Center for Healthier Children, Families, and Communities.
Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Pediatrics. 2022 May 1;149(Suppl 5). doi: 10.1542/peds.2021-053509O.
Childhood adversity and its structural causes drive lifelong and intergenerational inequities in health and well-being. Health care systems increasingly understand the influence of childhood adversity on health outcomes but cannot treat these deep and complex issues alone. Cross-sector partnerships, which integrate health care, food support, legal, housing, and financial services among others, are becoming increasingly recognized as effective approaches address health inequities. What principles should guide the design of cross-sector partnerships that address childhood adversity and promote Life Course Health Development (LCHD)? The complex effects of childhood adversity on health development are explained by LCHD concepts, which serve as the foundation for a cross-sector partnership that optimizes lifelong health. We review the evolution of cross-sector partnerships in health care to inform the development of an LCHD-informed partnership framework geared to address childhood adversity and LCHD. This framework outlines guiding principles to direct partnerships toward life course-oriented action: (1) proactive, developmental, and longitudinal investment; (2) integration and codesign of care networks; (3) collective, community and systemic impact; and (4) equity in praxis and outcomes. Additionally, the framework articulates foundational structures necessary for implementation: (1) a shared cross-sector theory of change; (2) relational structures enabling shared leadership, trust, and learning; (3) linked data and communication platforms; and (4) alternative funding models for shared savings and prospective investment. The LCHD-informed cross-sector partnership framework presented here can be a guide for the design and implementation of cross-sector partnerships that effectively address childhood adversity and advance health equity through individual-, family-, community-, and system-level intervention.
儿童逆境及其结构原因导致健康和福祉在一生中及代际间的不平等。医疗保健系统越来越了解儿童逆境对健康结果的影响，但不能单独治疗这些深刻和复杂的问题。跨部门伙伴关系，整合医疗保健、食品支持、法律、住房和金融服务等方面，越来越被认为是解决健康不平等的有效方法。那么，指导解决儿童逆境和促进生命历程健康发展（LCHD）的跨部门伙伴关系设计的原则是什么？LCHD 概念解释了儿童逆境对健康发展的复杂影响，它是优化终身健康的跨部门伙伴关系的基础。我们回顾了医疗保健领域跨部门伙伴关系的演变，为制定基于 LCHD 的伙伴关系框架提供信息，以解决儿童逆境和 LCHD 问题。该框架概述了指导伙伴关系采取生命历程导向行动的原则：（1）主动、发展和纵向投资；（2）护理网络的整合和共同设计；（3）集体、社区和系统影响；（4）实践和结果的公平。此外，该框架阐明了实施所需的基本结构：（1）跨部门变革的共同理论；（2）使共同领导、信任和学习成为可能的关系结构；（3）链接的数据和通信平台；（4）用于共享储蓄和预期投资的替代供资模式。这里提出的基于 LCHD 的跨部门伙伴关系框架可以作为设计和实施跨部门伙伴关系的指南，通过个人、家庭、社区和系统层面的干预，有效解决儿童逆境问题，促进健康公平。
