Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Children In America - Do We Accept the Responsibility

Category: Access To Children's Health Care


A recent conference was held in America comparing the health of children from several developing nations including the European nations and Canada compared with children's health care in the United States. The conference was sponsored by the American Academy of Pediatrics and one of the goals of the conference was to learn from these other countries to provide better care for the children in our society.

One thing was made extremely clear during this conference: We lag behind practically every modern industrial nation in Europe and Canada in providing good health care for all of our children. We have a higher infant mortality than all of these other modern countries which have a lower standard of living than we do. We have poorer preventive care in the sense of immunization rates. As an example, in the Netherlands, 97% of the children have received the recommended DPT immunizations by age three; in Norway, 80%, and in the United States, less than 65%.

Another example where we lag behind these other countries is in deaths caused after birth in children. We have a much higher rate of deaths caused by car accidents, homicide and suicide. These issues transcend all races in our society. Another area where we fall short is in pregnant adolescents. The adolescent pregnancy rate in America is almost double that of the majority of European countries and Canada. This is so despite the fact that the age of onset of sexual activity is the same in the United States and these other countries. Because of a higher adolescent pregnancy rate we also, consequently, have a higher adolescent birth rate with a higher percentage of birth defects, high risk babies and higher mortality. We also have a much higher abortion rate, almost double most of the other countries.

What did we learn from examining these other countries and how they do a better job at immunizing their children and decreasing pregnancies among teens and decreasing abortions? The country with the best immunization rate is Holland and this is what they do: When a baby is born, the parents of that child receive a computer card which shows exactly when they are to get immunizations for the child and where. If the child is not brought in for that shot, a public health nurse calls the family. If the family still does not come in for the shot, the nurse calls a second time and, if necessary, goes to the parents' home to be sure the child receives that immunization. In Great Britain, a health worker is responsible for insuring that each new child born ultimately receives their needed immunizations. In the United States, parents are expected to know when their children need immunizations. They are expected to go to a doctor or a health unit and get the immunizations. If out of their ignorance or poverty or lack of access to either a doctor or a local health unit, they do not get their immunizations, there is no system in place to immunize these children who fall through the cracks.

Another issue which amazed the foreigners was the way we handled drunk drivers in our country. In the other countries, the acceptable blood alcohol level is about 1/2 the level accepted in our country. When persons are found driving drunk in Europe, they lose their license for a year and, in many cases, are even put in jail. Consequently, responsible people do not drink and drive in these countries and teenagers have a strong incentive not to drink and drive, because they certainly don't want to lose their license for a full year. We have moved forward in this area in the past few years but probably could still move a lot further in stopping this major cause of death and suffering among our young people and all of our society.

Another very high percentage cause of death among young people in our society is wounds and deaths from gunshots particularly in large cities in our country. If you contrast Vancouver, Canada with Seattle, you can see that our easy availability of guns compared to Canada's more than doubles the rate of accidents due to guns in similar size cities only a few miles apart but worlds apart in the way access to guns are handled.

Regarding the issue of high risk teenage pregnancies and teen abortions being so much higher, most studies indicate that the Europeans start sex education at a younger age in the home as well as in schools. Because of our individualistic rights attitude in America, we continue to fight sex education in the schools. Many parents fail to provide sex education in their homes, consequently we continue to lead the modern world in teenage pregnancies, infant deaths and abortions. The issue of condoms is certainly a controversial one and I personally think that anytime condoms are provided it should be with sexual education combined with a teaching of values. You may say, "How can you teach values if you are handing out condoms so people can have sex out of marriage?" That's a valid question and I don't have an answer for it. I do know that I do abhor suffering among our young people in our society from sexually transmitted diseases and I particularly abhor babies being born with AIDS and other diseases which could be prevented. In that sense I agree with our former Surgeon General, Dr. Koop, that we should be doing all of these things: Teaching safe sex, providing condoms for high risk populations, and teaching values. In a process of moving toward a more perfect society, we should not penalize those at high risk, particularly the babies of those high risk teens.