Community Pediatrics: Navigating the Intersection of Medicine, Public Health, and Social Determinants of Children’s Health

Abstract

This policy statement provides a framework for the pediatrician' s role in promoting the health and well-being of all children in the context of their families and communities. It offers pediatricians a definition of community pediatrics, emphasizes the importance of recognizing social determinants of health, and delineates the need to partner with public health to address population-based child health issues. It also recognizes the importance of pediatric involvement in child advocacy at local, state, and federal levels to ensure all children have access to a high-quality medical home and to eliminate child health disparities. This statement provides a set of specific recommendations that underscore the critical nature of this dimension of pediatric practice, teaching, and research. Pediatrics 2013;131:623-628Environmental and social factors contribute significantly to the health and well-being of children in the contexts of families, schools, and communities. Over the past decade, the Institute of Medicine recognized and quantified the effects of external factors on early brain development and the health of children in 2 seminal reports, Neurons to Neighborhoods 1 in 2000 and Children' s Health, the Nation' s Wealth 2 in 2004. As understanding of the mechanisms and impact of biological, behavioral, cultural, social, and physical environments on healthy development deepens and expands, the long-standing role of pediatricians in promoting the physical, mental, and social health and well-being of all children must also evolve. 3 The field of pediatrics must address the problems facing children in the 21st century by influencing these critical determinants of child health and well-being. 4 To do so, pediatricians must successfully merge their traditional clinical skills with public health, population-based approaches to practice, and advocacy.

Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders in Early Childhood — United States, 2011–2012

“…For example, the American Academy of Pediatrics has published policy statements on screening for postpartum depression (e.g., one way to address poor maternal mental health), the medical home, recognizing ¶ http://nccp.org/publications/pub_1099.html. social determinants of health, and partnering with public health to address child health from a population perspective (3). Increased awareness of the association of these factors with MBDDs by agencies serving children, (e.g., health departments, schools, and community organizations) might improve referrals and stimulate partnerships to address early childhood health within established community settings (3).…”

“…social determinants of health, and partnering with public health to address child health from a population perspective (3). Increased awareness of the association of these factors with MBDDs by agencies serving children, (e.g., health departments, schools, and community organizations) might improve referrals and stimulate partnerships to address early childhood health within established community settings (3).…”

“…For example, poverty has been shown to have adverse effects on cognitive, socio-emotional, and physical development (1). A safe place to play is needed for gross motor development, and accessible health care is needed for preventive and illness health care (3). Positive parenting and quality preschool interventions have been shown to be associated with prosocial skills, better educational outcomes, and fewer health risk behaviors over time (2).…”

Translation to Primary Care of an Effective Teen Safe Driving Program for Parents

“…Partnerships between public health and primary care can further reduce this threat. From primary care, the AAP’s Council on Community Pediatrics’ policy statement 16 argues that pediatricians should partner with public health to prevent prevalent problems such as injuries. From public health, Gielen and colleagues 12 call for partnerships with practitioners to conduct translation research to implement and dis-seminate effective injury prevention programs.…”

The case for exploring the usage of employee wellness programs for pediatric asthma control

“…Despite the economic and employee recruitment appeal that such a family-oriented health program may have for businesses, these sorts of initiatives are unfortunately rare in the corporate arena. This scarcity is even more disconcerting when pediatricians are actively trying to partner with community-based stakeholders to promote positive socioecological changes in caregiver behaviors–an issue that ranks among the chief determinants of control of chronic diseases like childhood asthma (4). Unfortunately, pediatricians focusing on asthma have traditionally directed their advocacy efforts using traditional community partners (e.g., schools, government agencies, and child care).…”