Persistent threats to U.S. children’s health the focus of #AHCJ19 session

Ali H. Mokdad

While measles may be the hot topic in the news at the moment for children’s health, it’s far from the only concern. Even as the historical success of vaccines has reduced child mortality and morbidity from infectious disease, chronic disease, assault and injuries have increasingly become killers of U.S. children.

These were among the issues Ali H. Mokdad, Ph.D., a professor of global health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, discussed during his session at Health Journalism 2019, “From measles to obesity: Key health trends affecting children and adolescents.”

Drawing from his research, Mokdad reviewed some of the biggest threats to the health of children ages 5-14 today, particularly obesity, depression, firearms, conduct disorders, sexual abuse and alcohol use disorders, as well as the growing concerns about measles outbreaks.

To provide a sense of scale to these issues, Mokdad shared the burden of these threats as measured in terms of disability-adjusted life years (DALYs), a common way to quantify the impact of a condition or threat as one lost year of a healthy life. Consider the rates he shared for each of the conditions and problems above:

  • Obesity: The highest rate of obesity, based on disability-adjusted life years (DALYs), is in New York (44 DALYs per 100,000), and the lowest is in Iowa (17 DALYs per 100,000).
  • Depression: Utah leads with 251 DALYs per 100,000, and lowest is in North Dakota with 179 DALYs per 100,000.
  • Self-harm by firearms: Idaho leads with 56 DALYs per 100,000 and lowest is in New Jersey with 6 DALYs per 100,000.
  • Conduct disorders: Texas leads with 461 DALYs per 100,000, and the lowest is in Oregon with 360 DALYs per 100,000.
  • Sexual abuse: Washington leads with 12 DALYs per 100,000, and the lowest is in Minnesota with 5 DALYs per 100,000.
  • Alcohol use disorders: Montana leads with 11 DALYs per 100,000, and the lowest is in Georgia with 7 DALYs per 100,000.
  • Measles: Nationwide currently cases sit at 704, most of which are in New York: 309 cases in Brooklyn and Queens and 235 additional cases in the state. Washington state currently has 73 cases, Michigan has 40, and quarantines are in effect at UCLA and California State University in LA.

Mokdad already drew attention to the increasing problem of antibiotic resistance, which the CDC estimates affects more than 2 million people and causes an estimated 23,000 deaths a year.

But solving these issues won’t be simple. When an audience member asked Mokdad about where the blame for obesity prevalence in youth should be placed, he described the many societal factors, both locally and nationally, as well as personal and family factors involved. There is no one culprit, but there are social contributors, such as food deserts and inadequate emphasis or opportunity for physical activity, that play a role as much or more so than particular behaviors within a family.

Another audience member asked about the role of medical anthropology in an age of increasing data, and Mokdad agreed that assessing and recognizing cultural factors, including education and access to care, is essential to addressing the threats to today’s youth.

“We cannot address the factors and the behaviors [of an issue] for an Hispanic community in Texas and decide on an intervention unless we understand the culture,” he said. Addressing these problems requires a “comprehensive approach to population health, from the environment to the law, to change behavior at the local levels.”

Given the recent measles outbreaks and focus in the media on vaccines, the conversation also turned to the challenges of vaccine hesitancy during the Q&A portion of the panel. Mokdad discussed the importance of continuing to share accurate information about the safety and effectiveness of vaccines, and an excellent resource in doing so is AHCJ’s vaccine hesitancy tip sheet, which includes websites about vaccine information as well as vaccine and vaccine hesitancy experts and studies reporters can consult in their work.

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