title: Child Health Disparities: What Can a Clinician Do?
abstract: Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity.
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Baltimore, Maryland; tcheng2@jhmi.edu.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Cheng
authors.affiliation: University of Florida College of Medicine, Gainesville, Florida;
authors.forename: Mickey A
authors.initials: MA
authors.lastname: Emmanuel
authors.affiliation: Child and Teen Wellness Center, Owings Mill, Maryland; and.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Levy
authors.affiliation: Department of Pediatrics and Child Health, Howard University, Washington, District of Columbia.
authors.forename: Renee R
authors.initials: RR
authors.lastname: Jenkins
mesh_terms: D002648:Child; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D010372:Pediatrics; D010819:Physician's Role; D014481:United States