we have to choose, because we don’t, and shouldn’t. When it comes to children, there is no “them” and “us.” As pediatricians, we have a duty to all children. Individually and collectively, we must commit to improving the lives of children everywhere, by addressing global barriers to children’s health.
Pediatricians Have a Duty to Provide a Voice for All Children
Although children’s needs are universal, the likelihood of having them met is not. More than 400 million of the world’s children live in extreme poverty and, despite marked reductions in global under-5 mortality, 5.9 million young children still die each year.
Of these, 2.7 million are neonates, dead within 1 month; 1 million the day they are born. Every 5 seconds, somewhere in the world, a child dies. More than 16 000 dead children every day.1 As recognized, trusted experts in child health, we have the power to change this.
Pediatricians are uniquely qualified to advocate and care for children, but there aren’t enough of us working in settings where children’s needs are greatest.2 For this reason, all pediatricians must help provide a voice for children everywhere, by calling for global prioritization of children’s needs, and inclusion of specific health targets for children in all global development agendas. Regardless of where we practice, each of us has the ability, and responsibility, to promote global child health.
We Must Be Prepared to Meet the Needs of an Increasingly Diverse Population
Changing demographics underscore the reality that global is, undeniably, now local. One in 4 US children is an immigrant, or the child of immigrants.3 In the past decade alone, more than 200 000 refugee children have resettled in communities throughout our country.4 To provide high-quality local care to all patients in a global world, pediatricians must understand pathogenesis and physiology, but also must know how to work across language barriers, understand the social determinants of health for diverse communities, and effectively engage children and families with differing cultural beliefs and practices. One size no longer fits all.
Global Connectivity Increases Exposures
Last year, 32 million flights carried 3.1 billion passengers worldwide.5 Children traveling internationally are vulnerable to both environmental hazards and infectious exposures, especially when visiting low or middle-income countries. Even among children who never leave the United States, recent measles outbreaks provide sobering evidence of the growing risk of domestic exposure to diseases transported by American or foreign travelers.
Most US pediatricians have never seen measles, and may fail to recognize this highly contagious disease, despite multiple outbreaks in recent years. In 2014, measles was reported in 27 different states; earlier this year, a massive outbreak was traced to a Disney theme park.6,7
Escalating domestic and travel-related exposures, and recent public hysteria about Ebola, highlight the need for all pediatricians to be educated about global patterns of both common and “exotic” infectious diseases. We must be prepared to advise families about injury and disease prevention at home and abroad, and to recognize and manage travel-borne illnesses in all our patients.
We must also advocate for increased funding for global immunization programs, like the global Vaccine Alliance (Gavi). Not only is it the right thing to do, but until we eliminate vaccine preventable diseases like measles globally, domestic efforts will be insufficient to fully protect the children in our own communities.
Global Problems Necessitate Global Solutions
The actions of individual nations have repercussions for children living far beyond their borders. Just as contaminants in imported foods and medications pose hazards to children in the United States, our carbon emissions contribute to growing rates of asthma and to global climate change, endangering the health and wellbeing of children worldwide. Intentional or not, we are responsible for the consequences.
As champions of children’s health, it is not enough for us to speak out solely on behalf of our own patients, citing the dangers of lead and asbestos in imported toys, and pesticides on produce. We must also provide a voice for child migrants working in American fields, and child laborers in factories around the world, whose hazardous exposures are much greater, and whose basic needs go unmet, while cultivating food and manufacturing products for our consumption.
As members of the American Academy of Pediatrics (AAP), whose sustained advocacy has been vital to domestic tobacco control measures, we must demand equal protection for children in other countries, given systematic global efforts by the US Chamber of Commerce to block antitobacco initiatives throughout the world.8
As pediatricians, who know that children subjected to extreme poverty or intractable violence often experience toxic stress, we have a responsibility to speak out about repercussions that are not only lifelong, but multigenerational.9 Immigrant and refugee children, separated from caregivers and familiar support systems, are especially vulnerable to the effects of physical and emotional distress. We must demand that these young victims of circumstance be treated gently and with compassion, that their rights be protected, and their complex needs prioritized. Not just internationally, but within our own borders, as well.
There Is Greater Strength, and Success, in Numbers
There are limits to what any of us can achieve on our own. Our greatest successes occur when we emerge from our silos and join forces, especially under the auspices of professional associations like the AAP, to amplify the power, reach, and impact of our voices.
Tremendous gains have been made in our country through children’s health and safety research, education of parents and other caregivers, and targeted legislative advocacy campaigns at local, regional, and national levels. The next step is global. We must apply this same formula: evidence, education, and advocacy, to address children’s health needs throughout the world.
Through engagement in multisector partnerships and global development alliances, the AAP and its members are already helping implement global solutions to significant global health challenges. Helping Babies Breathe exemplifies the powerful gains that can be achieved through collaboration, and demonstrates the importance of scaling up simple, evidence-based approaches to decreasing infant and child mortality.10
Through broad-based advocacy for funding proven, cost-effective interventions like antenatal steroids, newborn resuscitation, and routine childhood immunizations, we can all contribute to efforts to level the global playing field, and save children’s lives.
Children’s Futures Depend on What We Do, or Don’t Do, Today
We must all be global pediatricians, prepared to meet the complex needs of children from diverse backgrounds; equipped to provide high quality local care to children born or traveling internationally; and committed to pooling knowledge, expertise, and resources with colleagues and organizations throughout the world, to improve the lives of children everywhere.
It takes a village, we are told, to raise a child. The world is our village, and all of its children are our responsibility. We must commit to ending the global birth roulette that determines which of our children will die, and how the others will live.
- Accepted September 8, 2015.
- Address correspondence to Linda D. Arnold, MD, FAAP, 100 York St, Suite 1F, New Haven, CT 06511. E-mail:
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The author has indicated [he/she] has no potential conflicts of interest to disclose.
- World Health Organization Global Health Observatory Data
- Foundation for Child Development
- DHS Office of Immigration Statistics
- International Civil Aviation Organization
- Centers for Disease Control and Prevention
- Centers for Disease Control and Prevention
- New York Times
- Garner AS,
- Shonkoff JP
- Niermeyer S,
- Tobin A,
- Schoen E,
- Carter T,
- Klein JD
- Copyright © 2016 by the American Academy of Pediatrics