standards, and there has been a great deal of progress in reducing childhood death and diseases. But the country should not be blinded by these facts—several indicators of children’s health point to the need for further improvement, children in the United States do not fare as well as their European counterparts on many aspects of health, and there are marked disparities in health among children in the United States. Recent improvements in children’s health need to be sustained and further efforts are needed to optimize it. To accomplish this, the nation must have an improved understanding of the factors that affect health and effective strategies for measuring and using information on children’s health. This chapter starts with what is known about the health of children. It then moves to a discussion of why measuring children’s health is important. The chapter concludes with an examination of why critical differences between children and adults establish the need for children’s health to be held to a standard different from that used for adults.

CHILDREN AND THE STATE OF THEIR HEALTH

Dramatic improvements have occurred over the past several decades in such areas as reducing infant mortality, reducing mortality and morbidity from many infectious diseases and accidental causes, increasing access to health care, and reducing environmental contaminants, such as lead (Centers for Disease Control and Prevention, 1999b, 2000a). There have been steady increases in the proportion of immunized children, and both acute mortality and long-term disabilities resulting from certain infectious diseases have been greatly reduced. Learning how environmental exposure to lead adversely affects children’s development contributed to great reductions in ambient lead and significantly reduced childhood blood lead levels (Lanphear, Dietrich, and Berger, 2003). Average concentrations of lead in the blood of children younger than 5 years dropped 78 percent between 1976–1980 and 1992–1994 (U.S. Environmental Protection Agency, 2000a). Fewer adolescents are having babies—in 1999, the teenage pregnancy rate reached the lowest recorded rate since 1976 (Child Trends, 2003). Daily cigarette use fell by over 50 percent (from 10 to 5 percent) among 8th grade students between 1996 and 2002, and by over two-fifths (from 18 to 10 percent) among 10th grade students (Child Trends, 2003).

Yet despite these improvements, some national indicators raise questions about the health of the nation’s children and point to the need for continued progress. The children behind each of these statistics face serious barriers to healthy childhoods and healthy, productive adult lives. For example, 12–19 percent of children in the United States have chronic health conditions (Newacheck, Hung, and Wright, 2002; Stein and Silver, 2002), an estimated 15 percent of children and adolescents ages 6–19 years are overweight (National Center for Health Statistics, 2002b), and 1 in 10 children have significant mental health conditions that cause some form of impairment (Satcher, 2001). Despite the



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