Child Health in America: Making a Difference through Advocacy (review)

Child Health in America: Making a Difference through Advocacy focuses on the issues that affect quality of care for U.S. children. Palfrey’s efforts revolve around the fact that despite a whopping $1.8 trillion health care budget, many U.S. children still receive inadequate care. “There are unconscionable disparities in child health status between white and nonwhite, rich and poor, educated and less educated families,”^[p.xiii] she notes. Palfrey draws on her first-hand encounters with injustices faced by the children in the U.S. health care system and on the combined experience of many knowledgeable professionals. “Advocacy,” she quotes the 19th century French social commentator Honoré Daumier saying, is “speaking out, speaking up, speaking for.”[p.7] In that sense, Palfrey’s book is a perfect example of how writing can function as advocacy, reaching millions of people.

Palfrey’s book will prove to be invaluable for the committed individuals who seek to change the current health care system in a positive way. Activists and advocates who are active participants can use it as an excellent tool to modify the dysfunctional landscape of child health care in America. The inclusion of the list of online resources increases the information that a reader can easily access. However, it is first crucial to understand Palfrey’s arguments in order to put the information to work.

In an ideal setting, from birth till adulthood, the right to achieve quality of life is respected. Good health habits, on top of “satisfactory housing, good nutrition, a quality education, an adequate family income, a supportive social network, and access to community resources”^[p.3] would improve the health of many children who suffer ill health today. Moreover, proper health can be ensured through “ready access to coordinated, comprehensive, health-promoting, therapeutic, and rehabilitative medical, mental health, and dental care.”^[p.2] Palfrey contends that lack of accountability in every step of the way has led to the need for increased advocacy.

Palfrey details the history of child health care advocacy and the role of leading individuals and organizations. Group advocacy can be an all-inclusive effort through structured grouping by age and social factors (such as national, ethnic, or cultural attributes) and by clinical conditions. Legislative advocacy, on the other hand, promotes policies to ensure social justice and reduce administrative burden. In a democratic society it allows for a “large-scale policy change that affects the lives of children now and for many years to come.”^[p.181]

Although this volume has been faulted in a previous review [Child Health in America: Making a Difference Through Advocacy: Book Review: JAMA 2007;297(24): 2768–9], this reader found it well-grounded in the literature and likely to remain relevant in years to come.

Dr. Palfrey is a general pediatrician and child advocate. She is the president of the American Academy of Pediatrics (AAP) and the T. Berry Brazelton Professor of Pediatrics at Harvard Medical School. She also directs the Children’s International Pediatric Center, Children’s Hospital, Boston. “Child Health in America: Making a Difference through Advocacy” is one of the five books and more than 100 articles written by her on children heath system.