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A Musing Pediatrician

The Low Hanging Fruit is Gone

Gregory Lawton, MD, Pediatrics, General, 05:30AM Jul 1, 2013

I recently stumbled upon a Public Health Report from 1953 entitled Mortality in the United States, 1900-1950.   The absolute numbers were stunning.  More stunning was the realization of what was needed, as a nation, to enact the changes that made the numbers possible.

Deaths due to typhoid fever fell from 31.3 per 100,000 population in 1900 to 0.1 per 100,000 in 1950.

In 1900, there were 242 deaths per 100,000 children younger than 15 years of age due to diphtheria, measles, pertussis, and scarlet fever.  By 1950, there were only 5 per 100,000. 

For every 1,000 live births in 1915, nearly 100 infants would die before their first birthday.  The infant mortality rate fell to 29.2 per 1,000 by 1950. 

These improvements did not come about by happenstance.  The federal government made funds available for both basic and applied research.  Regulations, making use of these scientific advances provided for improved water and food safety.  Municipalities made strides in their sewage and sanitation facilities.  Publicly and privately owned companies became part of the equation.  Citizens demanded results and improvement and accountability from their local and national political leaders.  A messy and disorganized collection of disparate groups brought about a remarkable advance in the quality of health for our nation.  The numbers speak for themselves.  Things changed.  Lives were saved.  


What are the greatest threats to our children today, 63 years later?  If not typhoid, pneumonia, or cholera, then what?  In other parts of the world, some of these diseases still wreak havoc.  Global health initiatives have a mighty task ahead of them, as the world groans under the weight of 7.1 billion people.

In the United States, however, what ails our children, if not the pestilential numbers of 1900?  The Centers for Disease Control grid citing causes of death by age is a starting point.  But what kills use and what ails us, while related, are not identical 

As pediatricians and those who care for children, how would we answer the question as to what are the greatest barriers to the collective health of our nations' children?  The answers in 1900 would be a no-brainer.  What about today?

Obesity?  Congenital anomalies?  Gun violence?  Cancer?  Over-reliance on technology to amuse?  Helicopter parents?  Access to economic and educational opportunities?  Availability of quality health care?  Indifference?  Inaction?

This is not an article that proposes any solutions.  It is a Socratic exercise, perhaps best engaged with a meaty merlot and a span of hours.  The solutions are infused with religious, political, cultural, financial, ethical, and practical considerations.  They are messy, damnably frustrating, and ineffably infuriating.  They involve conversation, collaboration, compromise, and collegial consideration.  They are not "the low hanging fruit."

You might be asking yourself, as you read this before you begin your day of seeing patients, "what does this have to do with being a pediatrician?"  

The answer is this.  In 1900, kids died from conditions or disease that had entries in medical textbooks.  Between 1900 and 1950, people had messy conversations about how to change these medical outcomes.  And change they did.  

Today, if we want to change things, we need to look beyond the index of Nelson's or the search bar of Up To Date.  Between 2000 and 2050, what improvements do we hope to be able to show for our nation's children?  As clinical caregivers for our patients, what role do we want to play?  

The low handing fruit has been picked.  Now it gets interesting.

About This Blog

My main job, as a general pediatrician, is “to explain, to reassure, and to know when to refer,” because most of what I see is a variation of normal. This blog discusses the art and science of pediatrics as well as the challenges and rewards of seeing newborns through to adulthood. It also looks at events in the world and how those events affect children, parents, and, the pediatricians who care for them. Look for it twice a month.

Look for me on Facebook at A Musing Pediatrician,
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Follow me on Twitter at @amusingpedsdoc, https://twitter.com/amusingpedsdoc

Disclosure: L. Gregory Lawton, MD, has disclosed no relevant financial relationships.Poll: Do you feel you have the time, expertise, and materials necessary to manage concussions in your patients? Yes - I have this now.|Not yet - but I will be getting this soon.|No - I don't feel prepared.|I don't think this is an area for the general pediatrician or family practice doctor.|

  • Gregory Lawton

    Dr. Gregory Lawton is a pediatrician with the Children's Hospital of Philadelphia (CHOP). He attended Jefferson Medical College in Philadelphia on a scholarship from the US Air Force and completed his pediatric residency at a teaching affiliate of the University of California, Davis at Travis Air Force Base, California.

    From 2000 to 2003, he served as the pediatrician at Hanscom AFB in Massachusetts.  

    He exchanged the polyester Air Force uniform for cotton fiber in 2003 when he moved to the Philadelphia suburbs to work for the Children's Hospital of Philadelphia.  He sees patients at CHOP Care HighPoint.

 
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