The world's children in 2001, The rising cost of health care, Teens and HIV. Eye on Washington



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The world's children in 2001

The United Nations Children's Fund (UNICEF), in its newest report card on children's status worldwide, argues that early investment in children's health, education, and nutrition is an effective and efficient way of guaranteeing positive future returns through savings on health and other social services. UNICEF focuses this year's report on children's earliest years, 0 to 3, because they are critical to the way the rest of childhood unfolds.

The report makes four key points:

  • Early childhood care is a human rights issue. All children—of whatever ethnic group or disability status—are entitled to have their births registered and to be provided with sound nutrition, health care, clean water, adequate sanitation, basic education, cognitive stimulation, and the opportunity to reach their full potential.

  • The emphasis on quality care in early childhood is grounded in sound science and practical experience.

  • Investing in early childhood brings substantial returns. Every dollar spent brings a $7 return in cost savings.

  • Poverty, war, and the HIV epidemic that plague the poorest nations siphon off resources that could and should be devoted to early childhood.

From Afghanistan to Zimbabwe, the UNICEF report details the shape of children's lives in 187 countries in terms of such parameters as mortality for infants and children under 5, percentage of low birth weights, life expectancy at birth, primary school enrollment, breastfeeding, vitamin A supplementation, consumption of iodized salt, access to clean drinking water, percentage of children who are fully immunized, use of oral rehydration therapy, maternal literacy, and contraceptive use. For further information on the data in the report and plans for the Special UN Session on Children to be held in September, visit the UNICEF Web site at www.unicef.org .

The rising cost of health care

Double-digit increases in health-care costs will usher in the New Year, according to experts in the economics of health care. For families with private health insurance, rising costs will show up as larger paycheck deductions and higher deductibles imposed by employers unwilling or unable to absorb the increases. A survey of large employers indicates that payroll deductions will rise on average by 20%, while deductibles and copayments will go up by approximately 15%—putting coverage out of the reach of some lower-paid employees.

The news is bad for patients whose care is covered by Medicare, too. A panel created to evaluate the federal government's assumptions about the adequacy of Medicare funding has concluded that current estimates of future health-care costs are too low. Here, as in the private sector, rising costs are fueled for the most part by new technologies and particularly by costly new prescription drugs. Under the new assumptions recommended by the advisory panel, Medicare's hospital insurance trust fund, will run out of money by 2021 unless changes in the program produce an effective combination of cost containment and increased funding.

Higher prices do not necessarily buy better health care, however. An international survey of physicians conducted by the Harvard School of Public Health, the Commonwealth Fund, and the Harris Interactive polling organization finds that more than half of all US physicians believe their ability to provide quality health care has deteriorated over the past five years. To a lesser extent, that concern is shared by physicians in Australia, Canada, New Zealand and the United Kingdom. For more data from this study, go to the Commonwealth Fund Web site at www.cmwf.org .

Teens and HIV

According to Donna Futterman, MD, who directs the Adolescent AIDS Program at Montefiore Medical Center in New York City, many young people think HIV infection can't happen to them, despite exploding rates of HIV infection in their age group. That's why Dr. Futterman and her colleagues have put together a publicity and outreach program to reach teenagers at risk.

This year's campaign, called "HIV. Live With It. Get Tested!" was launched on December 1, World AIDS Day. The goal is to promote free, confidential, youth-friendly HIV counseling and testing in communities with large populations of vulnerable teens. The "Get Tested" campaign uses up-to-the-minute teen slang in a variety of graphic and broadcast media to raise adolescent AIDS awareness. Conferences are organized to educate community leaders, health-care providers, and educators on HIV prevention and treatment approaches for the adolescent population.

The campaign publicizes health-care sites where adolescents can get confidential blood tests for HIV or—for teens who hate needles—an oral or urine HIV antibody test. Participating cities this year are Baltimore, Los Angeles, Miami, New York, and Washington, DC. For more information on teen-friendly HIV testing sites, send an e-mail to Get_Tested@sensiehealth.com.


