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Child Health in America

Making a Difference through Advocacy

Judith S. Palfrey, M.D.

Publication Year: 2006

Who will speak for the children? is the question posed by Judith S. Palfrey, a pediatrician and child advocate who confronts unconscionable disparities in U.S. health care—a system that persistently fails sick and disabled children despite annual expenditures of $1.8 trillion. In Child Health in America, Palfrey explores the meaning of advocacy to children's health and describes how health providers, community agencies, teachers, parents, and others can work together to bring about needed change. Palfrey presents a conceptual framework for child health advocacy consisting of four interconnected components: clinical, group, professional, and legislative. Describing each of these concepts in useful and compelling detail, she is also careful to provide examples of best practices. This original and progressive work affirms the urgent need for child advocacy and provides valuable guidance to those seeking to participate in efforts to help all children live healthier, happier lives.

Published by: The Johns Hopkins University Press


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pp. vii


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pp. ix-xi

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pp. xiii-xxi

Something is wrong in America. We have the finest medical capability in the world and spend over $1,800,000,000,000 on health care each year, but our children still confront serious physical and mental health concerns. Families of children with disabilities go without comprehensive support. There are unconscionable disparities in child health status between white and nonwhite, rich and poor, educated and less...

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CHAPTER ONE: Child Health Advocacy

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pp. 1-17

Health care in the United States is second to none, and the available technology is advanced beyond anything that Jules Verne or H. G. Wells could have imagined. The tools for the prompt medical diagnosis, surgical management, and rehabilitative care of the child with an inflamed appendix are readily available. The same cannot be claimed...

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CHAPTER TWO: A History of Child Health Advocacy

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pp. 18-50

Throughout American history, advocacy has been a natural component of the child health enterprise. As a backdrop to the present, let’s revisit the experiences of some of the many men and women who have made a difference by speaking up. These stories show not only how child health advocates witnessed problems but also how they documented...

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CHAPTER THREE: The Current Status of Child Health

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pp. 51-88

When Lauren Elizabeth Matthews drew her first breath at 12:05 a.m. on January 1, 2000, she became a citizen of the wealthiest nation the world has ever known. She joined 71 million children and youth aged 0–18, representing a quarter of the total U.S. population.1 By comparison, youth were more than 35 percent of the population in 1960 during the...

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CHAPTER FOUR: Clinical Advocacy

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pp. 89-120

Advocating clinically for individual children and their families comes naturally to child health providers. The office, the ward, the nursery, are comfort zones. Nonetheless, it is at the clinical level that many physicians and nurses feel dissatisfied, and even disgruntled, about their inability to make a difference. They worry that they cannot alleviate suffering stemming from family, economic, community-based, and...

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CHAPTER FIVE: Group Advocacy

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pp. 121-143

Advances in child health often depend on someone recognizing a pattern. John Snow discovers that all his patients with debilitating diarrhea obtain their water from the Broad St. pump;1 Martha Eliot observes that children from the cold, dark north are far more likely to suffer from rickets than children from the sunny south;2 Steven Gortmaker and William Dietz find that boys and girls who watch many hours of television...

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CHAPTER SIX: Legislative Advocacy

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pp. 144-181

There are at least three reasons to confront child health problems through the policy route: social justice, administrative burden, and creative pragmatism. Driven by concerns for justice, some child health advocates deem that societal forces are hurting rather than helping children. They find it unfair that any child lacks health insurance or that any...

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CHAPTER SEVEN: Professional Advocacy

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pp. 182-208

This book’s chapters discuss how professionals, families, and community organizations collaborate to improve the health of children and youth. In the best of all possible worlds, child health professionals act on their convictions with few constraints. But in the real world, forces within and outside the profession often prevent child health professionals...

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CHAPTER EIGHT: Political Will

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pp. 209-239

Chapter 1 ends with a description of Julius Richmond’s model of advocacy, which places equal importance on three components: knowledge base, social strategy, and political will. Chapter 3 reviews the knowledge base in some detail, and chapters 4 through 7 delineate social strategies for child health advocacy in clinical care, group programming, legislative/ systems reform, and professional activities. The last and perhaps the...

Appendix: Resources Online

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pp. 241-242


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pp. 243-273


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pp. 275-282

E-ISBN-13: 9780801891731
E-ISBN-10: 0801891736
Print-ISBN-13: 9780801884535
Print-ISBN-10: 0801884535

Page Count: 312
Illustrations: 5 halftones, 11 line drawings
Publication Year: 2006