SPECIAL ARTICLES
Indian J Pediatr 1992; 59 : 397-399
Priorities in Child Health Meharban Singh
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi I have been asked to deliver a key-note address but in all honesty, I must admit that there is no "key" to solve the colossal and complex child health problems in our country. I would like to share with you, some of my perceptions and perspectives regarding the emerging areas of importance in child health. Children are truly the foundation of a nation, and we the pediatricians are the custodians to promote their health and safeguard their interests. We must strive to allow each child to achieve his optimal growth and developmental potential in order to attain the goal of human resource development so that they can effectively c0"ntribute towards national productivity. Healthy children grow to become healthy adults who are strong both in body and mind. Pediatrics is one of the most cost effective disciplines of medicine because when we save the life of a neonate or an infant, we provide him a lease of 50 years or more of a productive life as compared to saving a patient with cancer or stroke which adds merely 2 to 5 years of longevity. I would like to focus on five emerging issues which are indeed crucial and should be acReprint requests : Dr. Meharban Singh, Professor and Head, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi-ll0 029.
corded due attention and promotion by all the child health dep~rtments in the country.
Importance of Genetics in Health and Disease Each one of us is distinctive and unique by virtue of his or her genome. There are 50,000 to 100,000 genes packed in 46 chromosomes. It is generally believed now that practically all diseases have a genetic basis. We are all destined to develop a disease or disorder on the basis of imprints in our genome. The ecological influences determine the timing or the onset of disease process in an individual. The preventive pediatrics should, therefore, have a broader scope than the conventionally promoted concepts of environmental sa/nitation, personal hygiene, vaccinations, control of environmental pollution, ecotoxins and accidents etc. It must be realised that seeds of most adult diseases are sown in childhood. We must identify clinical and biochemical markers of common adulthood diseases like obesity, hypertension, coronary artery disease and diabetes mellitus etc. Advances in molecular genetics have revolutionised diagnostic and therapeutic concepts and their applications. The emerging technology of polymerase chain reaction has led to the development of DNA probes
* Based on the key-note address delivered during the XIllth Annual Convention of UP State Branch of Indian Academy of Pediatrics held on April 14, 1992 at Aligarh.
398
Vol. 59, No. 4
T I l E INDIAN J O U R N A L OF PEDIATRICS
for identification of various pathogenic antigens. Gene therapy with the help of genetic engineering is no longer a fiction and it has become a reality. The scientists in the West have been successful in transferring normal gene controlling adenosine deaminase production with the help of a deactivated virus for its transfer to patient's leucocytes who are genetically deficient in ADA enzyme. Patients with Duchenne's muscular dystrophy, who were destined to lead a truncated crippled life, can now be cured by transfer of fibroblasts from a healthy individual with the help of available technology of genetic engineering. Most of us are likely to witness the miracles of genetic revolution during our life time. The pediatric departments in teaching hospitals must establish comprehensive genetic units to harness the dividends which are likely to accrue in increasing quantum in the near future. Establishment of Neonatal and Pediatric Intensive Care Units
The modern medicine has become highly technology-oriented and cost intensive. The pediatricians in teaching hospitals must acquire all the available technology for providing crilical care to neonates and children suffering from life threatening disorders. We must develop infrastructure and facilities to harness available technology for diagnosis, monitoring and providing life support to children with critical disorders. Otherwise our credibility is at stake and we may be left behind in the race with other superspecialities of medicine. The National Ne3natology Forum has catalysed development of newborn services in the country. But there is an urgent felt need to establish pediatric intensive care units in all the teaching hospitals on a priority basis. The
old fashioned concept of treatment rooms must be replaced by establishment of pediatric intensive care units. If the government and administrators can afford and arrange to provide expensive electronic gadgets for coronary care units, post operative intensive care units, cancer hospitals etc; there is no reason why it cannot be provided for pediatric and neonatal intensive care units. Establishment of Child Development Services
The basic goal of pediatrics is to assist every child to achieve his optimal growth and developmental potential. Development indeed is the most distinctive attribute of children, and we the pediatricians must excel in the art of developmental assessment of children. The pediatric departments must establish on priority, comprehensive child development centres for monitoring the development of children in order to make early diagnosis of neuromotor disability and provide stimulation and rehabilitation therapy to the disadvantaged children. The pediatricians must establish their identity by focussing on these specialized specific areas which encompass core pediatrics. The Art of Pediatrics
In the maze of scientific and technological advances, we must not lose sight of the art of child care. The art of listening and soothing, gaining confidence, explaining, consoling and providing health education is far more important than doling out half a dozen medicines which unfortunately are not only useless many a times but may be potentially unsafe. Each contact with the patient, must be taken as an important opportunity for providing health and nutrition
