-
CHAPTER FIVE: Group Advocacy
- Johns Hopkins University Press
- Chapter
- Additional Information
121 Group Advocacy 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 are heavier than their peers who spend time playing outside.3 Patterns, commonalities,associations,group characteristics—they may be so clear that any alert high school senior can appreciate them or they may be so subtle that only health service researchers using statistical analyses can discern them. However the pictures emerge, clinicians respond by tailoring interventions to alleviate common problems. This is group advocacy. By aggregating children and studying their similar experience, advocates find the point where change can happen. If the middle school principal discovers that a high proportion of her students are complaining of headaches, then the group who need attention are all the children in that school. If the problem is that all the 8th graders have jumped two percentiles in their BMI (body mass index) weight category, the group is those children as well as the students in the two grades below. The younger children belong in the group because weight gain is the result of long-term exposure and well-established eating habits. Group response also has built-in efficiencies and economies of scale. Why should a pediatrician ’s office assistant spend time translating the same document into Creole each time a Haitian family turns up? Doing the work once, printing it up, and making the information available to all patients from the same ethnic group saves everyone time and effort. Children and youth can be grouped by a variety of characteristics, including the nature of their biological impairment, their age, socioeconomic status, and cultural heritage or the language that they or their parents speak. Groups can be based on a particular outcome, such as failure to thrive or conductive hearing loss. Grouping may also be intervention based. Groups may be large or small, multiproblem or single focus. Child 5 122 Child Health in America health advocates often define a group in response to a service concern, but forming a group also greatly facilitates research opportunities. In all fields of medicine, subspecialists routinely use grouping techniques . By bringing patients with similar characteristics together, clinical investigators improve their observations, generate hypotheses, and test new interventions.One might well ask,how advocacy for a class or group of children is different from traditional subspecialty care. The answer is that there are many similarities but two substantial differences. Group advocacy expands the domains of investigation and calls on expertise from community members and families. What do we mean by expanding the domains? In group advocacy, child health professionals look for patterns beyond those defined by organ systems. A 2003 Commonwealth Fund study shows that adults with cardiac disease benefited enormously from new high-technology interventions .4 That was the subspecialty look. The authors then imposed the category insurance status on the data analysis and found that high technology was saving lives but not of those without insurance. Heart attack victims who were uninsured were 7 percent less likely to have access to invasive cardiac care than insured patients. The authors estimated that this lack of high technology treatment led to a loss of $6 million to $28 million in medical and death-related costs, a societal cost over and above the burden the patients had to bear. Here is the expansion beyond subspecialty care. A new element of group or subgroup advocacy is required to deal with the insurance dilemma, which is a very real and measurable contributor to morbidity and mortality. The other element that makes group advocacy different from standard subspecialty care is the explicit construction of partnerships among clinicians , community-based organizations, and families. In subspecialty care the doctor is generally the expert on most topics, but in group advocacy the expertise is shared. Clinicians who succeed in group advocacy recognize that they have only a limited number of puzzle pieces in their own hands. To complete the picture, they enter into partnerships with the community members, family experts, and sometimes with children and youth as well. Problems of Grouping Chapter 3 presents contemporary child health trends. The patterns that the demographers and epidemiologists see on...