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Developing Strategies to Reduce Children’s Health Care Disparities

机译：制定减少儿童医疗保健差异的策略

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Dear Editor,Reducing health disparities among children should be a high priority due to increases in disease prevalence throughout the world. Poor economic growth in various cities, unhealthy living, health care disparities, and lack of health educational awareness appear to be primary reasons why chronic disease rates among children continue to rise. The increased prevalence of chronic conditions has greatly changed the face of child health and the types of conditions observed by child health care professionals (Perrin, Bloom, Gortmaker, 2007). Recent research reports concluded that more than half of the children which were examined between 2010 to 2011 were diagnosed as having a chronic disease and almost one-quarter of those children were classified as developmentally disabled (Bethell, Kogan, & Strickland et. al., 2011). New evidence has shown that there is not only an association between obesity, cardiovascular disease (CVD) risk factors, diabetes, and cancer, there is also evidence which suggests that there continues to be a growth in both prevalence and mortality rates in children diagnosed with these types of chronic conditions (Rodriguez, Fujimoto, & Mayer-Davis, et.al. 2006). Since 1980, obesity prevalence among children and adolescents has almost tripled. Obesity has also been known as a risk factor in children that may be associated with diabetes, CVD, sedentary lifestyles, and socioeconomic status (Rodriguez, Fujimoto, & Mayer-Davis, et.al. 2006). The association between socioeconomic status and health holds true for children in that low-income children have higher rates of mortality (even with the same condition), may have higher rates of disability, and may be more likely to be diagnosed with multiple chronic conditions (Wise, Kotelchuck, Wilson, & Mills, 1985). Children from low-income families and children whose parents had less than a high school education were far more likely to be in fair or poor health when compared with other children, and when low-income children have health problems, they tend to suffer more severely (Newacheck, Jameson, & Halfon, 1994). Children whose parents have lower education levels and lower paid occupations also tend to have worse health than their more economically advantaged peers (Adler, Boyce, & Chesney, 1993).Numerous studies have also documented racial and ethnic disparities in health (Lieu, Newacheck, & McManus, 1993). White children are half as likely as Black and Latino children not to be in excellent or very good health (Children’s Defense Fund, 2006). Some disparities are starkest between White and Black children. For example, Black children were reported as more likely to have a limitation of activity and more than twice as likely to have elevated blood lead levels. Disparities are also apparent in access to quality health care. Children who lack sufficient resources due to family income or insurance status and children of color face greater problems in receiving appropriate quality health care (Newacheck, Hughes, & Stoddard, 1997). Quality health care should focus on enhancing health promotion and disease prevention and the inclusion of measurement and evaluation of services provided by various medical facilities to ensure that these objectives have been substantially met. Another factor to examine when establishing a quality health care environment would be cultural competence or awareness. Children’s health practitioners should receive the appropriate training necessary to achieve an effective level of cultural competence in the health care environment. This idea may help to eliminate some of the existing ethnic and racial disparities and additionally increase cultural awareness among children’s health care providers and practitioners. Medical facilities should provide children’s health providers and practitioners with continuing educational opportunities to enhance both learning and awareness of the application of the various practices that may be required to ensu
机译：亲爱的编辑，由于全世界疾病患病率的上升，减少儿童之间的健康差异应作为当务之急。各个城市的经济增长欠佳，不健康的生活，医疗保健差距以及缺乏健康教育意识，这似乎是儿童慢性病发病率持续上升的主要原因。慢性病患病率的增加极大地改变了儿童健康的面貌，并改变了儿童保健专业人员所观察到的疾病类型（Perrin，Bloom，Gortmaker，2007年）。最新研究报告得出的结论是，在2010年至2011年之间接受检查的儿童中，有一半以上被诊断为患有慢性疾病，其中将近四分之一的儿童被归类为发育性残疾（Bethell，Kogan和Strickland等， 2011）。新的证据表明，肥胖，心血管疾病（CVD）危险因素，糖尿病和癌症之间不仅存在关联，而且有证据表明，被诊断患有哮喘的儿童的患病率和死亡率均继续增长这些类型的慢性疾病（Rodriguez，Fujimoto和Mayer-Davis等人，2006年）。自1980年以来，儿童和青少年的肥胖率几乎增加了两倍。肥胖也被认为是儿童的危险因素，可能与糖尿病，CVD，久坐的生活方式和社会经济状况有关（Rodriguez，Fujimoto和Mayer-Davis等人，2006年）。儿童的社会经济地位与健康之间的联系是正确的，因为低收入儿童的死亡率较高（即使在相同条件下也是如此），残障率可能更高，并且更有可能被诊断出患有多种慢性疾病（ Wise，Kotelchuck，Wilson和Mills，1985年）。与其他孩子相比，来自低收入家庭的孩子和父母受过高中教育的孩子的健康状况很可能较差，而当其他收入较低的孩子有健康问题时，他们遭受的苦难则更为严重。 （Newacheck，Jameson和Halfon，1994年）。父母的文化程度较低和报酬较低的孩子，其健康状况往往也比经济上较优势的同龄人差（Adler，Boyce和Chesney，1993年）。许多研究还记录了种族和种族之间的健康差异（Lieu，Newacheck， ＆McManus，1993）。白人儿童健康状况不佳或非常好的可能性是黑人和拉丁裔儿童的一半（儿童防卫基金，2006年）。白人和黑人孩子之间的差距最为明显。例如，据报道，黑人儿童活动受限的可能性更高，血铅水平升高的可能性是后者的两倍以上。在获得优质保健服务方面也存在明显差距。由于家庭收入或保险地位而缺乏足够资源的儿童以及有色儿童在接受适当的优质医疗保健方面面临更大的问题（Newacheck，Hughes和Stoddard，1997）。高质量的卫生保健应侧重于促进健康促进和疾病预防，并包括对各种医疗机构提供的服务进行衡量和评估，以确保基本实现这些目标。建立优质医疗保健环境时要检查的另一个因素是文化能力或意识。儿童保健人员应接受必要的适当培训，以在保健环境中达到有效的文化能力水平。这个想法可能有助于消除一些现有的种族和种族差异，并进一步提高儿童医疗保健提供者和从业者的文化意识。医疗机构应为儿童保健提供者和从业人员提供继续教育的机会，以增强他们对可能需要采取的各种做法的学习和认识

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