Medicine:Social pediatrics

Social pediatrics is a whole-family and whole-community approach to child medical problems and prevention. It was pioneered in Montreal by a group of doctors who took the African proverb as their guide:

It takes a village to raise a child.

Others argue that Abraham Jacobi (1830-1919) was the Father of Social Pediatrics. He recognized that “It is not enough to work at the individual bedside in the hospital…(but also to influence) school boards, health department, legislature, advisor to judge and jury, seat in council.”

Social Pediatrics can be considered a branch of Social Medicine, whose founder was also the founder of Pathology--Rudolf Virchow (1821-1902). As a politician, he worked to improve health of Berliners including water and sewage systems--“Disease never purely biological, often socially derived.”

Social pediatricians recognize that many common diseases in children are refractory to traditional and research interventions because health outcomes are intimately involved with reality:

- macro-environment: societal, community, and institutional factors

- micro-environment: intra and interpersonal factors

For example, an asthma patient may be admitted to the ICU not because of treatment failure, but because a lack of recognition of early signs, supervision of medication compliance (both parents work, has variable care givers) or cost of medication. Because of this realization, it is necessary that pediatricians strive to change conditions to elevate life trajectories of those socially excluded, by acting on the social determinants of health, as they drive brain development by the experiences they create.

A main center of training for social pediatrics exists in the Department of Family and Social Medicine at Montefiore Medical Center in New York City. The Social Pediatrics Program at Montefiore is designed for individuals who see their future as pediatricians interested in clinical practice and the process of health care delivery in the community. Graduates of social pediatrics continue to work towards social justice by practicing in underserved inner-city health centers, community hospitals, rural and urban medical centers. Some of them serve as health policy advocates, health administrators, and leaders in community medicine. Others use their social pediatrics training in subspecialties or Global Health, bringing a community-oriented approach.

In the medical model of pediatrics, physicians are typically divorced from community groups and anti-poverty efforts. As an illustrative case, a child with asthma moving between foster homes was treated in a series of hospitals that never detected her cystic fibrosis - resulting in mistaken assumptions about her care that led to removal from her original foster home. An extremely damaging and stressful shift that affected her well-being was avoided by integrating information about her case from the various sources in contact with the child.

The social pediatric model is thus purported to save greatly on hospital care costs and to increase social capital in the community as a whole, which is reported in most analyses (e.g. those of the London Health Observatory) to be a main predictor of well-being.