Book Review

Community Child Health: An action plan for today

N Engl J Med 1995; 333:530-531August 24, 1995

Article

Community Child Health: An action plan for today
By Judith S. Palfrey. 302 pp. Westport, Conn., Praeger, 1994. $55. ISBN: 0-275-94696-7

Judith Palfrey has written a well-organized, readable book about children's health as it is affected by forces in the community. Physicians, social workers, and community health workers, as well as politicians and others who shape public policy, would benefit from reading it.

Palfrey leads the reader to conclude that we have entered a new era in child health. She divides the 20th century into the initial classic period, when physiologic investigation and technological innovation led to remarkable improvements in nutrition, the treatment of infectious diseases, and approaches to prematurity, and the second period, characterized by the “new morbidity,” with attention to psychosocial and educational concepts. Palfrey introduces us to a third period, in which children suffer from epidemics of violence, acquired immunodeficiency syndrome, homelessness, and social disorder. She also includes the increasing numbers of survivors of chronic disease, children who initially benefited from high-technology care but who are now left with the chronic aftermath. She portrays the present status of childhood health with brief, practical clinical vignettes and suggests how child health workers could involve the community in attacking these problems. She advocates an inclusive approach that would extend far beyond individual practitioners and even beyond the established teams of hospital-based physicians, nurses, social workers, and dietitians in large cities. She invites teachers, community members, and others to help solve the problems children face in their homes, neighborhoods, and schools.

Drawing on 20 years of experience in the community-health arena in Boston, Palfrey gives detailed plans of action. Concrete examples include averting teenage pregnancy, controlling infection in a group home, and caring for preschoolers with chronic illness. The last chapters encourage community political action to improve the lot of children. They explore the political realities that hamper even well-meaning attempts to assist children living in poverty or in disrupted families, children in violent environments and foster and group care, and children with chronic diseases. The author's message is one of optimism, in spite of widespread problems facing such children. Her prescription is for a focused approach, often starting with small, achievable goals and established granting agencies. A team may then build on their successes and pursue more ambitious needs. The book clearly identifies many resources, each chapter has a large supply of endnotes, and a 29-page bibliography ensures that this is a practical tool.

Palfrey is a leader in applying the resources of Children's Hospital of Boston, well known for highly technical tertiary care activities, to the preventive and continuing-care issues of children. Her personal approaches and her review of the experience of others will prove invaluable to anyone interested in meeting the challenge of child health today. This book will benefit generalists working with the community and specialists who wish to provide the best environment for their chronically ill children. I can do no better than repeat the contention of Julius Richmond in the foreword, that this work represents a “seminal volume for child health workers.”

Dennis Styne, M.D.
University of California, Davis, Sacramento, CA 95817