Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:101-102

Editorial

Community Paediatrics

CHOW Chun Bong


Child health status and services have improved significantly over the past two to three decades in Hong Kong. As pointed out by Prof. CY Yeung, childhood illnesses encountered today have become more similar to those in the West.1 With conquest of many deadly infectious diseases and with advances in paediatrics, increasing attention is now paid to the maintenance of good physical and mental health of our children. More and more child health care services are being provided in the community on an ambulatory basis than in hospitals.

Ambulatory paediatrics aim at the delivery of paediatric health care to children with non-urgent medical problems in settings outside the hospital ward. Community paediatrics which incorporates a variety of programmes that are community based, family-centred and focused on factors that affect the health and development of children is the cornerstone of today's effective and cost-efficient child health services. However, it has long been considered a less important than hospital based hard-core paediatrics. The scope of community paediatrics is developing rapidly and it usually includes developmental paediatrics, child health surveillance and screening, epidemiology, educational and school medicine, behavioural paediatrics, social paediatrics, child protection and disability. It incorporates primary and the primary-secondary care interface.

The present child health services in Hong Kong are very much compartmentalised. They are scattered in various sectors with little coordination. Medical practitioners in the private sector provide the majority of primary curative care while secondary and tertiary care is provided mainly by the Hospital Authority. Most of the primary preventive health services are provided by the Department of Health and rehabilitative services are supported by various agencies including Social Welfare Department, Department of Health, Hospital Authority and Education Department. They are fragmented, discontinuous and poorly coordinated. The formation of the Hospital Authority in 1992 has resulted in farther separation of Health Services from Hospital Services. It is a setback for the development of a fully integrated child health service and has further hampered the development of community paediatrics in Hong Kong. Much is needed to ensure the full cooperation and good communication between the preventive and curative services, which are complementary and supplementary to each other. The development of community paediatrics in Hong Kong is vital to bridge this gap towards the building of a combined child health service.

The current issue focuses on several component elements of community paediatrics. It is exciting that several papers presented at the 9th Asian Congress of Paediatrics held from 23-27 March 1997 at the Hong Kong Convention and Exhibition Centre are published in the journal.

Injury is a major cause of childhood morbidity and mortality. The official statement on "Prevention of Childhood Injuries: Intentional and non-intentional" issued at the pre-congress workshop organized by WHO, APPEEAR and IPA is published in the Journal. It calls for concerted efforts all over the world to tackle this very important problem.2 With the advent of modern technology in saving more lives of children, vexing ethical questions on eugenics, the rights of children, suscitation, resuscitation and termination of interventional therapies have evolved and grown rapidly. In an attempt to make a treatment decision, Prof. Arneil suggested that "the child and the paediatrician are considered in relation to the parents, the clinical background, cost to hospital and parents and common sense" and he emphasized the need for the involvement of an independent multidisciplinary ethical committe.3

With improvement in medical care and provision of active immunization programme and other public health measures, infectious diseases and many acute illnesses are adequately treated or controlled and the challenges now are care of childrens with chronic illnesses or handicap and psycho-social problems. Dr. Hu in his article4 has outlined the major causes of child death today, the trends of child health problems and problems related to the consequences of urbanization and changing life-style. With modernization and rapid social, political and economic changes in the world, 'new morbidities' emerged or emotional problems, learning disorders, decision problems (e.g. suicide, accidents and violence), life-style problems (e.g. smoking, drug abuse, unhealthy eating habit) and child abuse have emerged as major issues facing our new generation. He calls for health reform and actions to remedy these. Dr. David Fang, President of Hong Kong Academy of Medicine also urges for the need of a long-term, sustainable health care policy for Hong Kong.5

Physical growth and development is usually a good index of the state of health of a child. Dr. Low has provided a comprehensive review on growth problems commonly encountered in Hong Kong and their management in particular, growth hormone treatment.6 The article by Dr. Bennett and Reed on "Adolescent health care: a collaborative challenge" is most informative in defining the needs of young people and how adolescent services should be provided. It calls for a collaborative approach - "connect with the family and invite them into partnerships care, create alliances for health via innovative, interdisciplinary teamwork and to broaden the horizons of advocacy at local and international level".7

With improvement in health standards, besides the growing trend for all health care to be concentrated in the community other than in hospitals, multidisciplinary approaches involving medical, health, social and educational specialities are required to provide total child health care. This calls for a unified child care policy and intergrated child health services in Hong Kong.Training on community child health need to be enforced and community paediatrics should become a branch of paediatrics with a well-defined career path.

CHOW Chun Bong

References

1. CY Yeung. Changing pattern of childhood illness in Hong Kong. J Paediatr Child Health 1997;Suppl 1:S1-S185.

2. Prevention of childhood injuries intentional and unintentional. Summary and recommendations. IPS/WHO/UNICEF/HKPS Pre-Congress Workshop March 22-23, 1997. HK J Paediatr 1997;2:165.

3. GC Arneil. Some ethical issues related to child care. HK J Paediatr 1997;2:103-7.

4. CL Hu. Child health priorities in the 21st century with special concern for Asia. HK J Paediatr 1997;2:116-22.

5. D Fang. Towards a sustainable health care policy. HK J Paediatr l997;2:166-8.

6. LCK Low. Management of short stature in childhood. HK J Paediatr 1997;2:169-74.

7. DL Bennett, MS Reed. Adolescent health care: a collaborative challenge. HK J Paediatr 1997;2:108-15.

 
 

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