Some Steps Needed to Ensure the Health of America’s Children: Lessons Learned From 50 Years in Pediatrics

  • Robert J. Haggerty
    Correspondence
    Address correspondence to Robert J. Haggerty, MD, University of Rochester, School of Medicine & Dentistry, Department of Pediatrics, Box 777, University of Rochester Medical Center, Rm 4-8104, 601 Elmwood Ave, Rochester, NY 14642
    Affiliations
    School of Medicine & Dentistry, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
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      In 1975, while I was at the Stanford Center for Advanced Study of the Behavioral Sciences, three of us wrote a paper (never published) titled “After National Health Insurance, What?” Our opening sentence read, “Now that some form of National Health Insurance seems imminent, there will be a number of problems that providing universal health insurance to ensure access to health care will not solve.” Having established my failure as a prognosticator of the imminence of national health insurance, you may wonder why I should have any more credibility in outlining some other steps I think are needed to improve the health of America’s children, beyond access to quality health care. In spite of some gains in access to care for children, the result of expanded Medicaid and the State Children’s Health Insurance Program, 30 years later, we are not much closer to achieving universal access to health care for all children. Therefore, it seems to me even more important to implement changes in health services and deal with the other factors that will improve the health of children with, or without, universal access. It would certainly help if we had universal access, but at best that will be a floor upon which we will need to build a better house to improve the health of America’s children. In the unpublished paper noted above, we listed some of the other problems that need to be solved: lack of humane care, overuse of some costly technology with little benefit or even harm, and lack of delivery of services of proven efficacy while curtailing use of services now being given that have been proven to be of little or no value. These points are still valid.
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      References

        • Frost R.
        The road not taken. 1920 (Available at: http://www.bartleby.com/119/1.html. Accessed February 11, 2006.)
        • Schroeder S.
        Don’t let medicine lose its soul.
        Pharos. 2004; (Summer): 21-24
        • Haggerty R.J.
        The academic generalist.
        Pediatrics. 1990; 86: 413-420
        • Haggerty R.J.
        • Sutherland S.A.
        The academic general pediatrician.
        Pediatrics. 1999; 104: 137-142
        • Ludwig S.
        Academic general pediatrics.
        Ambul Pediatr. 2004; 4: 407-410
        • Haggerty R.J.
        Family medicine.
        J Med Educ. 1962; 37: 531-580
        • Meyer R.J.
        • Haggerty R.J.
        Streptococcal infections in families.
        Pediatrics. 1962; 29: 539-549
        • Barr R.G.
        • Boyce W.T.
        • Zeltzer L.K.
        The stress-illness association in children.
        in: Haggerty R.J. Sherrod L.R. Rutter M. Stress, Risk, and Resilience in Children and Adolescents Processes, Mechanisms, and Interventions. Cambridge University Press, New York, NY1994: 182-224
        • Haggerty R.J.
        American Pediatric Society John Howland Award 1998.
        Pediatr Res. 1999; 45: 153
        • Robertson L.S.
        • Kosa J.
        • Heagarty M.C.
        Changing the Medical Care System. Praeger Publishing, New York, NY1974
        • Haggerty R.J.
        • Roghmann K.J.
        • Pless I.B.
        Child Health and the Community. John Wiley & Sons, New York, NY1975
        • Shonkoff J.P.
        Science, Policy, and the Young Developing Child. Ounce of Prevention Fund, Chicago, Ill2004
        • Perrin E.C.
        • Stancin T.
        A continuing dilemma.
        Pediatr Rev. 2002; 23: 264-275
        • Zuckerman B.
        • Parker S.
        • Kaplan-Sanoff M.
        • et al.
        Healthy steps.
        Pediatrics. 2004; 114: 820-826
        • Perrin J.M.
        Youth and disability in the 21st century.
        Ambul Pediatr. 2004; 4: 402-406
        • Jessop D.J.
        • Stein R.E.K.
        Providing comprehensive care to children with chronic illness.
        Pediatrics. 1994; 93: 602-607
        • Schor E.L.
        Rethinking well-child care.
        Pediatrics. 2004; 114: 210-216
        • Roberts K.
        • DeWitt T.
        Faculty development of pediatric practitioners.
        Pediatrics. 1996; 97: 389-393
        • Finkelstein J.A.
        • Lozano P.
        • Farber H.J.
        • et al.
        Underuse of controller medications among Medicaid-insured children with asthma.
        Arch Pediatr Adolesc Med. 2002; 156: 562-567
        • Adams R.J.
        • Fuhlbrigge A.
        • Finkelstein J.A.
        • et al.
        Use of inhaled anti-inflammatory medication in children with asthma in managed care settings.
        Arch Pediatr Adolesc Med. 2001; 155: 501-507
        • Szilagyi P.G.
        • Rodewald L.E.
        Missed opportunities for immunizations.
        J Public Health Manage Pract. 1996; 2: 18-25
        • Bauchner H.
        Changing physician behavior.
        Arch Dis Child. 2001; 84: 459-462
        • Starfield B.
        • Shi L.
        Determinants of health.
        Ann N Y Acad Sci. 1999; 896: 344-346
        • Weitzman M.
        Keynote address presented at. 2004
        • Dietz W.H.
        • Robinson T.N.
        Assessment and treatment of childhood obesity.
        Pediatr Rev. 1993; 14: 337-343
        • Etzel R.A.
        • Crain E.F.
        • Gitterman B.A.
        • et al.
        Pediatric environmental health competencies for specialists.
        Ambul Pediatr. 2003; 3: 60-63
        • Brent R.
        • Weitzman M.
        The vulnerability, sensitivity, and resiliency of the developing embryo, infant, child, and adolescent to the effects of environmental chemicals, drugs, and physical agents as compared to the adult.
        Pediatrics. 2004; 113: 1167-1172
        • Janeway C.A.
        Pediatrics.
        N Engl J Med. 1947; 236: 867-873
        • Janeway C.A.
        Concluding speech to Mexico City IPA Congress. Quoted by: Vahlquist B.
        Pediatrics. 1977; 59: 151-152
        • Janeway C.A.
        Vision or Reality. University of North Carolina School of Medicine, Chapel Hill, NC1976 (Merriman Lecture)