Why we need social paediatrics

The past 20 years have produced dramatic changes in the configuration of Europe and the health of our children. While important progress has been made in areas such as neonatal and intensive care, treatment of malignancy, and transplant surgery, paediatricians enter the new millennium knowing that many children are increasingly disadvantaged by the social and political climate of their countries.

In the early 1980s when community paediatrics became a sub-specialty in the UK and the World Health Organisation drew up its policy document “Targets for health for all”, Europe consisted of 32 member states. Today we are divided into 51 countries with very different history, culture, economy, and health needs.1 The multiple armed conflicts of central and eastern Europe have resulted in massive migration, separation of families, disruption of even the most basic health services, and regression of child health indicators to levels far below those targets set 20 years ago.2-4 Although the incidence of most communicable diseases has fallen radically throughout Europe, in the eastern states the numbers infected with HIV continue to rise and old enemies such as diphtheria and tuberculosis are re-emerging.

Even in those states untouched by conflict, poverty remains a resilient enemy. The most recent figures from the UK (which has the third largest child population) show an increasing gap between rich and poor, with 3.4 million children now living below the poverty line. Morbidity is increasingly sociogenic rather than biogenic but the patterns have altered. While under-nutrition remains a reality,5 obesity poses a much greater overall threat to children's health; changes in the structure of society and raised expectations are associated with increasing mental health problems in adolescence.6Increasing identification of abuse and neglect and of special needs has contributed to this “new morbidity”.7-9 Ironically, advances in public health, …