Paula M. Minihan, PhD, MPH; Aviva Must, PhD; Betsy Anderson; Barbara Popper, MEd; Beth Dworetzky, MS
Suggested citation for this article: Minihan PM, Must A, Anderson B, Popper B, Dworetzky B. Children with special health care needs: acknowledging the dilemma of difference in policy responses to obesity. Prev Chronic Dis 2011;8(5):A95. http://www.cdc.gov/pcd/issues/2011/sep/10_0285.htm. Accessed [date].
PEER REVIEWED
Abstract
Children with special health care needs (SHCN) account for part of the increasing prevalence of childhood obesity in the general population and can face an elevated risk for obesity. The federal government, in partnership with states, has assumed the role of steward for this vulnerable population and supports a network of services designed to promote their health through increased access to quality health services. Addressing obesity-related health risks among children with SHCN requires policies that support family- and community-based initiatives in addition to health services. We discuss the ethics of child obesity policy from the perspective of children with SHCN and their families, and identify salient issues to optimize benefits for children and families. We refer to the dilemma of difference to identify policy concerns that are specific to children with SHCN and ethically may require different approaches. Determining the appropriate mix of inclusive and special obesity prevention initiatives for children with SHCN and identifying approaches to ensure their full participation in community-based obesity prevention activities present challenges. Children with SHCN from low-income and minority communities are particularly vulnerable and warrant special attention.
Introduction
During 2008, approximately 1 in 7 children younger than 18 years (10.2 million children) were classified as having special health care needs (SHCN) according to the federal definition (1). Estimates of the prevalence of overweight and obesity among children with SHCN obtained from nationally representative surveys revealed that they contribute to the increase in childhood obesity in the general population (2-4). Advances in medical care and successes of policy initiatives have improved children’s access to quality health services, and the majority of children with SHCN now live close to normal lifespans in relatively good health (1). Childhood obesity, which is associated with health problems throughout life, is a particular threat to children with SHCN and may slow or reverse other health gains. Obesity is a stigmatizing condition and can be another characteristic that identifies these children as different (5). Interventions for childhood obesity have not yet been included in the formal support and policy networks designated for children with SHCN. Multifactorial efforts to promote healthy weights in children do not routinely include children with SHCN, according to anecdotal information. Policy responses to childhood obesity must reach children with SHCN, yet ethical concerns about child obesity policy may thwart development of workable solutions (6). In this article, we discuss the ethics of child obesity policy from the perspective of children with SHCN and their families. Our goal is to identify the issues that are most pertinent to efforts to optimize benefits of child obesity policy for children with SHCN. We describe the profile of these children and review what is known about the prevalence of overweight, obesity, and associated risk factors to inform the policy discussion.
Acknowledgments
This article highlights ideas generated and conclusions reached at the Symposium on Ethical Issues in Interventions for Childhood Obesity, sponsored by the Robert Wood Johnson Foundation and Data for Solutions, Inc. The authors represent a collaboration among Tufts University, Family Voices, a national grassroots organization of families supporting the health of children with SHCN, and Mass Family Voices at the Federation for Children With Special Needs. They work together on initiatives to promote the health and wellness of children with SHCN and disabilities through family-based interventions.
Author Information
Corresponding Author: Paula M. Minihan, PhD, MPH, Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111. Telephone: 617-636-2461. E-mail: paula.minihan@tufts.edu.
Author Affiliations: Aviva Must, Tufts University School of Medicine, Boston, Massachusetts; Betsy Anderson, Family Voices, Boston, Massachusetts; Barbara Popper, Federation for Children With Special Needs, Boston, Massachusetts; Beth Dworetzky, Mass Family Voices at the Federation for Children With Special Needs, Boston, Massachusetts.
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TEMA ESPECIAL
Paula M. Minihan, PhD, MPH; Aviva Must, PhD; Betsy Anderson; Barbara Popper, MEd; Beth Dworetzky, MS
Citación sugerida para este artículo: Minihan PM, Must A, Anderson B, Popper B, Dworetzky B. Niños con necesidades médicas especiales: Reconocimiento del dilema sobre la diferencia en las políticas para combatir la obesidad. Prev Chronic Dis 2011;8(5):A101. http://www.cdc.gov/pcd/issues/2011/sept/10_0285_es.htm. Consulta: [fecha].
REVISADO POR EXPERTOS
Resumen
Los niños con necesidades médicas especiales (SHCN, por sus siglas en inglés) representan parte de la creciente prevalencia de la obesidad infantil dentro de la población general y pueden enfrentar un alto riesgo de obesidad. El gobierno federal, en colaboración con los estados, ha asumido el papel de protector de este segmento vulnerable de la población y apoya una red de servicios diseñados para promover su salud mediante mayor acceso a servicios de salud de calidad. Hacerle frente a los riesgos de salud relacionados con la obesidad entre los niños con necesidades médicas especiales requiere políticas que apoyen iniciativas basadas en la comunidad y en las familias, además de los servicios de salud. Abordamos los aspectos éticos de las políticas contra la obesidad infantil desde la perspectiva de los niños con necesidades especiales y sus familias e identificamos aspectos destacados para optimizar los beneficios para todos ellos. Nos referimos al dilema de las diferencias para identificar preocupaciones sobre las políticas específicas para los niños con necesidades médicas especiales y que pueden requerir enfoques éticos diferentes. Resulta un reto determinar la combinación de iniciativas inclusivas y especiales de prevención de la obesidad y las políticas inclusivas para los niños con necesidades médicas especiales, e identificar los enfoques que aseguren su total participación en las actividades de prevención de la obesidad basadas en la comunidad. Los niños con necesidades médicas especiales de comunidades minoritarias de bajos ingresos son más vulnerables y ameritan atención especial.
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