Current models of delivering health care to children in the United States are woefully inadequate to deal with a pediatric disease pendulum that has swung from acute to chronic illnesses, CHP/PCOR core faculty member Paul H. Wise asserts in the September issue of the journal Health Affairs. In addition, Wise notes, some of the most effective clinical advances for children may actually be increasing the health disparities between children of low socioeconomic status and their more fortunate peers.

"There's a growing gap between where child health is moving and how we're attempting to deliver health care to kids," said Wise, who is also a clinical professor of pediatrics at the Stanford School of Medicine.

Acute childhood illnesses, particularly infectious diseases, are now prevented or managed so well that chronic illnesses such as asthma, obesity and diabetes have become more important threats to children's health, according to Wise's article, which is based on a review of recent epidemiological data. Other chronic illnesses are on the rise in part because children are surviving previously lethal congenital and perinatal conditions.

"Helping children with these complex problems is the primary challenge facing pediatric hospitals today," said Wise. But current policies and programs don't respond adequately to the needs of chronically ill children, particularly as they move into their teen and adult years, and these policies often ignore the increasingly evident linkages between adult-onset diseases -- such as heart disease, high blood pressure and diabetes -- and child health.

"The programs that tend to support kids with chronic illness often end abruptly when the child turns 18, although their needs can remain profound," Wise said. "It's not unusual for families to find themselves with virtually no support, which is really quite tragic."

Wise's article, "The Transformation of Child Health in the United States," calls for looking at disparities in child health in a new way. "Medical progress cannot guarantee equity in health outcomes," he said. "Indeed, under our current health policies, new medical interventions are more likely to widen rather than reduce inequalities in child health."

More than one in six children in the United States lives in poverty, according to recent data from the U.S. Census Bureau. In addition to struggling for adequate food and shelter, the frequent lack of access to health insurance and regular checkups leaves many of these children medically adrift.

Wise's report documents that despite remarkable advances in medical treatment, the disparity between white and African-American children has actually increased over the past 30 years. For example, the introduction of surfactant, a treatment that can help the lungs of premature babies function properly, has proven highly effective in reducing mortality. Evidence suggests, however, that the disparity between white and African-American newborn mortality rates has actually widened over this same time period. The report provides evidence of the same kind of phenomenon for interventions designed to prevent or treat Sudden Infant Death Syndrome, severe birth defects and asthma.

"We can't just keep throwing clinical improvements out there and expect to reduce disparities in health outcomes," Wise said. "Each new intervention must be accompanied by programs to ensure it's reaching those kids who need it most."

Treating children regardless of their ability to pay is one way to overcome some of the observed disparities in healthcare access, Wise explained. Nationally recognized programs to reduce and treat obesity, cardiovascular disease and asthma are also successful ways to deliver the benefits of bench-to-bedside practices to children, he said. Finally, he believes programs that teach pediatric advocacy to medical students and residents are critical to providing the best that modern pediatrics has to offer to all children, regardless of their social status.

"It's a sad fact of modern medicine that, despite major improvements in health care for children, a growing number of poor and chronically ill children are not getting the care they need," he said. "These issues are the central challenge to all those who worry about the health and well-being of children."