The Past, Present, and Future of Children at Risk

Keynote address THE PAST, PRESENT, AND FUTURE OF CHILDREN AT RISK HONORABLE ANTONIA C NOVELLO, M.D. U.S. Surgeon General Washington, D.C. 20201 IT has been said that if you wish to take the measureof any society, you should look no further than how it treats its children. It was my own concern for children that initially led me to a career in pediatrics and now, as your Surgeon General, I have identified child health as one of my primary agenda items. This is why I am so pleased to be with you here at Meharry Medical College for your Children at Risk Conference. The men and women of Meharry obviously care about children. I wish you could have been with me yesterday at the United Nations. I accompanied President Bush and U.S. Health and Human Services Secretary Dr. Louis Sullivan to the U.N. Summit on Children, joining other nations to address the root causes of childhood illness, illiteracy, mental health suffering, and social anguish. The pledge has been made but the needs are great. There is much work to be done. I see the issues that you study as essential. You are identifying what children need to thrive. You are calibrating the damage done by adverse conditions, marking the harm done to children by violence, malnutrition , family dysfunction, alcoholism, poverty, and other harsh conditions. These show us indirectly the conditions under which children thrive. We have learned a lot about the way children grow and learn in the past 50 years. We all agree that early childhood is extremely important. As a pediatrician and the former Deputy Director of the National Institute of Child Health and Human Development, I can tell you that the statistics are staggering. Notonly do we face such striking issues such as pediatric AIDS, with many more sick children and babies to come, but there are more everyday risks as well. Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 Past, Present, and Future A statistical view Today's global child and youth population is 2.8 billion, a figure which exceeds the total world population of just 26 years ago. Young people under age 25 constitute 52 percent of the world's population. More than 1,000 babies per hour—about 10 million in all—will die throughout the world thisyear. Of those, about 970 will have been born in nonindustrialized countries. About 40,000 babies die each day from malnutrition, lack of clean water, inadequate sanitation , and the effects of drug problems.1 Countless babies are exposed to dangers that hamper their growth and development. They are casualties of war and violence; victims of racial discrimination, apartheid, and aggression; refugees; disabled; victims of neglect , cruelty, exploitation, poverty, economic crisis, hunger, hopelessness, and illiteracy. Every minute of every day, an American child drops out of school; an American child runs away from home; an American child is abused or neglected .1 Every hour, an American child is killed or injured by guns, and another dies of poverty.1 Everyday, 100,000 of our children are homeless, living on the street, in cars, or in shelters.1 Each year, 600,000 children are hospitalized due to injuries.2 Three million children living in metropolitan areas are exposed to enough lead to place them at risk to adverse health effects.2 From 1982 to 1990, more than 2,300 cases of pediatric AIDS in children under age 13 were reported.3 If this trend continues, pediatric AIDS may one day rank among the top five causes of childhood mortality. In 1987, 38,408 infants—the equivalent of 105 infants a day—died before their first birthday.2 Today, that number is 40,000.4 Only half of all poor children are covered by Medicaid.1 Twelve percent of the nation's children do not have regular source of health care.1 It is well known that the risk of low birthweight is higher for women who are poor, black, younger than age 17, have little or no prenatal care, have inadequate diets and gain fewer than 20 pounds during pregnancy, and for women who smoke, abuse...