Voices: Dr. Mark Schuster

Dr. Mark Schuster is a professor of pediatrics at Harvard Medical School and Chief of General Pediatrics at Children’s Hospital Boston and the lead author of a study that looked at health disparities through the eyes of 5,119 randomly selected fifth-graders attending public schools in and around Birmingham, Ala., Houston and Los Angeles.

“Where you live – the neighborhood you live in – affects your health. It affects your health in terms of the environment – if there is lead in the paint in the homes and in the soil. If the air quality is better or worse. If there is a lot of violence – a lot of violent crime – not only might your child get shot, but also you might not let your child go outside to play because you’re afraid your child is going to get harmed. So there’s lots of ways in which where you live has an effect …”

The black and Latino children were reporting health experiences and behaviors that were not as healthful as white children. And it was a pretty broad set of health indicators, and what was also important was that when we looked at things like what school they attended, and their parents’ education, and their parents’ income, that those accounted for a lot of what was going on. Another way to put that is, it didn’t matter what race or ethnicity you had if you were in certain schools. If your parents are more highly educated or you have a higher-income home, you were doing better. But, of course, white children are more likely to live in homes with families with higher education and higher income, so there are these substantial racial-ethnic differences across races and ethnicities.

Dr. Mark Schuster

Dr. Mark Schuster

We already know that there are a lot of disparities in adolescents for these issues we were looking at, but there hadn’t been as much work on elementary school kids, on pre-adolescents. So I don’t know I’d say it surprised me. It disappointed me, but it was something we were concerned about. It’s why we did the study, that we were concerned that these disparities existed earlier. At the same time, it is, maybe, frustrating that there are such substantial disparities. And I think we as a society and we as healthcare people in healthcare and public health do need to think about how to address these disparities.

It is a standard part of pediatric practice to advise parents and the kids when they’re old enough about the importance of seat belts and the importance of bike helmets, so we do view that as part of what we’re doing in pediatrics with preventive care. But I do get that that’s not what you think of when you’re going to the hospital because you were in a car accident and were thrown from the car. But a lot of pediatrics is about preventing poor health. But I do get that these are preventive issues, and one might think that the Affordable Care Act would directly affect them. If everyone had access to healthcare and to well visits and to preventive care, I would hope that there would be some improvement to these kinds of indicators. But I don’t want to suggest the pediatrician is the major player in whether kids wear seat belts, whether they wear bike helmets. I think that we have a role to play, but we are not – you know, I don’t think if someone were to do a study looking at the various factors that affect health behaviors that anyone would suggest that the pediatrician talking about this with the parent and child is the major factor. So, I do think that we need to reach out into communities and to try to support and encourage healthier behaviors in the communities and not just in the doctor’s office.

When I think of health, I don’t just think of healthcare. I think of any factors that affect health. That socio-economic status does affect health. Where you live – the neighborhood you live in – affects your health. It affects your health in terms of the environment – if there is lead in the paint in the homes and in the soil. If the air quality is better or worse. If there is a lot of violence – a lot of violent crime – not only might your child get shot, but also you might not let your child go outside to play because you’re afraid your child is going to get harmed. So there’s lots of ways in which where you live has an effect – whether there are grocery stores, and whether those grocery stores have fresh fruits and vegetables. So I do think that the factors that influence health go well beyond the healthcare system.

The health care system has an important role to play in disparities, particularly in treatment – whether people of one racial or ethnic group get lower quality treatment, or fewer appropriate medications, than another group. But in terms of overall health and the kind of indicators we were looking at, these were much more related to prevention or to health as kind of measured in the community.

I think it’ll be really important to watch how health care reform plays out over the next few years, but it is encouraging to me as a pediatrician, and someone who studies child health, that more and more children will be covered, will have access to healthcare, or at least will have insurance. But I also think there is more awareness, and I hope there will be more attention to the health implications of the environment in which kids live, and the influence of schools on kids on health, and communities on health, and the important role of parents on influencing their children’s health. So I hope that there will be even greater attention paid to those issues. The more we call attention to them, the more I hope that people will try to address them.

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