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Three US public health campaigns focusing on issues important to the health and wellbeing of children—immunisations, supine sleeping for infants, and appropriate use of oral antibiotics—achieved success during the past decade. The campaigns have been similar, and valuable lessons have been learned.
Despite the addition of many new vaccines to the US immunisation schedule, hepatitis B, varicella, haemophilus influenzae type b, conjugate pneumoccocal vaccine, and the switch from oral polio to inactivated polio, immunisation levels for most vaccines approach 90%. Despite some parental concerns about the link between measles–mumps–rubella vaccine and autism, and other potential complications of immunisations, the high rate of immunisation has been maintained because of the combined efforts of clinicians, professional societies, and governmental agencies. I would predict that despite the increasing complexity of the immunisation schedule, immunisation levels will remain high unless there is new information about potential side effects.
The number of infants dying from sudden infant death syndrome (SIDS) in the United States has declined from approximately 6000 per year to 2000 per year. Although the US was slower than the UK, Australia, and New Zealand to adopt the Back to Sleep campaign, the reduction in SIDS deaths is enormously gratifying. Despite the success, there appears to be some groups of infants, particularly African-Americans, very low birth weight infants, and infants from large families, in which the campaign has been less successful. This points out the dilemma of health care disparities, particularly given the rapidity of advances in medicine. New public health approaches are being developed that will focus on these groups.
Oral antibiotic use in the US decreased by approximately 30% over the past 10 years. This equates to approximately 10–15 000 000 less antibiotic prescriptions each year. Several actions led to this success. Parents and physicians have clearly been re-educated. While in the past many parents may have pressured clinicians to dispense antibiotics, now they are much more accepting of not receiving antibiotics for colds and coughs. While some US clinicians are experimenting with a wait and watch approach to the treatment of acute otitis media (AOM), it has not yet won wide acceptance. It is possible that the new pneumococcal conjugate vaccine will further reduce the occurrence of AOM. In both the California and Finnish studies there was approximately a 7% decline in AOM in the group of children who received the vaccine. The decline of antibiotic usage in practice may be even greater since clinicians may be willing to withhold treatment from children with AOM (or more willing not to make the diagnosis if they are uncertain) if the child has received the conjugate vaccine.
These three campaigns are instructive. We can maintain certain behaviours (immunisation rates), change parent behaviour (Back to Sleep campaign), and change physician behaviour (antibiotic use) if professional societies, governmental agencies, parent groups, the media, and other stakeholders, such as health plans, acknowledge controversies, but speak with a consistent and unified voice. Just as direct to consumer advertising enhances the sales of specific drugs, a coordinated media approach to certain health care problems can be successful.
There are other common and significant medical problems that occur in US children and adolescents in which we have been largely unsuccessful in effecting change—obesity, smoking, sexually transmitted diseases, dental caries, exposure to guns, and the care of children with significant mental health problems. Admittedly, these problems are complex and often involve lifestyle issues as well as the organisation and financing of health services in the USA. Regardless, approaches to these morbidities should draw on the experience of the past decade in increasing immunisation rates, reducing mortality from SIDS, and curbing the use of oral antibiotics.