Recently, I had the privilege of sitting down with Dr. Judith Palfrey, Chief of the Division of General Pediatrics at Children's Hospital Boston to discuss her recent book entitled "Child Health in America" and her thoughts about how to improve child health around the world.
An alumna of Columbia University College of Physicians and Surgeons, Dr.Palfrey completed her internship and residency in pediatrics at Albert Einstein College of Medicine and a fellowship in Community Child Health at Children's Hospital Boston. Her work focuses on identifying and better serving children by developing and implementing innovative community health care systems.
Currently, Dr. Palfrey directs the Children's International Pediatric Center in the Department of Medicine at Children's Hospital Boston. The center provides a forum for physicians, scientists, and educators to share their expertise and address children's health problems internationally. A new project for Dr. Palfrey involves consultation with the Ministry of Education in Chile to bring universal, comprehensive early childhood services (including health, education and family support) to the country; a model much like the Early Head Start program.
Q. Where did your interest in public health and advocacy for children originate?
A: My father was a doctor and my mother a social worker so I grew up in an environment where I saw the confluence between biological and social factors. I can't ever remember a time that I did not want to be involved in promoting health for children. As an undergraduate, I studied American History and Social Justice and I chose to attend programs thereafter, like Albert Einstein College of Medicine that shared the same philosophy and focused on social medicine. When I graduated from that program, I came to Children's Hospital Boston and joined a fellowship program in community child health. Here, I met one of my most influential mentors- Dr. Julius Richmond, Surgeon General and Founder of the Head Start project. This was a really wonderful opportunity for me because I was able to work with professionals like Dr. Richmond and Dr. Janeway who focused on the intersection of education, health and social service programming.
Q: You were involved in the Brookline Early Education Project (BEEP) in the 1970s. Could you describe the goals of this initiative and why it was innovative for its time?
A: I was very young when I was initially involved in BEEP. I was the Pediatric Director of the program. The key leaders of the project were Julius Richmond, Burton White, and Berry Brazelton was also involved. BEEP was the first comprehensive, school-based early intervention program in the U.S. in the public sector. It grew from the recognition of educators in the Brookline, Massachusetts public school system that children coming to kindergarten were unprepared for kindergarten and had health concerns. The goal of the initiative was to promote learning readiness for children before they entered kindergarten (at age 5 years) by reducing or eliminating health and developmental issues. Children were enrolled in the Brookline public school system three months before birth- this was innovative because it recognized that maternal prenatal health and infant health were important factors for later child development and learning. At that time, this was an emerging concept in neuropsychology and brain development research. So the major question was, "Could a town (Brookline and Boston) take the research seriously and put it into practice by providing services to families so that they could educate their babies?" The project included home visits with highly skilled educators during the first year of life, a library for families to visit with their children through age 4 years, and a pediatric developmental assessment that provided information to families about their child's health and development. In the short-term, the intervention was very successful. In fact, it was most successful for children at highest social risk. Children who participated in the project demonstrated fewer behavior problems and reading problems in kindergarten. The project has informed many other early intervention systems and approaches in the broader community; some examples include the Parents as Teachers program and the Infant Health and Development Project.
Q: In your opinion, do you think children are more vulnerable than in years past and what do you see as the key issues affecting children today?
A: We are dealing with rapid change, which is a particular vulnerability for children and adults. The rate of change in our world is stunning since the 1960s-1970s. If we think within the context of family development and dynamics, there are stressors that emerge with changing environments. In my book I talk about this concept as "changing morbidity" and describe what we are confronting now as "millennial morbidity". Children have never had opportunities for learning, communication, and travel like they do today. However that said, the 21st century presents rapidly changing conditions at a new rate, putting certain individuals at risk that we cannot anticipate. The kinds of health risks for children today in the U.S. are related to the environmental changes that have taken place. For example, TV viewing and obesity and violence. There are many social determinants that affect child health and development. Poverty is the worst social determinant, but there is also some recent discussion about the risk of affluence on child health as well. In my book, I talk about the developmental shifts that are happening, such as "what is a young person?" We see now that the period of adolescence is extending into the 20 some things; with this change, there are new stressors for young people. These are the social issues, but the other issue is that medical technology in the U.S. is advancing, so we are seeing more children with illness. We have not quite discovered cures, but we are quite effective in prolonging life, sometimes at the expense of quality. I think what's driving medicine now is growing illness and disability among children.
Q: For the purpose of our international readership, what do you see as the major health implications for children across the globe?
A: As I go around the globe I notice that child health is very much dependent on the level of development of the country. Underdeveloped countries deal with a lot of infant death cases, but as countries become more developed I see an increase in the number of disability cases. This is a very complicated dynamic and in my book I talk about this issue in greater detail. I do think there are 4 major health implications where concerted thinking would be helpful: 1) HIV, 2) maternal and infant health, 3) child disabilities, and 4) early childhood health and education.
Q: What do you believe professionals should focus on to achieve better child health?
A: In my book I talk about advocacy. I actually think of 4 areas of advocacy: 1) Clinical advocacy- look at your job and ask, "Am I doing the very best work possible?" "Am I doing a needs assessment with my clients and striving to meet those needs?" 2) Group advocacy- reflect on the characteristics of a group of clients and with your colleagues, ask "What is similar and dissimilar among these individuals and how can identification of these characteristics help inform solutions and/or determine intervention points?" 3) Policy advocacy- play an active role regarding legislation and get involved at a local or national level 4) Professional advocacy- find a voice amidst infrastructural constraints, seek ways to influence professional and systematic change for the benefit of children. It is important to remember though, that the latter two areas of advocacy can at times involve risk-taking, particularly in cultures that are not democratic or those that consider challenge of authority to be disrespectful.
I wish to personally thank Dr. Palfrey for sharing her thoughts and expertise during this interview. Her comments were insightful and inspiring for professionals working with children and families.