SINGH : PRIORITIES IN CHILD HEALTH
education to the family in order to reduce the recurrence of disease. The Reaiizatiou of the Lofty Goal of "Health for All by 2000 AD" There is no doubt, that it is important for all pediatricians to actively participate in the national programmes aimed at improving health status of the children in the community. The attention to child health programrues at the grassroot level is essential to improve child survival'in the country. We have all heard the slogan of "Health for all by 2000 AD" ad nauseum. There are merely 8 years left to attain the projected MCH targets, but nothing substantial or concrete has been done and it is obvious that the anticipated targets cannot be met. There are many reasons for the failure of our commitments to provide health care to the masses, but it appears that the major flawis the lack of political will. There are lopsided priorities in allocation of funds to various sectors. Health sector is allocated less than 2 per cent of GNP, while in most developed countries more than 10 per cent of GNP is allocated to the health and family welfare sector. We are more concerned with the anticipated epidemic of AIDS rather than the current existent raging epidemics of protein energy malnutrition, diarrheal disorders, respiratory infections and tuberculosis etc. There is greater emphasis in opening new cancer and coronary care hospitals rather than institutes for promotion of health of mothers and children. The slogan of
399
"Health for all by 2000 AD" is an empty promise unless it is supported and complemented by additional slogans of food for all, education for all, safe drinking water for all, homes for all, jobs for all and above all dignity for all by 2000 AD. It is unfortunate that the medical profession in India has not done an)thing outstanding or revolutionary as compared to the scientists in the agricultural field who have created successive green (wheat), white (milk) and yellow (oil seeds) revolutions. We all must muster our strength, expertise and resources to create a revolution in the field of health information, education and communication to improve the health awareness of the community. The health education strategies should focus attention on issues such as care and nutrition of girl children, health and nutrition education, environmental sanitation, vaccinations, female literacy and above all status of women in society. It must be realised that mother is the best primary health worker and we must improve her knowledge, skills and attitudes in the art of mothercraft. The women must be accorded special status in society, keeping in mind that they are the creators of progeny and health of mothers and children is closely interlinked. It is impossible to improve the health status of children and health of our nation, unless due attention is paid to the welfare of female children without any discrimination by the society. This indeed is the "key" for the success of child survival movement in the world.
Indian J Pediatr 1992; 59 : 397-399
Priorities in Child Health Meharban Singh
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi I have been asked to deliver a key-note address but in all honesty, I must admit that there is no "key" to solve the colossal and complex child health problems in our country. I would like to share with you, some of my perceptions and perspectives regarding the emerging areas of importance in child health. Children are truly the foundation of a nation, and we the pediatricians are the custodians to promote their health and safeguard their interests. We must strive to allow each child to achieve his optimal growth and developmental potential in order to attain the goal of human resource development so that they can effectively c0"ntribute towards national productivity. Healthy children grow to become healthy adults who are strong both in body and mind. Pediatrics is one of the most cost effective disciplines of medicine because when we save the life of a neonate or an infant, we provide him a lease of 50 years or more of a productive life as compared to saving a patient with cancer or stroke which adds merely 2 to 5 years of longevity. I would like to focus on five emerging issues which are indeed crucial and should be acReprint requests : Dr. Meharban Singh, Professor and Head, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi-ll0 029.
corded due attention and promotion by all the child health dep~rtments in the country.
Importance of Genetics in Health and Disease Each one of us is distinctive and unique by virtue of his or her genome. There are 50,000 to 100,000 genes packed in 46 chromosomes. It is generally believed now that practically all diseases have a genetic basis. We are all destined to develop a disease or disorder on the basis of imprints in our genome. The ecological influences determine the timing or the onset of disease process in an individual. The preventive pediatrics should, therefore, have a broader scope than the conventionally promoted concepts of environmental sa/nitation, personal hygiene, vaccinations, control of environmental pollution, ecotoxins and accidents etc. It must be realised that seeds of most adult diseases are sown in childhood. We must identify clinical and biochemical markers of common adulthood diseases like obesity, hypertension, coronary artery disease and diabetes mellitus etc. Advances in molecular genetics have revolutionised diagnostic and therapeutic concepts and their applications. The emerging technology of polymerase chain reaction has led to the development of DNA probes
* Based on the key-note address delivered during the XIllth Annual Convention of UP State Branch of Indian Academy of Pediatrics held on April 14, 1992 at Aligarh.
