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■ Children first: Is it ever going to happen?? ■
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9 Children First: Is It Ever Going to Happen??
T h o s e o f us who work with children and their families are aware o f how important education and guidance are to the prevention o f future health care problems and the promotion o f health. Perhaps we take this too much for granted and have not been as vigilant as we should have been in proving this point. Indeed, those of us in pediatrics usually become real advocates for the children we care for and their families. We are surprised when others do not put the same emphasis on the importance o f childhood and children. We are appalled when politicians speak o f reducing funding to programs that provide necessities for children, such as school lunch programs and the WIC supplemental nutrition program. Such approaches make us wonder: H o w can this occur? What about the children? What about the future? To me the key word here is "future." Yes, we should be concerned about children per se; every child deserves the best life possible. However, a major reason for this concern is that that child will one day become an adult, and problems not addressed in that childhood will come to haunt us as a society in the future. That is the message that society often seems to miss. We keep the focus on now this crisis, this week not what the future will bring. To me this was really captured by the horrible tragedy in Oklahoma this past spring. The devastation o f that bombing was truly unbelievable to most people. However, many seemed particularly upset and angered that someone could do that to children. I will never be able to understand it either. Nevertheless, we as a society continue to let millions o f children live in poverty, and few people take notice o f t h a t tragedy. Indeed, between 1987 and 1992 the number o f children under the age o f 6 years who live in poverty grew from 5 to 6 million, comprising 26% o f all children under the age o f 6 years in 1992 (National Center for Children in Poverty, 1995). Unfortunately, these children, like the millions without health insurance who have inadequate health care, do not come under public scrutiny. The media is not showing them on the nightly J PEDIATRHEALTHCARE.(1995). 9,197-198. Copyright 9 1995 by the National Association of Pediatric Nurse Associates and Practitioners. 0891-5245/95/$5.00 + 0 25/8/66554 JOURNAL OF PEDIATRIC HEALTH CARE/September-October 1995
9
news, and their crisis gets lost. Why shouldn't we as a society be concerned about these children too? They have a future; unfortunately a future that may be filled with school problems, health problems, and un- or under-employment unless help is given soon. I know we as health care providers cannot solve all these problems, but we can work to improve the awareness o f these problems and work with other groups and agencies as solutions are proposed and explored. One area we can definitely influence, however, is the future health status o f today's children. Perhaps by working on this goal and documenting the success as these children move toward adulthood, we can then prove our point that the needs o f children must become a national priority. By focusing on health promotion and education, we can influence the future health of today's children. McGinnis and Foege (1993) have been able to identify the actual causes o f death in the United States, that is the external (nongenetic) factors that have been found to contribute to death in the United States. Although the ten leading causes of death are listed each year, these causes generally indicate diseases or conditions, such as cancer or suicide. These authors investigated external risk or external contributing factors for these diseases/conditions. The study found the following actual causes o f death: tobacco, diet/activity patterns, alcohol, microbial agents, toxic agents such as environmental pollutants and contaminants, firearms, sexual behavior, motor vehicles, and illicit use o f drugs. For example, diet and sedentary lifestyles have been associated with cardiovascular deaths, cancer deaths, and deaths from diabetes mellitus. Surprising? N o t to most o f us. The external problems/areas found by McGinnis and Foege are the core areas o f health prevention; that's where we begin. Unfortunately, today we face a big challenge to provide the education and counseling needed regarding critical health issues. As visits are shortened and reduced in number, we must make sure we are not omitting this important aspect o f health promotion. We must be creative in the ways we provide this care. Today we need to consider both cost and effectiveness as we review the approaches we use to provide health education. We may have to give up the one-to-one teaching that has often 197
198
Journal of Pediatric Health Care Volume 9, Number 5
Editorial
been the routine and use group approaches instead. The use o f such approaches does not necessarily mean we are providing less than optimal care; indeed, we rarely have evaluated the effectiveness o f one-to-one teaching. Group teaching can be fun, and effective groups can be arranged on a variety o f topics. Groups may consist o f certain individuals, such as fathers, single parents, or adoptive parents, or groups may focus on certain topics, such as well child care issues for certain ages. This approach enables parents to learn and share with other parents; these groups can thus be very creative and informative. Suggestions for dealing with issues such as drug use by adolescents or the promotion o f physical activities for families can bc presented in practical ways. Certainly written materials and videos can be used or recommended to enhance these group learning experiences, but the group experience itself is an important educational approach. Too often today's shorter visits mean we run out o f time and end up just handing out materials or discussing a number o f issues in a rushed manner. Group approaches can help counter this.
