1. 1 CHILD HEALTH RESEARCH Bernard Guyer Ling Shi Johns Hopkins Bloomberg School of Public Health Panel on “The Future Research Agenda for MCH” 2004 APHA Annual Meeting Washington DC, November 10, 2004

2. 2 Objectives for Panel What are the major data sets & sources? –Will not cover What are the current key issues? –Agendas from MCHB & AHRQ What are the future questions? –Changing approach to child health research

3. 3 Child Health Research- Current Key Issues Inadequate funding levels Childhood divided into age groups & conditions Impact of Children’s Health Study MCHB & AHRQ funding strategies for child health (next slides) –MCHB: population focus & service delivery issues –AHRQ: disease focus & quality of care

4. 4 MCHB Strategic Research Issues (2004-2009) Public health service systems and infrastructure at all levels, applied to MCH populations; MCH services & systems of care to eliminate disparities and access barriers; Services & systems to assure quality; Promoting healthy development of MCH populations. Draft: September 12, 2003

5. 5 Agency for Healthcare Research & Quality: current themes Acute care/injuries; Asthma; ADHD Chronic illness; Mental health; Newborn & infant Oral health; Otitis media Costs, use & access to care Emergency care/hospitalizations Preventive Services Quality of Care/ Patient Safety Capacity-building www.ahrq.gov/child

6. 6 Child Health Research- Future Directions Move from disease lists to population focus: multiple-determinants & life-course perspective Integrative approach- social, biological, environmental, systems, etc. Longitudinal research- don’t divide into age groups Promote translation- research to practice

7. 7 Important sources Evans & Stoddart: Multiple determinants Promoting Health. IOM 2000 New Horizons in Health: An Integrative Approach. IOM 2003 Children’s Health, the Nation’s Wealth; Assessing & improving child health. IOM 2004

8. 8 Social Environment Physical Environment Genetic Environment Individual Response Behavior Biology Health and Function Disease Health Care Well-Being Prosperity Multiple Determinants of Health Source: R.G. Evans and G.L. Stoddart, Social Sci & Med (1983)

9. 9 New Horizons in Health (NRC 2001) (Recommendations 1 of 3) Predisease pathways- early & long-term biological, behavioral, psychological, & social precursors to disease Positive health- contributors to resilience, resistance, wellness Gene expression- environment interactions Personal ties- how proximal social interactions influence health & disease

10. 10 New Horizons in Health (NRC 2001) (Recommendations 2 of 3) Healthy communities- collective properties of social & physical environment Inequality- how SES hierarchy, racism, discrimination, stigma influence health Population health- macro-level tends in health status & performance of health care system

11. 11 New Horizons in Health (NRC 2001) (Recommendations 3 of 3) Interventions- scope & effectiveness of strategies for social & behavioral change Methodology- new measures & study designs for multiple determinant & life course research Infrastructure- sustain long-term study populations & scientific training across disciplines

12. 12 New Horizons… What about Kids? ChaptersPagesChild Health hits Pre-disease25-449 Positive health45-626 Gene expression63-720 Personal ties73-903 Community91-994 Inequality100-1174 Trends…118-14717 Interventions148-1634 Methods164-1837 Infrastructure184-1890

13. 13 Children’s Health, The Nation’s Wealth (2004) definition Children’s health: extent to which individual or group of children… –Develop and realize their potential –Satisfy their needs –Develop capacities to interact successfully with biological, physical & social environments

14. 14 Children’s Health, The Nation’s Wealth (2004) Recommendations HHS focus for children’s health Improved measures of health status Improved national surveys Monitor the origins & development of health disparities Collection, geocoding & linkage of local- level data to environmental exposures

15. 15 Children’s Health, The Nation’s Wealth (2004) Recommendations Focus training & research on emerging: –Interactions among “range of influences” –Biopsychosocial pathways of development –Measures of function & health potential –Exposures to environment –Health disparities –Longitudinal methods –Integrative measures of children’s health –Trajectories for domains of children’s health

16. 16 Shi, Guyer model for child health

17. 17 Translation of Research to Practice Critical initial element of research strategy “Public health services” research Partnership between research and practice communities Federal funding