398
Vol. 59, No. 4
T I l E INDIAN J O U R N A L OF PEDIATRICS
for identification of various pathogenic antigens. Gene therapy with the help of genetic engineering is no longer a fiction and it has become a reality. The scientists in the West have been successful in transferring normal gene controlling adenosine deaminase production with the help of a deactivated virus for its transfer to patient's leucocytes who are genetically deficient in ADA enzyme. Patients with Duchenne's muscular dystrophy, who were destined to lead a truncated crippled life, can now be cured by transfer of fibroblasts from a healthy individual with the help of available technology of genetic engineering. Most of us are likely to witness the miracles of genetic revolution during our life time. The pediatric departments in teaching hospitals must establish comprehensive genetic units to harness the dividends which are likely to accrue in increasing quantum in the near future. Establishment of Neonatal and Pediatric Intensive Care Units
The modern medicine has become highly technology-oriented and cost intensive. The pediatricians in teaching hospitals must acquire all the available technology for providing crilical care to neonates and children suffering from life threatening disorders. We must develop infrastructure and facilities to harness available technology for diagnosis, monitoring and providing life support to children with critical disorders. Otherwise our credibility is at stake and we may be left behind in the race with other superspecialities of medicine. The National Ne3natology Forum has catalysed development of newborn services in the country. But there is an urgent felt need to establish pediatric intensive care units in all the teaching hospitals on a priority basis. The
old fashioned concept of treatment rooms must be replaced by establishment of pediatric intensive care units. If the government and administrators can afford and arrange to provide expensive electronic gadgets for coronary care units, post operative intensive care units, cancer hospitals etc; there is no reason why it cannot be provided for pediatric and neonatal intensive care units. Establishment of Child Development Services
The basic goal of pediatrics is to assist every child to achieve his optimal growth and developmental potential. Development indeed is the most distinctive attribute of children, and we the pediatricians must excel in the art of developmental assessment of children. The pediatric departments must establish on priority, comprehensive child development centres for monitoring the development of children in order to make early diagnosis of neuromotor disability and provide stimulation and rehabilitation therapy to the disadvantaged children. The pediatricians must establish their identity by focussing on these specialized specific areas which encompass core pediatrics. The Art of Pediatrics
In the maze of scientific and technological advances, we must not lose sight of the art of child care. The art of listening and soothing, gaining confidence, explaining, consoling and providing health education is far more important than doling out half a dozen medicines which unfortunately are not only useless many a times but may be potentially unsafe. Each contact with the patient, must be taken as an important opportunity for providing health and nutrition
SINGH : PRIORITIES IN CHILD HEALTH
education to the family in order to reduce the recurrence of disease. The Reaiizatiou of the Lofty Goal of "Health for All by 2000 AD" There is no doubt, that it is important for all pediatricians to actively participate in the national programmes aimed at improving health status of the children in the community. The attention to child health programrues at the grassroot level is essential to improve child survival'in the country. We have all heard the slogan of "Health for all by 2000 AD" ad nauseum. There are merely 8 years left to attain the projected MCH targets, but nothing substantial or concrete has been done and it is obvious that the anticipated targets cannot be met. There are many reasons for the failure of our commitments to provide health care to the masses, but it appears that the major flawis the lack of political will. There are lopsided priorities in allocation of funds to various sectors. Health sector is allocated less than 2 per cent of GNP, while in most developed countries more than 10 per cent of GNP is allocated to the health and family welfare sector. We are more concerned with the anticipated epidemic of AIDS rather than the current existent raging epidemics of protein energy malnutrition, diarrheal disorders, respiratory infections and tuberculosis etc. There is greater emphasis in opening new cancer and coronary care hospitals rather than institutes for promotion of health of mothers and children. The slogan of
399
"Health for all by 2000 AD" is an empty promise unless it is supported and complemented by additional slogans of food for all, education for all, safe drinking water for all, homes for all, jobs for all and above all dignity for all by 2000 AD. It is unfortunate that the medical profession in India has not done an)thing outstanding or revolutionary as compared to the scientists in the agricultural field who have created successive green (wheat), white (milk) and yellow (oil seeds) revolutions. We all must muster our strength, expertise and resources to create a revolution in the field of health information, education and communication to improve the health awareness of the community. The health education strategies should focus attention on issues such as care and nutrition of girl children, health and nutrition education, environmental sanitation, vaccinations, female literacy and above all status of women in society. It must be realised that mother is the best primary health worker and we must improve her knowledge, skills and attitudes in the art of mothercraft. The women must be accorded special status in society, keeping in mind that they are the creators of progeny and health of mothers and children is closely interlinked. It is impossible to improve the health status of children and health of our nation, unless due attention is paid to the welfare of female children without any discrimination by the society. This indeed is the "key" for the success of child survival movement in the world.
