Book Review

Social Paediatrics

N Engl J Med 1995; 333:1510-1511November 30, 1995

Article

Social Paediatrics
Edited by Bengt Lindström and Nick Spencer. 614 pp. New York, Oxford University Press, 1995. $135. ISBN: 0-19-262179-3

This is the first book in the English language that presents a detailed analysis of the many aspects of pediatric care that are heavily influenced by social, political, environmental, and familial factors. The book links public health concerns with traditional pediatric care, which is oriented toward the individual child. Thus, to an American audience, this is a crossover book and potentially an extremely important one, since so much of the morbidity and mortality among children in our society results from macroenvironmental and microenvironmental influences. The book reviews such issues as poverty, nutrition, injuries, prematurity, child abuse, and human immunodeficiency virus (HIV) infection.

Social pediatrics as a subspecialty of pediatrics is a particularly European concept. The European Society for Social Paediatrics draws its membership from all parts of Europe. This textbook was edited by two members of the society, and the majority of the chapters were written by pediatricians who are also members. The book has a clear European orientation, with only a few materials and references from the United States.

The first five chapters introduce the broad concepts of social pediatrics, with a detailed discussion of the major tenets of the U.N. Convention on the Rights of the Child (New York: United Nations, 1989), which in many ways is the political foundation of social pediatrics. The second part of the book presents a statistical review of social and demographic trends among children and families living in Europe. The third part examines global threats to children's health, particularly war and HIV infection. The fourth part discusses pollution and accidental deaths. The chapters in part 5 examine particular issues affecting health in childhood, including growth and development and risk taking in adolescence. The sixth part, on the “new morbidity,” addresses problems in nutrition, unexpected death, child abuse and neglect, and children and adolescents with special needs. Part 7 examines such topics as poverty, prematurity, family dysfunction, and children who are recent immigrants or members of ethnic minorities. Part 8 returns to more traditional public health topics, including planning for community services, outcome and performance measures, immunization programs, and health promotion. The final section examines solutions and practical changes, including examples of partnerships with parents and communities.

This book holds much promise. The importance of the issues it examines is well understood by the American pediatric community, but this marriage of public health and individual care and of public and private medicine, as well as the role of social pediatrics at the academic and community-practice levels, represents a potentially groundbreaking reorientation of pediatric care in our society.

Unfortunately, the book does not live up to its promise. There are moments of brilliance. The chapter by Jenks on historical perspectives on childhood is an illuminating review of the cultural image of childhood and presents an important foundation for understanding our current difficulties in improving the health and welfare of children. The discussions of war, risk and resilience, and immigrants and ethnic minorities are rarely found in American pediatric textbooks. A number of chapters present compilations of European data on childhood morbidity and mortality, but the data are not used for the purpose of developing theory or discussing opportunities for or barriers to care.

There is considerable redundancy among the chapters, and there are few cross-references. Much of the material in the book is dated. There are a few references to articles published in the 1990s, but most of the references date back to the 1970s and 1980s. There are also some errors of omission. The chapter on pollution has only a brief review of lead poisoning — clearly, the most studied environmental hazard for children. Much of the recent research on the effects of trauma and violence on children is not well covered. The interplay among such issues as poverty, domestic violence, failure in school, delinquency, and prostitution, which are core concerns of social pediatrics, is not adequately covered. For these reasons, I would not recommend this book to American pediatricians, although I believe the issues addressed are of great importance for our society. Either a second edition of this book or another book that encompasses American as well as European research and programs and is more focused and organized in its presentations would be a welcome and much-needed addition to our libraries.

Steven Kairys, M.D., M.P.H.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756