Unnatural causes: social determinants of child health and well-being.

摘要

Although nationwide trends like obesity and violence have gradually interwoven themselves into pediatric health care, we have been struck recently by the seemingly familial relationship among these disease entities. A young man visiting his cousin shortly after her gastric bypass operation recalls meeting the surgeon years earlier, as a victim of child abuse; as his stab wound is explored in the emergency department, another teenager remembers his brother's treatment in the same room for an acute asthma exacerbation. While seemingly unrelated, these entities-obesity, asthma, and violence-all share the common trait of being heavily influenced by environmental factors. The incidence of crime, including violent crime, is known to be increased in poor neighborhoods, and low socioeconomic status has long been known to be associated with poor health throughout an individual's lifespan. However, it is only recently that a direct correlation between crime and health disparity has been described.