Foreword

Abstract

In September 2000, 50 pediatricians from the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH) met in the United Kingdom to establish a sustainable international program to improve child health outcomes in our respective countries. This was the first such joint endeavor for the AAP and the RCPCH and the first organized effort by the societies to recognize the global dimension of health inequities and disparities and the challenges that confront us all as pediatricians.From its inception, the meeting was meant to go beyond a biomedical model of health to define the social, economic, political, and environmental determinants of child health. It was hoped the meeting could contribute to the political resolve in both nations to develop public policy and generate sustainable resources to tackle these health determinants and disparities. Within this context, the following 4 conference objectives were pursued: The meeting engaged participants in a variety of learning environments. Articles from participants in the United Kingdom and in the United States were organized into 6 critical focus areas: 1) the social, economic, and political determinants of child health; 2) health systems; 3) child health policy; 4) community pediatrics; 5) academic medicine and research; and 6) children’s rights. Small working groups then took the perspectives and information generated through the sessions to focus on roles and functions of community pediatrics as they relate to: 1) child advocacy, 2) the care of marginalized children and children with special needs (the term “marginalized” is used throughout the proceedings to describe populations of children with limited access to the social, economic, and environmental prerequisites and resources for optimal growth and development), 3) child mental health, 4) medical education, and 5) child health practice. The results of these discussions were presented and prioritized during the final session as recommendations for further action by the AAP and the RCPCH.A mission, goal, and 4 “Implementation Groups” have been established to begin the process of translating these recommendations into practice as the Equity Project. The mission of this joint AAP-RCPCH initiative is to reduce health disparities among populations of children in the United States and in the United Kingdom, in particular among children living in poverty and other groups of marginalized children. The goal of the Equity Project is to sustain and expand the commitment and activities of the RCPCH and the AAP to ensure that equity in health outcomes remains a fundamental tenet and task of the respective societies.Four Implementation Groups are the venues in which the priorities established during the meeting will be developed and implemented as the Equity Project. Pediatricians can do much to improve child health outcomes by understanding and mitigating the effects of social determinants on individual children and families. Research, knowledge, and experience have been accrued over the last decade to provide pediatricians options for intervention. By jointly working on these issues and engaging community pediatricians and other public and private sector partners, the RCPCH and the AAP can develop and advocate for programs that will improve the health of all of our children.The Equity Project is the inheritor of the knowledge and experience of many past and current AAP and RCPCH initiatives. It will provide a venue for the AAP and the RCPCH to work together to ensure pediatrics and pediatricians remain relevant to the current and future determinants of the global health of children. Toward this end, the following articles and framework for action are presented to engage all pediatricians and those so committed to this endeavor and these outcomes.Child poverty is increasing in the United Kingdom and in the United States. Given the known impact of social, economic, environmental, and other nonmedical determinants on child health, an impact that continues through adulthood, it is incumbent on pediatrics and pediatricians to focus their efforts on dealing with the root causes of these social injustices. The Royal College of Paediatrics and Child Health and the American Academy of Pediatrics, through this joint Equity Project, should establish the education, practice, and research framework to integrate these issues into the corpus of pediatrics. Much is available to be learned from our mutual experience, but also from the efforts of other countries. Advocacy and political resolve will be necessary for success. Recommendations include: