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Improving the Quality of Care Delivered to Children Served by State Agencies

Scope of Children's Health Problems

Presenter:

James M. Perrin, M.D., Director and Associate Professor of Pediatrics, Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA.


Dramatic changes have occurred in the health of children and adolescents over the past decade. More than 7 percent of children currently live with limitations of activity due to a chronic health condition. This is a steady increase from less than 2 percent in 1960. Various reasons for this increase include new and increasing conditions both among pre-school and school-aged children.

  • Obesity rates have tripled since 1970 and doubled since 1980. The increases are due to a combination of changes in diet and physical activity.
  • Diabetes Mellitus-Type 2 has increased tenfold among adolescents. High-risk factors include obesity, family obesity, intrauterine malnutrition, and early feeding habits.
  • Asthma has at least doubled since the 1980s. It is likely that different causes predominate in different classes and cultures; more evidence exists for allergies among white and middle class children, and for infestations and air pollution among poor children.
  • Attention-Deficit Hyperactivity Disorder (ADHD) is a difficult health condition to assess, making it a challenge to arrive at accurate rates. Between 6 percent and 7 percent of the school age population meet diagnostic criteria for ADHD, a doubling in the past decade. Theories of possible etiology include changing family situations and early childhood environments.

The long-term implications of not taking action to reduce these health problems include:

  • Public health burdens as people become debilitated at age 30 or 40 from cardiovascular problems.
  • Decreased workforce participation and quality of life.
  • Significant impact on disability programs.

Public agencies' purchasing and regulatory power gives them the ability to affect changes throughout health care systems. Since one of every four children obtains health care through publicly funded programs, public agencies' purchasing power can affect not only the care of children in these programs, but the care of other children as well. Public agencies can create regulations to increase the likelihood of preventing various health problems.

Dealing with crossover among problems requires multi-agency collaboration. Strategic planning requires agencies to work together and share resources in order to create comprehensive solutions.

Five criteria can guide policymakers in choosing a problem area to address:

  • Identification: Can children with, or at-risk for, this problem be easily identified?
  • Prevention: Can the problem be prevented?
  • Intervention: Can the State or locality's efforts make a difference?
  • Agency coordination: Will addressing this problem work to the benefit of multiple agencies?
  • Monitoring outcomes: Can longitudinal tracking measure whether the effort is having an impact?

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