Foreword

Article Outline

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The title of this issue would lead us to think there still is work to be done in this area of racial and ethnic disparities. Isn’t the US renowned for its medical excellence? Don’t we have outstanding medical facilities and remarkable technology available throughout this country? Aren’t research activities at innumerable academic and commercial facilities producing new advances at lightning-speed, thus making it impossible for clinicians to keep up on every aspect of medical progress? Aren’t considerable dollars being spent each year for health care? Doesn’t this reflect ready accessibility to outstanding health care resources for our patients? Unfortunately studies continue to document health care inequities. We hope you will feel not only disheartened after reading this monograph by Dr. Oberg and Ms. Rinaldi, but also committed to advocacy in this area.

The impression that the US provides the ultimate in medical care, while comforting, is not supported by the health indicators for children. Embarrassing and unacceptable gaps in accessibility, affordability, and desirable health outcomes continue to increase. Dr. Barbara Starfield’s presentation, “Patients and Populations: The Challenge to Pediatric Practice,” at the 2005 Pediatric Academic Societies Annual Meeting in Washington, DC quickly dispelled any misconceptions regarding our preeminence in pediatric outcomes; we were ranked 37th in the world in mortality for children under age 5; 20 to 26th in childhood death rate from injuries; and 68 to 69th in age-appropriate pediatric immunizations.¹, ² These data are startling. Definitely not statistics to make one feel proud!

As Dr. Oberg and Ms. Rinaldi delineate so well, our advocacy must also focus on collaborative activities. In response to the growing understanding of the importance of health disparities, the American Academy of Pediatrics and Royal College of Paediatrics and Child Health in Great Britain implemented “The Equity Project” in 2001. The Project is seeking to better understand disparities in health status and to establish an Equity and Human Rights-based framework to support the efforts of pediatricians and others to improve the health and well-being of all children and families. This is the first organized effort by national pediatric societies to recognize the global dimension of health inequities and disparities and the challenges that confront us all. Four implementation groups were established at that meeting, with the first goal being to ensure all pediatricians and child health professionals understand the issues and experiences of marginalized children, the impact of social determinants on health, and the health implications of inequities; and have the knowledge, attitudes, and skills to deal with child health disparities.

Subsequent to the implementation of the Equity Project, the American Academy of Pediatrics has included equity in health care as one of its strategic goals and sponsored a 2-day CME event in May of 2006 called “Hidden in Plain View: Pediatric Disparities, What You Need to Know.” Most recently, The Society for Equity in Child Health has been formed to work with the AAP, the Ambulatory Pediatric Association, and other interdisciplinary professions and organizations to advance an agenda of equity, social justice and children’s rights in child health.

We hope that this issue will both educate and inspire readers to look for ways to “be a part of the solution.” One way is to become involved in the new society. For more information and to be placed on the society’s listserve, please contact Hope Tackett at the Society for Equity in Child Health, email: htackett@health.usf.edu. For further information about the Equity Project, contact Jeffrey Goldhagen, MD at jeffrey.goldhagen@jax.ufl.edu.

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References 

1. Starfield BUS . Child Health (What’s amiss, and what should be done about it?) . Health Affairs . 2004;23:165–170
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2. UNICEF. State of the World’s Children 2005. Available at: http://www.unicef.org/sowc05/english/index.html.
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