Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Wash.
Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Wash.
Acad Pediatr. 2021 Nov-Dec;21(8S):S102-S107. doi: 10.1016/j.acap.2021.08.004.
Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of pediatric preventive care, or well-child care, have evolved to better acknowledge and address health disparities due to racism and poverty, the structures of care have remained mostly stagnant. To cultivate long-term health and wellness of Black and Brown children, we must adopt an explicitly antiracist structure for well-child care. The pediatric medical home model is touted as the gold standard for addressing a host of health, developmental, and social needs for children and their families. However, the medical home model has not resulted in more equitable care for Black and Brown families living in poverty; there are ample data to demonstrate that these families often do not receive care that aligns with the principles of the medical home. This inequity may be most salient in the context of well-child care, as our preventive care services in pediatrics have the potential to impact population health. To appropriately address the vast array of preventive care needs of families living at the intersection of racism and poverty, a structural redesign of preventive care in the pediatric medical home is needed. In this paper, we propose a re-imagined framework for the structure of well-child care, with a focus on care for children in families living at the intersection of racism and poverty. This framework includes a team-based approach to care in which families build trusting primary care relationships with providers, as well as nonclinical members of a care team who have shared lived experiences with the community being served, and relies on primary care connections with community organizations that support the preventive health, social health, and emotional health needs of families of young children. Without a structural redesign of preventive care in the pediatric medical home, stand-alone revisions or expansions to processes of care cannot appropriately address the effects of racism and poverty on child preventive health outcomes.
种族主义和贫困在美国社会中相互交织，这是历史上和当前基于阶级和种族的系统性压迫的结果。随着儿科预防保健或儿童保健的发展，更好地认识和解决种族主义和贫困导致的健康差距，保健结构基本保持不变。为了培养黑人和棕色儿童的长期健康和幸福，我们必须为儿童保健采用明确的反种族主义结构。儿科医疗之家模式被吹捧为解决儿童及其家庭的一系列健康、发育和社会需求的黄金标准。然而，医疗之家模式并没有为生活在贫困中的黑人和棕色家庭带来更公平的护理;有大量数据表明，这些家庭通常没有得到符合医疗之家原则的护理。这种不平等在儿童保健方面可能最为明显，因为我们的儿科预防保健服务有可能影响到人口健康。为了适当满足生活在种族主义和贫困交叉点的家庭的广泛预防保健需求，需要对儿科医疗之家的预防保健进行结构性重新设计。在本文中，我们提出了一个重新构想的儿童保健结构框架，重点是为生活在种族主义和贫困交叉点的家庭的儿童提供保健。该框架包括以团队为基础的护理方法，使家庭与提供者建立信任的初级保健关系，以及护理团队中具有共同生活经历的非临床成员，他们与服务社区有联系，并依赖于支持幼儿家庭预防健康、社会健康和情感健康需求的社区组织的初级保健联系。如果不对儿科医疗之家的预防保健进行结构性重新设计，那么对护理流程的单独修订或扩展都无法适当解决种族主义和贫困对儿童预防健康结果的影响。
