Disparities in Children s Health: Major Challenges and Opportunities

Transcription

1 Disparities in Children s Health: Major Challenges and Opportunities Institute of Medicine Roundtable on Health Disparities Atlanta, Georgia January 24, 2008 David Satcher, M.D., Ph.D. Director, The Satcher Health Leadership Institute and The Center of Excellence on Health Disparities Poussaint-Satcher- Cosby Professor of Mental Health Morehouse School of Medicine 16th U.S. Surgeon General

2 Healthy People 2010: Overarching Goals Increase Years and Quality of Healthy Life Eliminate Racial and Ethnic Health Disparities

3 Infant Mortality Rates, by Maternal Race/Ethnicity --- United States, 1995 and 2003

4 Global Perspective 2003 Under-Five Mortality Rate Per 1000 Live Births Worldwide Industrialized Countries Sub-Saharan Africa South Asia Sweden U.S. 80/1000 7/ / /1000 3/1000 8/1000 Source: UNICEF 2004; United Nations Statistics Division

5 What If We Had Eliminated Disparities in the Last Century? Fewer Black Deaths in ,500 overall 24,000 from heart disease 7,000 from HIV / AIDS 4,700 infant deaths 22,000 from diabetes 2000 fewer Black women from breast cancer More Health Insurance Coverage 2.5 million Blacks, including 620,000 children ource: D. Satcher et al, Health Affairs, March/April 2005

6 Source: Healthy People 2010 Determinants of Health

7 Environmental Quality Major Concerns Safe Environments For walking/physical activity From poverty and hopelessness For living African-American and Hispanic children much more likely to grow up near hazardous waste sites than majority children 25% of preventable illnesses worldwide due to poor environmental quality

8 Mental Illness Throughout the Lifespan Children 1 in 10 American children and adolescents suffers from mental illness severe enough to cause some level of impairment. Fewer than 1 in 5 receives treatment. An estimated 20% of children have mental disorders with at least mild functional impairment.

9 Prevalence of Family violence Family violence accounted for 11% of all reported and unreported violence between 1998 and million violent crimes committed against family members.

10 Risk Factors for Being a Perpetrator of or Victim of Family Violence Mental illness Violent intimate partners more likely to have personality disorders, i.e. schizoidal/borderline, dependency and attachment problems. Depressed and have low self-esteem Alcohol and drug use or addiction Often have been witness to violence. Feeling that domestic violence is a family or private matter.

11 Youth Violence: A Report of the Surgeon General Conclusions and Accomplishments Careful analyses, including those conducted by the justice system, have demonstrated the pervasiveness of youth violence in our society. We possess knowledge and have translated it into programs that are effective in preventing serious youth violence. Intervention strategies exist today that can be tailored to the needs of youths at every stage of development.

12 Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years years of age years of age Source: CDC//NCHS, NHES and NHANES

13 AFHK Has Three Major Thrusts Improving children s eating habits by increasing access to nutritious foods and integrating nutrition education into curriculum. Increasing children s physical activity by adding or improving physical education courses, recess, after school programs, and co-curricular programs. Educating administrators, teachers, students, parents about how nutrition and physical activity impact health and academic performance.

14 McKinlay s Population Model of Health Promotion: Healthy Diet for Children Agriculture policy Food subsidies And expanded funding/ Eligibility for NSLP/NSBP State/Federal Food and menu Label regulations Community-wide Education campaigns Restaurant/grocery store/school point of purchase prompts Parent training re; feeding Practices/healthy diets BMI screening And treatment Nutrition training Requirements for professional certification (childcare Healthcare) Federal /State Lobbying/discharge regulation Zoning/business Inventive for grocery stores Farmers markets School soda bans/ Competitive food restrictions (upstream) (midstream) (downstream) Source: Based on McKinlay (1995), Glanz (1999)

15 Global Perspective: Immunization A Success Story Source: WHO

16 Points of Attack Access to Care Improving Quality of Care Lifestyle Enhancement Improving Environmental Quality A Balanced Research Agenda

17 hat Will It Take to Eliminate Health Disparities? We must care enough. We must know enough. We must be willing to do enough. We must persist in our efforts.

18 Life is filled with golden opportunities, carefully disguised as irresolvable problems. -- John Gardner former Secretary of Health, Education & Welfare

19 Disparities in Children s Health: Major Challenges and Opportunities Institute of Medicine Roundtable on Health Disparities Atlanta, Georgia January 24, 2008 David Satcher, M.D., Ph.D. Director, The Satcher Health Leadership Institute and The Center of Excellence on Health Disparities Poussaint-Satcher- Cosby Professor of Mental Health Morehouse School of Medicine 16th U.S. Surgeon General