Certainly group classes will not solve all the problems of providing optimal health education. We need to continue our search for better ways to provide this important aspect o f health care. The key point is, we must continue to provide this health education and promotion. I truly believe the secret to making more people see the importance of putting children first can come from seeing the effects of such interventions with children and their families. All children count; we know that, and we can make a difference. Health promotion may be the way to make the larger society realize this point and appropriately respond with needed support. Wouldn't that make our efforts worthwhile? Let's try it! Bobble Crew Nelms, PhD, R N , C P N P Editor REFERENCES
McGinnis, J. M., & Foege, W. H. (1993). Actual causes of death in the United States. Journal of the American Medical Association, 270, 2207-2212. National Center for Children in Poverty. (1995). Number of poor children under six increasedfrom 5 to 6 million 1987-1992. News and Issues, 5, 1-2.
Bound Volumes Available to Subscribers Bound volumes of the JOURNALOF PEDIATVaCHEALTHCAREare available to subscribers (only) from the Publisher, at a cost o f $34.00 ($42.80 for Canadian and $40.00 for international) for January-December. Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. Copies are shipped within 60 days after publication o f the last issue o f the volume. The binding is durable buckram with the JOURNAL name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Dr., St. Louis, M O 63146-3318, USA; telephone (800) 453-4351 or (314) 453-4351. Subscriptions must be in force to qualify. B o u n d volumes are n o t available in place o f a regular Joum~AI. subscription.
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9 Children First: Is It Ever Going to Happen??
T h o s e o f us who work with children and their families are aware o f how important education and guidance are to the prevention o f future health care problems and the promotion o f health. Perhaps we take this too much for granted and have not been as vigilant as we should have been in proving this point. Indeed, those of us in pediatrics usually become real advocates for the children we care for and their families. We are surprised when others do not put the same emphasis on the importance o f childhood and children. We are appalled when politicians speak o f reducing funding to programs that provide necessities for children, such as school lunch programs and the WIC supplemental nutrition program. Such approaches make us wonder: H o w can this occur? What about the children? What about the future? To me the key word here is "future." Yes, we should be concerned about children per se; every child deserves the best life possible. However, a major reason for this concern is that that child will one day become an adult, and problems not addressed in that childhood will come to haunt us as a society in the future. That is the message that society often seems to miss. We keep the focus on now this crisis, this week not what the future will bring. To me this was really captured by the horrible tragedy in Oklahoma this past spring. The devastation o f that bombing was truly unbelievable to most people. However, many seemed particularly upset and angered that someone could do that to children. I will never be able to understand it either. Nevertheless, we as a society continue to let millions o f children live in poverty, and few people take notice o f t h a t tragedy. Indeed, between 1987 and 1992 the number o f children under the age o f 6 years who live in poverty grew from 5 to 6 million, comprising 26% o f all children under the age o f 6 years in 1992 (National Center for Children in Poverty, 1995). Unfortunately, these children, like the millions without health insurance who have inadequate health care, do not come under public scrutiny. The media is not showing them on the nightly J PEDIATRHEALTHCARE.(1995). 9,197-198. Copyright 9 1995 by the National Association of Pediatric Nurse Associates and Practitioners. 0891-5245/95/$5.00 + 0 25/8/66554 JOURNAL OF PEDIATRIC HEALTH CARE/September-October 1995
9
