Academic journal article The Future of Children

Childhood Health: Trends and Consequences over the Life Course

Academic journal article The Future of Children

Childhood Health: Trends and Consequences over the Life Course

Article excerpt

Evidence indicates that childhood health has persistent effects through adulthood on health and socioeconomic status. (1) This paper examines the changing prevalence of childhood physical and mental health conditions, particularly in the United States; considers the estimated lifetime economic costs of childhood health problems; and reviews the literature on costs and consequences of childhood interventions.

Recent work has documented the shift in developed countries from focusing on early life health crises that often result in death to identifying and treating specific chronic childhood illnesses and providing a foundation for good child mental health. At a societal level, the growing importance of childhood mental health is emphasized in several recent papers. (2) We argue that poor treatment of childhood mental health problems carries significant long-term costs not only to individuals but to large populations.

How the approximately 75 million U.S. children through age 18 are provided with the best possible conditions for good mental and physical health will affect their well-being now and have implications for America's transition to an increasingly graying society. Americans spend proportionately more of their income on health care than residents of any other country in the world, and federal, state, and local health care agencies spend more than $1 trillion each year. It is possible that the promotion of childhood health might reduce these costs in the long run.

We present evidence on the changing prevalence of physical and mental health problems for American children and raise issues about the reliability of this evidence. Then we examine the lifetime economic consequences of poor health in childhood, with an emphasis on distinguishing between childhood physical and mental health. Finally, we discuss potential routes to improve outcomes for children with mental health disorders and offer suggestions for research and policy.

Global Trends in Childhood Health

Robert Fogel documents historical shifts in patterns of health through three periods: first, where infant mortality is high and life expectancy low, largely because of food shortages; second, where, although improved from the first stage, infant mortality remains high and life expectancy remains low because of infectious diseases; and third, where infant mortality falls and life expectancy increases significantly as major infectious diseases are suppressed by sanitation systems, vaccinations, improved nutrition, and other factors. (3)

Inadequate sanitation and nutrition are common in poor countries, where an estimated 7.8 percent of childhood deaths are caused by complications arising from below-normal birth weight, 6.6 percent of childhood deaths stem from unsafe sex (that is, sexual behaviors that increase the risk of contracting a sexually transmitted disease), and 6.1 percent arise from unsafe water. (4) Globally, the main causes of death among children are pneumonia (17 percent), diarrhea (17 percent), other infections (12 percent), severe neonatal infections (11 percent), premature birth (11 percent), and malaria (7 percent). The main factors implicated in child deaths in developing countries include deficiencies of zinc, iron, and iodine; poor sanitation; suboptimal breast-feeding

patterns; and poor nutrition. Worldwide, deaths of children younger than age five dropped from 11.9 million in 1990 to 7.7 million in 2010, with almost half of the percentage decline occurring in sub-Saharan Africa, a third in South Asia, and less than 1 percentage point in high-income countries. (5)

In the United States, recent work has demonstrated a shift in patterns of childhood illness away from acute health problems and toward chronic conditions. Several recent papers have argued that, contrary to the picture of improving child health suggested by mortality data discussed below, the extent of childhood chronic physical illnesses is increasing in the United States. …

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