Health markers show major deficits in children's health care.
Maureen Shawn Kennedy, MA, RN, AJN Editor-in-Chief E-mail: firstname.lastname@example.org
When my children were small, I was fortunate to have a wonderful babysitter. She and her husband, a retired firefighter, had already raised five children of their own. The two of them would spend a few days each week with my boys, playing ball, visiting his old firehouse, reading, or going to the park.
Their 19-year-old son Frank had been a good student and star athlete throughout high school. Though he no longer lived with his parents, he visited often, and my boys regarded him with awe. He was that classic all-American boy from a solid family; his future looked bright. But then things began to change. He saw his family less often and dropped his old friends. His parents suspected he was using drugs. One day he was arrested for burglarizing a home, and this led to jail time. Repeated cycles of rehabilitation, relapse, and jail followed. His parents endured their own painful cycles of hope, disappointment, and despair as they watched their son spiral downward. At some point Frank cut off all contact with his family. They eventually learned that he'd died from AIDS at the age of 26, homeless and addicted to crack cocaine. To this day, they don't understand what happened or, more important, whether anything could have prevented this outcome.
Frank's story isn't unusual. Adolescence is a period of tremendous change in every way imaginable—physically, psychologically, emotionally, and socially. It's a period marked by experimental and sometimes risky behaviors, and events during this time often influence the subsequent trajectory of a life. Yet many adolescents don't receive vital health care services. In 2009, the Institute of Medicine (IOM) released a report, Adolescent Health Services: Missing Opportunities, which describes the lack of services specifically designed for this population. (The report focuses on youths ages 10 through 19, while recognizing that many sources use a wider age range.) In it, the IOM acknowledges the problem of uncoordinated care for this population and goes so far as to state, “In some areas, such as the organization of mental health services for adolescents, the system of services is in substantial disarray.” A decade ago, the New York Times reported that poor access to affordable mental health services was prompting many parents to relinquish parental rights so that their children could receive treatment as wards of the state. Things have not improved much since then.
Indeed, the need for such services for adolescents remains dire in this country. In 2009, a national profile of health trends among youths ages 10 to 24 reported that the three leading causes of death were motor vehicle accidents (with alcohol a significant factor for 23% to 41% of drivers, depending on age range), homicide (82% involving firearms), and suicide—all preventable deaths. National survey findings published in 2012 in the Archives of General Psychiatry found that among nearly 6,500 adolescents ages 13 to 17, 8% had a “diagnosable mental, behavioral, or emotional disorder” (defined as one that “substantially interferes with or limits the child's role or functioning in family, school, or community activities”).
And mental health care is just one area in which we're failing our children. In a report released by UNICEF in April, Child Well-Being in Rich Countries: A Comparative Overview, the United States ranked 26th among 29 developed countries for children's overall well-being, putting us above only Lithuania, Latvia, and Romania. This country falls short in several critical areas, as indicated by high rates of childhood poverty, infant mortality, and low birthweight. The United States also has the highest percentage of overweight children and the third highest homicide rate (a measure of environmental safety).
UNICEF states that its report serves as an “international comparison that can say to politicians, press and public everywhere—‘This is how your performance in protecting children compares with the record of other nations at a similar level of development'.” As a nation, we should be ashamed. We need more—not fewer—programs to support children's health. I'm tired of politicians who put special interests ahead of the public good and worry more about their campaign chests than their constituents. In five months, many of our public servants will be seeking reelection. Let's remind them who they work for.