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Foreword: Screening for Social Determinants
Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians Esther K. Chung, MD, MPH, Benjamin S. Siegel, MD, Arvin Garg, MD, MPH, Kathleen Conroy, MD, MS, Rachel S. Gross, MD, MS, Dayna A. Long, MD, Gena Lewis, MD, Cynthia J. Osman, MD, MS, Mary Jo Messito, MD, Roy Wade Jr, MD, PhD, H. Shonna Yin, MD, MS, Joanne Cox, MD, Arthur H. Fierman, MD
Surveillance and Screening for Social Determinants of Health-Where Do We Start and Where Are We Headed? Adam Schickedanz, MD, Tumaini R. Coker, MD, MBA
Reflections on Caring: Reflections on Caring: An Introduction Perri Klass, MD
Traveling in Other People’s Shoes Howard Trachtman, MD
Foreword: Screening for Social Determinants Dr. Esther Chung and her colleagues have written a timely review for all child health clinicians that addresses the social determinants of health with special emphasis on children who live in poverty. Her review is accompanied by an excellent commentary written by Drs. Adam Schickedanz and Tumaini Coker from UCLA. This review is particularly timely given the American Academy of Pediatrics’ (AAP) recent publications, a Technical Report1 and a Policy Statement2 regarding childhood poverty. In addition, the Academic Pediatric Association and the AAP
Curr Probl PediatrAdolesc Health Care, May 2016
recently created task forces to address child poverty.3 This paper begins by describing the magnitude of childhood poverty in the United States and the importance of understanding the causal factors that mediate the adverse effects of poverty. She explains the difference between surveillance and screening and why both are important in the context of social determinants of children’s health. She then provides the reader with overviews of 10 important social determinants of children’s health. These include child maltreatment, child care and
133
education, the physical environment (including housing), social support, parental depressive symptoms, and domestic violence. Dr. Chung and colleagues end the narrative of this excellent review by reminding the reader that one in five children live in poverty and childhood poverty is ubiquitous in our society—poverty occurs in rural, urban, and suburban communities. Appendices are included that identify screening tools for a number of social determinants as well as resources (both within and outside the family) that are available to assist families who are struggling with various social determinants. In their commentary Drs. Schickedanz and Coker note that addressing the social determinants of children’s health is critically important to improve population health. They assert that the evolution of health care delivery to foster screening, surveillance, referral, and follow through for social determinants of health is becoming “increasingly urgent” as our understanding of the impact of the social determinants on health across the life course is better understood. They recognize that, in most communities, children’s population health would benefit from better coordination between pediatric health care delivery and various sectors of public health services. Drs. Schickedanz and Coker are also very cognizant of the assets that many communities possess to promote health. Near the end of their insightful commentary they describe effective clinical workflows for social determinants surveillance/screening, they advocate for team-based care and community coordination of services and
134
creating systems of coordinated care that meet the unique needs of children/families that reside in local communities. With this review Drs. Chung, Schickedanz, Coker, and their colleagues join the ranks of the authors of the AAP’s recent Technical Report1 and Policy Statement2 on poverty as well as the November 2015 book by Sir Michael Marmot.4 Taken together, these publications from the past few months have created a giant “leap forward” in the child health community regarding our understanding of the mediators and consequences of childhood poverty and effective policies/actions to implement that will attenuate poverty’s adverse effects. As Nelson Mandela stated years ago “There is no keener revelation of a society’s soul than the way in which it treats its children.”
References 1. Pascoe JM, Wood DL, Kuo A, Duffee JH. AAP Committee on Psychosocial Aspects of Child and Family Health; Council on Community Pediatrics. Mediators and adverse effects of child poverty in the United States. Pediatrics 2016;137(4):e20160340. 2. American Academy of Pediatrics. Council on Community Pediatrics, Committee on Psychosocial Aspects of Child and Family Health. Poverty and Child Health in the United States. Pediatrics 2016;137(4):e20160339. 3. Block RW, Dreyer BP, Cohen AR, Stapleton FB, Furth SL, Bucciarelli RL. An agenda for children for the 113th Congress: recommendations from the pediatric academic societies. Pediatrics 2013;131(1):109–19. 4. Marmot M. Equity from the start. In: The Health Gap: The Challenge of an Unequal World. New York: Bloomsbury, 2015. pp. 111–42.