news, and their crisis gets lost. Why shouldn't we as a society be concerned about these children too? They have a future; unfortunately a future that may be filled with school problems, health problems, and un- or under-employment unless help is given soon. I know we as health care providers cannot solve all these problems, but we can work to improve the awareness o f these problems and work with other groups and agencies as solutions are proposed and explored. One area we can definitely influence, however, is the future health status o f today's children. Perhaps by working on this goal and documenting the success as these children move toward adulthood, we can then prove our point that the needs o f children must become a national priority. By focusing on health promotion and education, we can influence the future health of today's children. McGinnis and Foege (1993) have been able to identify the actual causes o f death in the United States, that is the external (nongenetic) factors that have been found to contribute to death in the United States. Although the ten leading causes of death are listed each year, these causes generally indicate diseases or conditions, such as cancer or suicide. These authors investigated external risk or external contributing factors for these diseases/conditions. The study found the following actual causes o f death: tobacco, diet/activity patterns, alcohol, microbial agents, toxic agents such as environmental pollutants and contaminants, firearms, sexual behavior, motor vehicles, and illicit use o f drugs. For example, diet and sedentary lifestyles have been associated with cardiovascular deaths, cancer deaths, and deaths from diabetes mellitus. Surprising? N o t to most o f us. The external problems/areas found by McGinnis and Foege are the core areas o f health prevention; that's where we begin. Unfortunately, today we face a big challenge to provide the education and counseling needed regarding critical health issues. As visits are shortened and reduced in number, we must make sure we are not omitting this important aspect o f health promotion. We must be creative in the ways we provide this care. Today we need to consider both cost and effectiveness as we review the approaches we use to provide health education. We may have to give up the one-to-one teaching that has often 197
198
Journal of Pediatric Health Care Volume 9, Number 5
Editorial
been the routine and use group approaches instead. The use o f such approaches does not necessarily mean we are providing less than optimal care; indeed, we rarely have evaluated the effectiveness o f one-to-one teaching. Group teaching can be fun, and effective groups can be arranged on a variety o f topics. Groups may consist o f certain individuals, such as fathers, single parents, or adoptive parents, or groups may focus on certain topics, such as well child care issues for certain ages. This approach enables parents to learn and share with other parents; these groups can thus be very creative and informative. Suggestions for dealing with issues such as drug use by adolescents or the promotion o f physical activities for families can bc presented in practical ways. Certainly written materials and videos can be used or recommended to enhance these group learning experiences, but the group experience itself is an important educational approach. Too often today's shorter visits mean we run out o f time and end up just handing out materials or discussing a number o f issues in a rushed manner. Group approaches can help counter this.
Certainly group classes will not solve all the problems of providing optimal health education. We need to continue our search for better ways to provide this important aspect o f health care. The key point is, we must continue to provide this health education and promotion. I truly believe the secret to making more people see the importance of putting children first can come from seeing the effects of such interventions with children and their families. All children count; we know that, and we can make a difference. Health promotion may be the way to make the larger society realize this point and appropriately respond with needed support. Wouldn't that make our efforts worthwhile? Let's try it! Bobble Crew Nelms, PhD, R N , C P N P Editor REFERENCES
McGinnis, J. M., & Foege, W. H. (1993). Actual causes of death in the United States. Journal of the American Medical Association, 270, 2207-2212. National Center for Children in Poverty. (1995). Number of poor children under six increasedfrom 5 to 6 million 1987-1992. News and Issues, 5, 1-2.
Bound Volumes Available to Subscribers Bound volumes of the JOURNALOF PEDIATVaCHEALTHCAREare available to subscribers (only) from the Publisher, at a cost o f $34.00 ($42.80 for Canadian and $40.00 for international) for January-December. Shipping charges are included. Each bound volume contains a subject and author index and all advertising is removed. Copies are shipped within 60 days after publication o f the last issue o f the volume. The binding is durable buckram with the JOURNAL name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Dr., St. Louis, M O 63146-3318, USA; telephone (800) 453-4351 or (314) 453-4351. Subscriptions must be in force to qualify. B o u n d volumes are n o t available in place o f a regular Joum~AI. subscription.