CHANGING MORBIDITY

CHANGING MORBIDITY

Changing morbidity stresses the relationship between environmental, social, emotional, and developmental issues and child health status and outcome. This approach is based on significant interactions of biopsychosocial influences on health and illness and stresses that poverty and access to health care should be a major concern of pediatricians. These health issues include the following:

• School problems, learning disabilities, and attention problems


• Child and adolescent mood and anxiety disorders


• Adolescent suicide and homicide


• Firearms in the home


• School violence


• HIV


• The effects of media violence, obesity, and sexual activity


• Substance use and abuse by adolescents, especially the abuse of alcohol

Currently, 20% to 25% of children are estimated to have some mental health problem; 5% to 6% of these problems are severe. Pediatricians are estimated to identify only 50% of mental health problems. Data based on screening in pediatric office settings suggest an overall prevalence of psychosocial dysfunction of preschool and school-age children to be 10% and 13%, respectively. Children from poor families are twice as likely to have psychosocial problems as children from higher income families.

Other important influences on children's health include poverty, homelessness, single-parent families, parental divorce, domestic violence, both parents working, and adequate childcare. Related pediatric challenges include improving the quality of health care, social justice, equality in healthcare access, and improving the public health system. For adolescents, there are special concerns about sexuality, sexual orientation, substance use and abuse, violence, depression, and suicide (see Section XII).