YL Lau

The three wise men from Britain,¹ United States² and Hong Kong³ have described perspicaciously the changing states of our children in three different societies which are uncannily similar despite our ethnic and cultural diversity. They argued with passion and cogent analysis that we, as paediatricians, need to come up with an urgent and responsive strategy to cope with the rapidly changing morbidity of our children, otherwise our future is bleak.

The challenges being faced by our children and families now differ enormously from that in the past. In developed societies such as ours³ and the West,^1,2 acute illnesses have been adequately prevented and controlled due to provision of universal immunisation, better public health measures and improving living standards. Chronic illnesses and disabilities, injuries and psycho-social disorders become the major health issues yet to be adequately addressed. The increase in the number of children with chronic disabilities is in part due to our success in saving more children from cancer, extreme prematurity, acute neurological insults, congenital anomalies, biochemical disorders and so on. The rise in injuries, whether non-intentional or intentional, and psycho-social disorders is related to the stresses of modern life and economic inequality. Whether in Hong Kong, Britain or United States, we are seeing more children born unwanted or to a teenage mother, grow up in broken families or families with income under the proverty line, influenced to smoke, and experiment with drugs and sex due to intense peer pressure and commercialization of nearly every aspect of a young person's life. We should not be surprised that child abuse and neglect, conduct disorder, depression, suicide etc affect a very substantial proportion of our children.

With these difficult child health issues identified, the three wise men put forward their responses. Professor Sia is the instigator of the "Medical Home Concept" in United States² and identified the role of primary health care paediatricians is to assist in "breaking the vicious cycle of rotten outcomes" during infancy and early childhood years by organising a comprehensive, integrated and family-centred programme in order to identify all families of at risk infant from target areas, provide home-based supportive services and link to other community services. Professor Hall described the new pattern of services that the British paediatricians hope to develop in the next twenty years. The core concept is still a Primary Child Health Care Centre provided in a very large health centre with close links with education and social service.¹ Dr. Chow also argued for the needs for primary care

paediatiricans and organising themselves into a community-based integrated child health care service model, perhaps in the form of "Child and Adolescent Health Centre",³ very much like what Professors Sia and Hall advocated.

The changing morbidity and the inadequacy of our present child health care service is obvious but the solution is far from clear, with the political will to change even less. Paediatricians, like Dr. Chow and Professor Hall, who do "relish the changing demands on our services and see them as exciting new challenges", are unfortunately the minority and still engaged in an uphill struggle to change the status quo.¹ Let the rest of us start changing our attitude and embrace whatever changes that will take us to respond to the changing needs of our children. That much we owe to our Future.

References

1. Hall D. Primary health care paediatrics. HK J Paediatr (new series) 2002;7:180-2.

2. Sia CCJ. Primary health care in the USA: The medical home concept. HK J Paediatr (new series) 2002;7:240-3.

3. Chow CB. Primary care paediatrics in Hong Kong. HK J Paediatr (new series) 2002;7:244-54.