Chronic conditions in children will
pose future health and welfare challenges
Investigators describe probable causes,
forecast impact on health, welfare system
BOSTON - June 26, 2007 - The increased incidence of chronic
conditions among American children predicts serious strains on health
care and social welfare systems in the future, caution investigators
from Massachusetts General Hospital (MGH) and Harvard
School of Public Health (HSPH). In a commentary in the June
27 Journal of the American Medical Association - an issue
devoted to pediatric chronic disease - the authors explain how rates
of obesity, asthma and attention-deficit hyperactivity disorder
(ADHD) have increased over the past three decades, review factors
that may underlie those increases and examine future implications.
"These new epidemics in chronic health conditions among children
and youth will translate into major demands on public health and
welfare in upcoming decades," explains James Perrin, MD, of
the Center for Child and Adolescent Health Policy, MassGeneral Hospital
for Children, one of the authors of the report. "Active prevention
efforts likely offer the best hope of reversing these trends."
The authors reviewed data from many sources and numerous studies
in scientific journals to document their observation that more children
have chronic health conditions today. They found that rates of obesity
in children and adolescents have more than tripled - from 5 percent
in the 1970s to 18 percent today. The incidence of asthma has more
than doubled to almost 9 percent, and the diagnosis of ADHD has
also increased in past decades to include about 6 percent of school
aged children. Overall, from 15 to 18 percent of children and adolescents
have some sort of chronic health condition, nearly half of whom
could be considered disabled.
While all three of these disorders probably have some genetic basis,
the most probable explanation for the recent steep increases is
rapid change in social and environmental factors. These include
modern stresses on parents that reduce the time and energy they
can devote to their children; increased time children spend watching
television or in other indoor sedentary activities; reduced opportunities
for physical activity; and dietary changes that include more fast
foods and sugar-sweetened beverages, and overall increases in calorie
"The food, physical activity and media environments of children
have changed dramatically in recent decades, and primary prevention
efforts can begin by working to improve those environments,"
says study co-author Steven Gortmaker, PhD, of the HSPH Department
of Society, Human Development, and Health. "We know that major
health conditions continue into adulthood; so if these trends continue,
we will see increased health care costs and decreased quality of
life, as many of these young people find their opportunities limited."
He is a professor of the Practice of Health Sociology at HSPH, and
Perrin is a professor of Pediatrics at Harvard Medical School.
The authors - also including Sheila Bloom, MS, of MGH - list potential
outcomes if the current trends continue. Obesity is known to increase
incidence of type 2 diabetes, already being seen in young people,
hypertension and cardiovascular disease. Asthma persists into adulthood
in at least 25 percent of children, many of whom will risk disability.
ADHD is also known to continue into adulthood at least half the
time, putting affected individuals at increased risk of other mental
health problems and potentially limiting educational and employment
In their summary, the authors note that current health and welfare
programs are unprepared for the demands presented by this situation.
Planning for increased expenditures to meet these needs will be
critical, and further investigation of factors underlying these
conditions and the implementation of preventive strategies will
be essential. The authors' work was supported by grants from the
Robert Wood Johnson Foundation, the U.S. Centers for Disease Control
and Prevention, and the Maternal and Child Health Bureau of the
U.S. Department of Health and Human Services.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of more than $500 million
and major research centers in AIDS, cardiovascular research, cancer,
computational and integrative biology, cutaneous biology, human
genetics, medical imaging, neurodegenerative disorders, regenerative
medicine, systems biology, transplantation biology and photomedicine.
Harvard School of Public Health is dedicated to advancing the public's
health through learning, discovery, and communication. More than
300 faculty members are engaged in teaching and training the 900-plus
student body in a broad spectrum of disciplines crucial to the health
and well being of individuals and populations around the world.
Programs and projects range from the molecular biology of AIDS vaccines
to the epidemiology of cancer; from risk analysis to violence prevention;
from maternal and children's health to quality of care measurement;
from health care management to international health and human rights.
Media Contacts: Sue
McGreevey, MGH Public Affairs
Robin Herman, HSPH
Office of Communications
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