Earnestine Willis, MD, MPH, Editor

Social determinants of health have long been recognized as circumstances in which individuals are born, grow up, play, live, work, pray, and age, all influencing health status. Repeatedly, experts have acknowledged that health status is shaped by forces such as gene-environmental interactions, limited social capital, community resources, social policies, as well as families’ economic conditions. This issue conveys a contemporary perspective for common health conditions highlighting social burdens that underresourced children and families face. The 15 topics reviewed in this issue are just a few of the conditions that child health care providers should be up-to-date on regarding health conditions and promising preventive interventions among children. Authors have been requested to discuss the benefits of several interventions that child health care providers must consider in serving children. Those include the benefits of breastfeeding; immunizations; medical legal partnerships; early literacy promotion; community health workers as an expansion to the health care team; and oral health risk assessments. The prevalence of health conditions, including oral health disease, asthma, childhood maltreatment, and obesity, must be prevented and/or controlled. In the meantime, pediatricians and other child health care providers must become familiar with the Affordable Care Act and provisions impacting children. Preventive interventions need to be incorporated into every primary care setting to enable population health improvement for children. In other words, system-level interventions require community-level collaborations to improve health outcomes.

Child health care providers such as pediatricians and family medicine physicians are in pivotal positions to be strong advocates in preventive health services for children and families by broadening their understanding of service systems, unique population characteristics, and social factors acting favorably or unfavorably on children’s health. Robert Haggerty, MD stated years ago that pediatricians must recognize that children and their health needs are best understood and attended to within the interlinking context of their biology, family, and the community. In fact, the life course theory posits that understanding how to prevent threats to childhood and youth growth and development is essential for preventing adult onset diseases. This would suggest that we need to explore greater understanding of the latest theories proposed in the field of epigenetics that could offer promising interventions and could contribute to a reduction of existing and future health disparities. Future research that incorporates epigenetics might illuminate the mechanisms that result in the manifestation of health disparities experienced across generations by far too many children in this nation.