The long conflict is over. On January 20th, after an unprecedented five-to-four Supreme Court decision halted the recount of disputed ballots in Florida, George W. Bush will be inaugurated as the 43rd President of the United States. The margins of victory and defeat were exceedingly slim, and President-elect Bush's consensus-seeking pronouncements thus far seem to indicate a cautious awareness of that fact. What a Bush Administration will mean for policies that affect children, families, and health care remains to be seen.

The Congress the new Administration must work with is almost evenly split between the two parties, with Republicans controlling the House by a handful of votes and a 50-50 Senate in which Vice President Cheney will cast the tie-breaking vote. Ground-breaking legislation would seem unlikely in such a setting, but carefully crafted compromise may be a possibility. This is a situation in which directed lobbying by pediatricians on behalf of children could make all the difference. If you'd like to help, call your local chapter of the American Academy of Pediatrics or the AAP's Washington office.

While all this high drama was playing out, the federal health bureaucracy continued to play its vital role. For example:

The Food and Drug Administration approved a new treatment for atopic dermatitis. Called Protopic Ointment, the 0.03% formulation was approved for use in children 2 years of age and older who are not adequately treated with standard remedies.

The Department of Health and Human Services (HHS) released new statistics showing that only 12% of the children in families eligible for federal help in paying for child care are actually receiving assistance, as a result of inadequate program funding. According to HHS Secretary Donna Shalala, the data confirm that "working families still do not have adequate access to safe and affordable child care" and underline the need for congressional approval of an $817 million increase in the child-care block grant requested by the Clinton Administration.

The HHS Secretary, in collaboration with the Secretary of Education, also released a report to the president called Promoting Better Health for Young People through Physical Activity and Sports. The report includes a series of strategies for schools, families, and after-school care programs designed to promote youth fitness. You can read the report on the Centers for Disease Control and Prevention Web site, www.cdc.gov .

The Consumer Product Safety Commission (CPSC) released its list of the "dangerous dozen" toys the commission has recalled in the past year and urged parents to get rid of them. The list includes Pokémon balls, KFC Tangled Treeples Toy, and Fazoli's Pasta Pals, all giveaways with children's meals at certain fast food chains. Also on the list are two brands of scooters that can spring a vital part while in use, toy basketball nets that can strangle children on loops in the mesh, and a variety of toys that may shed parts small enough to choke on. For a complete list with instructions on how parents can secure replacement parts or recompense (free french fries, for example) visit the CPSC Web site at www.cpsc.gov .


February 9. Deadline for receiving proposals for Zero to Three 2001 National Training Institute, to be held in San Diego, CA, next November. For information on submissions, call Meeting Management Services at 202-624-1760.

March 3­5, 4th International Conference on Varicella, Herpes Zoster, and Post-Herpetic Neuralgia, La Jolla, CA. To register, go to the Varicella Foundation Web site, www.vzvfoundation.org .

March 3­10, Pediatrics 2001, Big Sky, MT. To register, call Maria Craig at Symposia Medicus, 925-969-1789.

April 18­21, 5th Annual Spring Conference on Pediatric Emergencies, Grand Bahama Island. To register, call 925-969-1789.

April 18­21, National Pediatric Infectious Disease Conference, Washington, DC. To register, call Robert Kruse at 317-488-1234.

April 27­May 1, Pediatric Academic Societies Annual Meeting, Baltimore, MD. To register, call 281-296-0244.

May 20­May 23, American Pediatric Surgical Association, Naples, FL. To register, call 978-526-8330.

June 13­June 17, Canadian Paediatric Society, Vancouver, BC, Canada. To register, call 613-526-9397.

Judith Asch-Goodkin
Contributing Editor


Julia McMillan. Updates. Contemporary Pediatrics 2001;1:11.

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