Srivastava Vanshika Ra5 11 17 18
Srivastava Vanshika Ra5 11 17 18
Srivastava Vanshika Ra5 11 17 18
A perspective that enlarges the pediatricians focus from one child to all children in the community;
A recognition that family, educational, social, cultural, spiritual, economic, environmental, and political forces
act favorably or unfavorably, but always significantly, on the health and functioning of children;
A synthesis of clinical practice and public health principles directed toward providing health care to a given
child and promoting the health of all children within the context of the family, school, and community4;
A commitment to use a communitys resources in collaboration with other professionals, agencies, and
parents to achieve optimal accessibility, appropriateness, and quality of services5 for all children and to
advocate especially for those who lack access to care because of social, cultural, geographic, or economic
conditions or special health care needs6,7; and
An integral part of the professional role and duty of the pediatrician.
For many pediatricians, efforts to promote the health of children have been directed at attending to the
needs of particular children in a practice setting, on an individual basis, and providing them with a medical
home.8 This approach, in combination with pediatricians own personal community interests and
commitments, has proven to be very successful. Increasingly, however, the major threats to the health of
Americas children, the new morbidities,9 arise from problems that cannot be addressed adequately by the
practice model alone.10 These problems include high infant mortality rates, children with chronic health
care needs, obesity, disproportionately high levels of intentional and unintentional injuries, exposure to
lead and other environmental hazards, substance abuse, behavioral and developmental consequences of
inappropriate care and experience, mental health conditions, poor school readiness,11family dysfunction,
sexually transmitted diseases, unwanted pregnancies, and lack of access to medical homes.12 An integral
component of a community-pediatrics approach incorporates interdisciplinary practice. As former AAP
president Robert Haggerty, MD, FAAP, reminded us in 1995, we must become partners with others, or we
will become increasingly irrelevant to the health of children.13
Communities should impart a sense of health, safety, and well-being and promote a supportive environment
for families of all types. Just as children depend on the interaction of families in which they live, the
communities that support them affect families. The health and welfare of children depend on the ability of
families and the community support system to foster positive emotional and physical development.14
Recently the AAPs Task Force on the Family examined the concept of family pediatrics and the discipline
that must be practiced within the context15 of the community.16,17
Pediatricians remain instrumental in efforts to create, organize, and implement changes in communities
efforts that can substantially improve the health of children. As far back as Abraham Jacobi, MD (18301919),
a leading child advocate of his time and a founder of the discipline of pediatrics, pediatricians recognized that
children are best understood, and their needs attended to, within interlinking contexts of biology, family, and
community.18 More recently, Haggerty identified the unique contribution and focus of community
pediatrics: Community pediatrics [has sought] to provide a far more realistic and complete clinical picture
by taking responsibility for all children in a community, providing preventive and curative services, and
understanding the determinants and consequences of child health and illness, as well as the effectiveness
of services provided. Thus, the unique feature of community pediatrics is its concern for all of the
populationthose who remain well but need preventive services, those who have symptoms but do not
receive effective care, and those who do seek medical care either in a physicians office or in a hospital.19
With the sweeping changes occurring in medicine and other human services, it is especially important now
for pediatricians to reexamine and reaffirm their role as professionals in the community, as community
pediatricians, and prepare themselves for it just as diligently as they prepare for traditional clinical roles.
RECOMMENDATIONS
1. Pediatricians should use community data (epidemiologic, demographic, and economic) to increase
their understanding of the health and social risks on child outcomes and of the opportunities for
successful collaboration with other child advocates.
2. Pediatricians should work collaboratively with public health departments and colleagues in related
professions to identify and decrease barriers to the health and well-being of children in the
communities they serve.20,21