The current issue of the Journal of the American Medical Association is devoted to health promotion and disease prevention in children. Even the usual fare about vaccinations was of interest: Nicaraguan children vaccinated against rotavirus suffered less from diarrhea. The outcome was of less interest than the fact that the effectiveness of the vaccinations for Nicaraguan children was half that for US children. What could account for the difference? Neither the authors nor the Journal’s editors discuss possible answers.
The diamond among these articles does suggest an answer. In “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities,” researchers review the substantial literature on how adversities and trauma in childhood affect a person’s risk of illness as an adult. The research points to two basic mechanisms for increased risk: one has to do with accumulated damage over time and the other has to do with biological effects embedded during specific developmental stages.
Accumulated damage occurs through the chronic stress brought on by exposures that can start in the womb. For example, African-Americans live 4 to 6 fewer years than whites even after taking into account things like income and access to medical care. On the other hand, exposures during certain developmental periods can affect a child’s biology in a way that is maladapted to subsequent stages of development, maturity, and aging. For example, adults who experienced maltreatment as very young children are more likely to suffer from inflammatory diseases regardless of their exposures to stressors later in life because their immune systems were permanently set on alert.
The recommendation that comes out of this research review is that greater policy attention needs to be placed on enhancing programs that support children’s health and welfare as a means of preventing adult as well as childhood illness. In essence, the authors call for government action to compensate for the consequences of inequity and adversity and the cruelties they incite. An obvious implication is that eliminating inequity and adversity in the first place would make a worthy focus of health policy, but that would be contrary to our cultural myth that anyone can become a millionaire, a myth that requires a social system built on inequity and adversity. But I digress.
What’s significant for me about this review is that a major medical journal has published an article about promoting health and preventing disease from a perspective that has nothing to do with doctors, medical practices, or medicine in any way. It’s about making sure children are safe and cared for in a stable environment.
However, another article, while promoting the same perspective, brings the medical model back into the picture. Its title gives it away: “Creating a Healthier Future Through Early Interventions for Children.” Interventions by whom? Why medical professionals, of course. They’ll be educating other medical professionals as well as parents and community organizations in how to make children safe and cared for in a stable environment using evidence-based science. What’s evidence-based science? Why that’s knowledge that’s been ground out of the health-industrial complex because that’s where the evidence is sanctioned.
Where are the parents and communities and their evidence and knowledge? They are intervenees: the people who are on the business end of an intervention. Again.
A single payer system is the most humane as well as the most economically and socially rational solution for delivering medical care. The forces of commerce continue to thwart it. And lost in the fight over single payer and all the second-best solutions is the fact that, for the most part, health doesn’t have anything to do with medicine. While universal medical care is worth fighting for, the real fight is for a stable environment in which children (and adults, too) are safe and cared for. That doesn’t happen in the doctor’s office. It happens in schools, stores, streets, factories, and homes.
