Fighting Chronic Disease Starts with Better Pediatric Care

The United States spends 40% more per patient than other developed countries but suffers the worse overall health outcomes. There is general consensus that a major solution lies in better managing and preventing adult chronic diseasessuch as diabetes and heart failure. But starting in adulthood is too late. Many adult health care outcomes are shaped in childhood. This means that the effort to improve those outcomes must begin in childhood. Radically new models of holistic pediatric primary care — which such organizations as Johns Hopkins Children’s Center Harriet Lane Clinic, the Harlem Children’s Zone, and Nationwide Children’s Hospital’s Partners for Kids accountable care organization are pioneering — can play an important role.

There are four major unhealthy behaviors that lead to adult disease: using tobacco, overly consuming alcohol, having a poor diet, and being physically inactive. So-called adverse childhood experiences (e.g., psychological, emotional, or physical abuse) also contribute to adult mental illness and numerous other adult chronic diseases. And adverse living conditions and poverty are perhaps the most pervasive negative influences on adult health, leading to 20% to 50% higher adult mortality even when, in adulthood, individuals are no longer living in poverty or in polluted or unsafe environments.

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