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Primary care (PC) is a strong determinant of overall health care. Children make up around a fifth of the population of the European Union and European Economic Area and have their own needs and uptake of PC. However, there is little research into how well PC services address their needs. There are large differences in childhood mortality and morbidity patterns in the EU and EEA countries, and there has been a major epidemiological shift in the past half century from predominantly communicable disease, to non-communicable diseases presenting and increasingly managed in PC. This increase in multifactorial morbidities, such as obesity and learning disability, has led to the need for PC systems to adapt to accommodate these changes. Europe presents a challenging picture of unexplained variation in health care delivery and style and of children’s different health experiences and health-related behaviour. The Models of Child Health Appraised (MOCHA) project aimed to describe the PC systems in detail, analyse their components and appraise them from a number of different viewpoints, including professional, public, political and economic lenses. It did this through nine work packages supported by a core management team, and a network of national agents, individuals in each MOCHA country who had the expertise in research and knowledge of their national health care system to answer a wide range of questions posed by the MOCHA scientific teams.

In order to assess the state of health of Europe’s children, or to appraise the systems and models of healthcare delivery, data about children are essential, with as much precision and accuracy as possible by small group characteristic. Unfortunately, the experience of the Models of Child Health Appraised (MOCHA) project and its scientists shows that this ideal is seldom met, and thus the accuracy of appraisal or planning work is compromised. In the project, we explored the data collected on children by a number of databases used in Europe and globally, to find that although the four quinquennial age bands are common, it is impossible to represent children aged 0–17 years as a legally defined group in statistical analysis. Adolescents, in particular, are the most invisible age group despite this being a time of life when they are rapidly changing and facing increasing challenges. In terms of measurement and monitoring, there is little progress from work of nearly two decades ago that recommended an information system, and no focus on the creation of a policy and ethical framework to allow collaborative analysis of the rich anonymised databases that hold real-world people-based data. In respect of data systems and surveillance, nearly all systems in European society pay lip service to the importance of children, but do not accommodate them in a practical and statistical sense.

The health consequences of child labor may take time to manifest themselves. This study examines whether children who began working at a young age experience increased incidence of illness or physical disability as adults. When child labor and schooling are treated as chosen without consideration of unobserved abilities or health endowments, child labor appears to have small adverse effects on a wide variety of health measures. Some adverse health consequences such as heart disease or hypertension seem unlikely to be caused by child labor. However, when we allow unobserved health and ability endowments to alter the age of labor market entry and years of schooling completed, the joint effects of child labor and schooling on health become larger while the less plausible health consequences lose significance. Results imply that delaying entry into child labor while increasing time in school significantly lowers the probability of early onset of physical ailments such as back problems, arthritis, or reduced strength or stamina. However, our methods are not able to distinguish between the health impacts of child labor from the impacts of reduced time in school.

Equity is an issue that pervades all aspects of primary care provision for children and as such is a recurring theme in the Models of Child Health Appraised project. All European Union member states agree to address inequalities in health outcomes and include policies to address the gradient of health across society and target particularly vulnerable population groups. The project sought to understand the contribution of primary care services to reducing inequity in health outcomes for children. We focused on some key features of inequity as they affect children, such as the importance of good health services in early childhood, and the effects of inequity on children, such as the higher health needs of underprivileged groups, but their generally lower access to health services. This indicates that health services have an important role in buffering the effects of social determinants of health by providing effective treatment that can improve the health and quality of life for children with chronic disorders. We identified common risk factors for inequity, such as gender, family situation, socio-economic status (SES), migrant or minority status and regional differences in healthcare provision, and attempted to measure inequity of service provision. We did this by analysing routine data of universal primary care procedures, such as vaccination, age at diagnosis of autism or emergency hospital admission for conditions that can be generally treated in primary care, against variables of inequity, such as indicators of SES, migrant/ethnicity or urban/rural residency. In addition, we focused on the experiences of child population groups particularly at risk of inequity of primary care provision: migrant children and children in the state care system.

The belief that children have mental health needs different than those of adults is a relatively recent phenomenon. Systematic field studies of mental illness began in the early 19th century (Anthony, Eaton, & Henderson, 1995), although awareness of these illnesses and the recognition of the need for treatment were well established by the 1600s (Grob, 1994). Field studies and census data from mental hospitals in the 1800s reveal few cases of mental illness identified among children under the age of 16. In the late 19th and early 20th centuries, the recognition that children have specific mental health needs arose as the result of the confluence of several factors. The Progressive Movement promoted child labor and mandatory public education laws that created legal separations between the role of children and adults (Abbott, 1908; Sutton, 1983). Hall (1905) helped popularize the idea that childhood and adolescence constituted distinct periods of development. Perhaps most pressing, however, was a perceived rise in juvenile delinquency and sexual promiscuity. To address these problems, separate courts were established for juvenile offenders to keep children out of institutions and to provide treatment and rehabilitation (Alper, 1941). Based on the work of Healy and Bronner (1916), researchers and policy makers began to think of juvenile crime as arising from “mental conflicts” in children. Institutions such as the Chicago Juvenile Psychopathic Institute and the Boston Psychopathic Hospital were established to care for these children (Horn, 1989).

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.

At the turn of the century, the developing world is experiencing the largest-ever generation of children and youth. Around 1 billion people – one out of every six on the planet – are between 10 and 19 years of age, 85% of them in developing countries. Because of the considerable drop in fertility rates, in the next 15–20 years, the children of today will constitute the largest generation-ever of active population. This is perhaps the greatest opportunity the world cannot afford to miss. This paper claims that the trends keeping the majority of the children in poverty and limiting their development are not irreversible, that the world has enough information, technology and financial resources to defeat these trends.

The chapter investigates: (1) Do married parents efficiently allocate time to children’s health care? (2) Are parents willing to sacrifice consumption for health improvements at an equal rate for all family members? (3) How does family structure affect health trade-offs parents make? (4) Are parental choices consistent with maximization of a single utility function?

A model is specified focusing on how parents allocate resources between consumption and goods that relieve acute illnesses for family members. Equivalent surplus functions measuring parental willingness to pay to relieve acute illnesses are estimated using data from a stated-preference survey.

Results provide limited support for the prediction that married parents allocate time to child health care according to comparative advantage. Valuations of avoided illness vary between family members and are inconsistent with the hypothesis that fathers’ and mothers’ choices reflect a common utility function.

Prior research on children’s health valuation has relied on a unitary framework that is rejected here. Valuation researchers have focused on allocation of resources between parents and children while ignoring allocation of resources among children, whereas results suggest significant heterogeneity in valuation of health of different types of children and of children in different types of households.

Results may provide a justification on efficiency grounds for policies to provide special protection for children’s health and suggest that benefit–cost analyses of policies affecting health should include separate estimates of the benefits of health improvements for children and adults.