John M. Pascoe, MD, MPH
Curr Probl Pediatr Adolesc Health Care, May 2016
Surveillance and Screening for Social Determinants of Health-Where Do We Start and Where Are We Headed? Adam Schickedanz, MD, Tumaini R. Coker, MD, MBA
Reflections on Caring: Reflections on Caring: An Introduction Perri Klass, MD
Traveling in Other People’s Shoes Howard Trachtman, MD
Foreword: Screening for Social Determinants Dr. Esther Chung and her colleagues have written a timely review for all child health clinicians that addresses the social determinants of health with special emphasis on children who live in poverty. Her review is accompanied by an excellent commentary written by Drs. Adam Schickedanz and Tumaini Coker from UCLA. This review is particularly timely given the American Academy of Pediatrics’ (AAP) recent publications, a Technical Report1 and a Policy Statement2 regarding childhood poverty. In addition, the Academic Pediatric Association and the AAP
Curr Probl PediatrAdolesc Health Care, May 2016
recently created task forces to address child poverty.3 This paper begins by describing the magnitude of childhood poverty in the United States and the importance of understanding the causal factors that mediate the adverse effects of poverty. She explains the difference between surveillance and screening and why both are important in the context of social determinants of children’s health. She then provides the reader with overviews of 10 important social determinants of children’s health. These include child maltreatment, child care and
133
education, the physical environment (including housing), social support, parental depressive symptoms, and domestic violence. Dr. Chung and colleagues end the narrative of this excellent review by reminding the reader that one in five children live in poverty and childhood poverty is ubiquitous in our society—poverty occurs in rural, urban, and suburban communities. Appendices are included that identify screening tools for a number of social determinants as well as resources (both within and outside the family) that are available to assist families who are struggling with various social determinants. In their commentary Drs. Schickedanz and Coker note that addressing the social determinants of children’s health is critically important to improve population health. They assert that the evolution of health care delivery to foster screening, surveillance, referral, and follow through for social determinants of health is becoming “increasingly urgent” as our understanding of the impact of the social determinants on health across the life course is better understood. They recognize that, in most communities, children’s population health would benefit from better coordination between pediatric health care delivery and various sectors of public health services. Drs. Schickedanz and Coker are also very cognizant of the assets that many communities possess to promote health. Near the end of their insightful commentary they describe effective clinical workflows for social determinants surveillance/screening, they advocate for team-based care and community coordination of services and
134
creating systems of coordinated care that meet the unique needs of children/families that reside in local communities. With this review Drs. Chung, Schickedanz, Coker, and their colleagues join the ranks of the authors of the AAP’s recent Technical Report1 and Policy Statement2 on poverty as well as the November 2015 book by Sir Michael Marmot.4 Taken together, these publications from the past few months have created a giant “leap forward” in the child health community regarding our understanding of the mediators and consequences of childhood poverty and effective policies/actions to implement that will attenuate poverty’s adverse effects. As Nelson Mandela stated years ago “There is no keener revelation of a society’s soul than the way in which it treats its children.”
References 1. Pascoe JM, Wood DL, Kuo A, Duffee JH. AAP Committee on Psychosocial Aspects of Child and Family Health; Council on Community Pediatrics. Mediators and adverse effects of child poverty in the United States. Pediatrics 2016;137(4):e20160340. 2. American Academy of Pediatrics. Council on Community Pediatrics, Committee on Psychosocial Aspects of Child and Family Health. Poverty and Child Health in the United States. Pediatrics 2016;137(4):e20160339. 3. Block RW, Dreyer BP, Cohen AR, Stapleton FB, Furth SL, Bucciarelli RL. An agenda for children for the 113th Congress: recommendations from the pediatric academic societies. Pediatrics 2013;131(1):109–19. 4. Marmot M. Equity from the start. In: The Health Gap: The Challenge of an Unequal World. New York: Bloomsbury, 2015. pp. 111–42.
John M. Pascoe, MD, MPH
Curr Probl Pediatr Adolesc Health Care, May 2016