Attention to women, children and adolescent health remains noteworthy.
Global health attention [1] to women, adolescent and children health disparities is excellent. Reports are thorough and remove monotony as information is presented [2]. Additionally, recommendations are clear and achievable.
Primary care focus could include strengthened processes for credentials, training, facility construction, transportation and community health centers, complete with telehealth capabilities.
Reports could include specifics to funding strategies, both public-private and government funders.
Strategies could be outlined for food security and nutrition quality.
Priority organization across the country income ranges.
Creative strategies to attend to global health priorities while continuing liaison work with high income countries should be clear.
Global health involvement or liaison work with high-income, self-sufficient countries could examine current issues and opportunities. This work could then seek to prevent the same issues for developing countries down the line.
US national attention to women, children and adolescents is strikingly different from LMIC and other global health priorities. There are multiple US offices, associations and professional societies charged with management.
There are a lot of data sources regarding adolescent health [3] and there is a lot of research, advocacy and evaluation on the topic [4]. Health promotion and prevention recommendations for adolescents are grouped alongside the child population at the CDC [5].
It is unclear which organizations are taking the lead on national strategic plans, and it is unclear which organizations are taking the lead on policy development. This is especially true for physical fitness, health eating, dentistry and oral health, and mental health.
It is unclear how medical insurance and after school resources are being redesigned for adolescent health.
Data source comparisons and best paths forward are also confusing.
There is a lack of responsibility or designated tasking when major research reports reveal findings and make recommendations [6].
It is also unclear how research quality will be improved. This is especially significant, given the decades of repeated concerns over adolescent mental health, including military-connected youth. In fact, a recent literature review on behavioral health interventions found all the studies included to be of poor or fair methodological quality [7]. This should be embarrassing to research funders, research portfolio strategists and adolescent health strategy planners, yet there appears to be no gameplan forward.
Women’s health has dedicated offices and departments in the US. Morbidity and mortality data continues to improve through excellent initiatives [8].
It is unclear how the offices and departments are working together for streamlined assessment [9], evaluation and strategic planning across the US.
It is also unclear how women’s health experiences and satisfaction are factored into data improvement, particularly at a time when the US has made headlines for poorer experience compared to peer countries [10,11].
There is no roadmap for how physician leadership is invested in national strategic plans for women’s health improvement, across specialties. When reviewing the excellent ACP work on policy recommendations, social service responsibilities between primary care and community social service are absent [12]. Tangible, specific responsibilities within a national strategic plan could enhance effort.
Children’s health oversight is multi-faceted and multi-disciplinary. Despite the depth of strong programming, a few opportunities remain. They are not insurmountable and can be addressed.
- Strategic agenda alignment between children’s health agencies, medical specialties and children’s welfare agendas [13,14,15,16,17, 18] is vague.
Alignment of data sources is opaque. Philanthropic and charitable contributions, as well as unpaid caregiver support, are not quantified.
Gaps in services or overlapping services of federal, state and local agencies are not publicly identified, nor acted upon.
Public satisfaction and experience with service navigation is also unclear.
Inclusion of the US military in women, children and adolescent health strategic plans is formally absent and informally intertwined. The US military has specific programs targeted toward children of military families [19] and some of these are addressed in some national organization resource pages. Additionally, civilian and military family comparisons continue to provide significant insight [20].
A national strategy should formally include children and adolescent health involving those in the US military. Overall, there is no strategic gameplan inclusive of military-connected children and adolescents.
A national strategy for women’s health must include active duty and military-involved women. Public health planning for women’s health services should seek this leadership at state and local levels as well. There is no strategic gameplan for women involved in the military, despite various departments and offices addressing the population.
Attention to children with special needs in the military should be a significant component to national efforts around special needs health equity.
The military has programs for children with special needs and disabilities. These departments may or may not be included in national organization messaging [21].
Special needs services for children of military families often use civilian healthcare. Civilian medicine may or may not be adequate for special needs children of active duty and reservist populations.
Outcomes and satisfaction comparisons are not available. Outcomes and satisfaction related to medical conditions that are not designated under special needs, yet require extra active duty or reservist time and resources, are unknown.
Recommendations to address military status as a component to pediatric healthcare should be decided upon and reimbursed accordingly. The American Academy of Pediatrics has made recommendations to best support children of military families [22,23]. How these recommendations have been adopted since 2019 are unclear. Any metrics to evaluate this effort is also unclear.
The basic three screening components, may or may not be reimbursed, including 1) establish a clinical process to identify children who are military connected and document it in the electronic medical record,2) take a thorough military history, including parental deployment history, relocation, and parental mental health, and 3) integrate an evidence-based behavioral and emotional rating scale in your practice to identify children who are at risk.
Pediatrician resources and conversations around military families are not measures. It is not clear if these conversations are happening, if pediatricians feel adequately trained and if they feel they have resources or referrals should they be asked.
There appears to be no mention of oral health and dentistry, despite known disparities between military and civilian oral health coverage.
Women, adolescent and child concepts of behavioral health and stress prevention, mitigation and resilience need organization to the research. This includes definition and implementation science clarity. It is no longer enough to have a small study taking up volunteer resource and time, with potential for interventions that may or may not be adopted by a wider healthcare system.
International research continues to inform on deployment and injury impact to families and children [24]. There could be better focus and efficiency to the research strategy.
References
https://opa.hhs.gov/adolescent-health/adolescent-health-facts
https://www.adolescenthealth.org/Advocacy/Position-Papers-Statements.aspx
https://www.cdc.gov/chronicdisease/resources/publications/factsheets/children-health.htm
https://www.childwelfare.gov/topics/systemwide/service-array/health/
https://www.apha.org/apha-communities/member-sections/maternal-and-child-health
https://childcare.gov/consumer-education/services-for-children-with-disabilities
https://childcare.gov/consumer-education/services-for-children-with-disabilities
https://www.aap.org/en/patient-care/military-families-and-deployment/
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