Uwemedimo Omolara T, Arora Gitanjli, Russ Christiana M
aDivision of General Pediatrics, Hofstra Northwell School of Medicine, Global Pediatrics Program, Cohen Children's Medical Center, New Hyde Park, New York bDepartment of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California cDivision of Medicine Critical Care, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2016 Oct;28(5):667-72. doi: 10.1097/MOP.0000000000000402.
This paper provides a brief overview of the current landscape of global child health and the impact of social determinants on the world's children. In the United States (US), global child health (GCH) has increasingly been highlighted as a priority area by national organizations, such as the National Academy of Medicine and American Academy of Pediatrics, as well as individual pediatricians committed to ensuring the health of all children regardless of geographic location. Although GCH is commonly used to refer to the health of children outside of the US, here, we highlight the recent call for GCH to also include care of US vulnerable children. Many of the lessons learned from abroad can be applied to pediatrics domestically by addressing social determinants that contribute to health disparities.
Using the 'three-delay' framework, effective global health interventions target delays in seeking, accessing, and/or receiving adequate care. In resource-limited, international settings, novel health system strengthening approaches, such as peer groups, community health workers, health vouchers, cultural humility training, and provision of family-centered care, can mitigate barriers to healthcare and improve access to medical services.
The creative use of limited resources for pediatric care internationally may offer insight into effective strategies to address health challenges that children face here in the US. The growing number of child health providers with clinical experience in resource-limited, low-income countries can serve as an unforeseen yet formidable resource for improving pediatric care in underserved US communities.
本文简要概述了全球儿童健康的现状以及社会决定因素对世界儿童的影响。在美国，全球儿童健康（GCH）日益被国家组织（如美国国家医学院和美国儿科学会）以及致力于确保所有儿童健康（无论地理位置如何）的个体儿科医生视为优先领域。尽管全球儿童健康通常用于指代美国以外儿童的健康状况，但在此我们强调最近有人呼吁全球儿童健康也应包括对美国弱势儿童的照护。通过解决导致健康差距的社会决定因素，许多从国外吸取的经验教训可应用于美国国内的儿科学领域。
运用“三延迟”框架，有效的全球健康干预措施旨在解决寻求、获得和/或接受充分照护方面的延迟问题。在资源有限的国际环境中，诸如同伴群体、社区卫生工作者、健康代金券、文化谦逊培训以及提供以家庭为中心的照护等新型卫生系统强化方法，可减轻医疗保健障碍并改善医疗服务的可及性。
在国际上创造性地利用有限资源进行儿科照护，可能为解决美国儿童所面临的健康挑战提供有效策略方面的见解。越来越多在资源有限的低收入国家拥有临床经验的儿童健康提供者，可成为改善美国服务欠缺社区儿科照护的意外但强大的资源。
