CHILDREN GET a pretty bad shake as far as medical care and health services are concerned, particularly in the United States, a country which makes so many sententious statements about the family and the future.
We have no children's or family allowance to maintain a secure level of nutrition and housing for families; nutrition programs for children are irregular and hardly adequate when available; school health services are a joke, and, despite increased expenditures, diminishing programs of well-baby care, pre-school health services and immunizations handicap case-finding and treatment and, of course, prenatal care.
The administration will soon introduce a bill humorously called "child health program," which will increase the number of eligible children under Medicaid for examination and treatment by 1 per cent. Keeping in mind that the states have managed to examine and perhaps treat (records are not kept) less than 10 per cent of the eligible children in the eight years of operation of the program, this effort is hardly the occasion for cheers.
"permissiveness" apparently is a national euphemism for neglect. Child abuse is said to be the leading cause of death in children under 5. While 200,000 cases were reported, estimates of actual incidence in a recent survey range as high as 1.5 million cases in this country. About 700 children a year are killed by their parents or guardians.
About 20 per cent of American children get little or none of the medical care they need; about a third are not immunized against diseases wiped out inother countries. Millions of children go to bed and to school hungry.
We don't know how many children who are hard of hearing or deaf are without hearing aids, because we don't do countrywide hearing tests or follow up those tested. We do vision tests, though, so we know that 17 per cent of children entering school at age 6 (650,000 have defective vision and in the school population of the Untied States (46 million) about 3 million who need glasses don't have them. These children with hearing and vision defects uncorrected will not, of course, do well in school; they will wind up at the bottom of the academic, occupational and social ladders.
POVERTY EXAGGERATES all these effects, but in health matters the well-to-do aren't so much better off. Black, brown and red babies die at a 50 to 100 per cent higher rate than white babies. True. But that's only a special case of failure to protect babies in this country. Our best infant mortality rate is 50 per cent higher than the average Scandinavian or Dutch rates.
We have no designated child health system in this country. There is a "parental responsibility," which can only be discharged if there is a medical care system. There isn't, so children turn to their parents. Where shall the parents turn?
European child health care systems have an unusual feature - separate preventive services for children. These include specialized nursing care, little in the way of physician care in the preventive role and lots of home visiting to educate, examine, immunize and act as a primary care focus and referral point for a sick child.
In Holland, this system costs the country 9 cents a day per child, with part of the money from the family, part from the local community and part from the national government. Scrupulous record keeping results in follow-up on every child from birth through the school years. Neglecting a child's health need is treated like child abuse and may involve social agencies, the courts and ombudsman and even appointment of a guardian.
There are aspects of the Dutch preventive program for children which would need thorough exploration before being recommended here. For example, prevention can be emphasized because there is also a comprehensive national health insurance system in place and every child can get treatment for illness or a handicapping condition. It would appear that preventive is difficult to impose without a currative system in place.
The Dutch operate the preventive system for children through private, non-profit agencies locally organized and controlled, with neighborhood, religious or ethnic sponsorship. Government makes up the deficit of every organization that meets national standards. The child health nurses are uniformly trained; salaries are nationally fixed. The well-to-do cannot, and do not seem to want to, outbid or outbuy the less well off.
THERE'S NO secret formula that the Dutch (or Scandinavians or French or Finns) have patented for a child health program, but there are a few critical elements.
First, all children must be eligible and all children covered. If a system is geared for the poor alone, it rapidly becomes a poor system. Preventive services are needed by every child and every family.
Immunizations to prevent epidemic diseases; health education to assure proper nutrition and living habits; family health educational support to put an end to epidemics of social diseases - drug abuse, alcoholism, veneral disease, child abuse - are as much general community public health measures as chlorination of water.
Second, the services should be carried out by experts in the practice of prevention. We've tried for years to get physicians interested in prevention. It hasn't worked.
The preventive health worker should be more like the public health nurse in background and training, with experience in preventive medicine, family and child care, health education. A British "health visitor" for example, has had nursing training, midwifery and public health training, sometimes with a dash of pediatrics.
A third necessary element is the participation of the family. Millions of parents and family members are involved in our school systems and, while we tend to be critical of the system, it is clear that in those schools where the most parents are involved, the school tends to be better.
Perhaps we cannot have all the private neighborhood organizations for preventive services that the Dutch have, but we can provide these services for our children. Even where there are official agencies carrying out these preventive activities, we should insist on citizen boards and advisory groups to insure against bureaucratization and assure responsiveness to the community.
Finally, children need preventive services from the beginning, which means prenatal services and observation and care all through pregnancy.
Newborns and infants should have handicaps detected early. Pre-school children can get care from neighborhood centers, where all immunizations and examinations can be done, and school-age children preventive supervision and examinations in the schools.
I am amused when I hear how we are a "a child-oriented" society. Are we ready for a child health program that is meaningful? Preventive minded? Offering comprehensive care? Raising the level of health and longevity of the next generation? For less than we are paying now?