Population and Culture: The Care of Children in Society

Most common reason for admissions- chronic disorders


Pediatricians must also address the increasing concern about environmental toxins and the prevalence of physical, emotional, and sexual abuse as well as violence


Childhood antecedents of adult health conditions, such as alcoholism, depression, obesity, hypertension, and hyperlipidemias, are increasingly being recognized

Infants who are smaller size and relatively underweight at birth because of maternal malnutrition have increased rates of coronary heart disease, stroke, type 2 diabetes mellitus, obesity, the metabolic syndrome, and osteoporosis in later life

Access to primary care
Health insurance coverage
Prenatal and perinatal care
Births
Cesarean sections
Preterm births
Birth rate in adolescents
Infant mortality
Initiation and maintenance of breastfeeding
Cause of death in U.S. children
Hospital admissions for children and adolescents
Significant adolescent health challenges: substance use and abuse
Children in foster care

Obesity
Sedentary lifestyle
Motor vehicle accidents and injuries
Children in protective services programs
Juvenile challenges, crime, and the juvenile justice system
Current social and economic stress on the U.S. population
Adverse child events leading to adult health challenges
Military deployment and children

•Infant mortality increases as the mother's level of education decreases.
•Poorer children are less likely to be immunized at 4 years of age and less likely to receive dental care.
•Rates of hospital admission are higher for people who live in low-income areas.
•Children of ethnic minorities and children from poor families are less likely to have physician office or hospital outpatient visits and more likely to have hospital emergency department visits.
•Children with Medicaid/public coverage are less likely to be in excellent health than children with private health insurance.
•Access to care for children is easier for whites and for children of higher income families than for minority and low-income families.

Culture is an active, dynamic, and complex process of the way people interact and behave in the world. Culture encompasses the concepts, beliefs, values (including nurturing of children), and standards of behavior, language, and dress attributable to people that give order to their experiences in the world, offer sense and purpose to their interactions with others, and provide meaning for their lives. Culture requires an attempt to understand, from the patient and family perspective, questions such as:
•What is the nature of health?
•What is the nature of illness?
Where does it come from?
•What is the approach to treatment?
•What is the expected outcome?

The core of professionalism is embedded in the daily healing work of the physician and encompassed in the patient-physician relationship. Professionalism includes an appreciation for the cultural and religious/spiritual health beliefs of the patient, incorporating the ethical and moral values of the profession, and the moral values of the patient. The inappropriate actions of a few practicing physicians, physician investigators, and physicians in positions of power in the corporate world have created a societal demand to punish those involved and have led to the erosion of respect for the medical profession.

Honesty/integrity
Reliability/responsibility
Respect for others
Compassion/empathy
Self-improvement
Self-awareness/knowledge of limits
Communication/collaboration
Altruism/advocacy

The ethics of health care are embedded in the process whereby patients, family members, and clinicians engage in medical decision making by balancing personal, family, cultural/religious/spiritual, and professional values

Sometimes ethical decision making in medical care is a matter of choosing the least harmful option for a patient among many adverse alternatives

Ethical problems derive from value differences among patients, families, and clinicians about choices and options in the provision of health care. Resolving these value differences involves several important ethical principles
Autonomy
Paternalism
beneficence
nonmaleficence

Children vary from being totally dependent on parents or guardians to meet their health care needs to being more independent. Infants and young children do not have the capacity for making medical decisions. Paternalism by parents and pediatricians in these circumstances is appropriate