support them, moving toward broader rather than narrower definitions of what constitutes child health services.42



1 Halfon, N., and M. Hochstein. 2002. Life course health development: An integrated framework for developing health, policy, and research. Milbank Quarterly 80(3):433-479. Forrest, C., and A. Riley. 2004. Childhood origins of adult health: A basis for life-course health policy. Health Affairs 23(5):155-164.


2 Family income and socioeconomic status also has strong correlations with a broad variety of child outcomes and with race and ethnicity. See Haveman, R., and B. Wolfe. 1994. Succeeding generations: On the effects of investments in children. New York: Russell Sage Foundation. There likely is no single etiology to explain all disparities, and there are substantial variations in different child outcomes by different races and ethnicities, independent from income and socioeconomic status, that also need to be addressed.


3 This refers to toxic elements in a broad sense, including environmental exposure to toxic elements (lead paint, chemicals, poor air quality, etc.), exposure to unsafe situations (violence and crime, poor housing, etc.), and presence of a socially toxic environment (social disorganization, absence of positive peer and adult activities, etc.). Garbarino, J. 1995. Raising children in a socially toxic environment. San Francisco, CA: Jossey-Bass.


4 In dominant culture, this positive identity often is based on a realistic belief that opportunity exists through personal achievement. The disconnect that minorities may face between that dominant culture belief and their own opportunity (because of institutional racism and/or cultural clashes in undergirding values and expectations) can be cause for alienation, anger, and anomie, all to the detriment of health and healthy development.


5 Views in other parts of the world tend to be more holistic and ecological, particularly within developing countries. The World Health Organization places a very pronounced role on community building as a tool for improving health. The United States itself has a very individualistic political culture, with strong underlying assumptions regarding both personal responsibility and availability of opportunity that tend to view adult outcomes as the result of adult decisions and not external factors. This has led to both health and social interventions and policies that focus upon individual change as opposed to community condition change.


6 The term child health practitioners refers to pediatricians, family practitioners, and pediatric nurse practitioners who provide primary care for children.


7 Schor, E. 2007. The future pediatrician: Promoting children’s health and development. Journal of Pediatrics Nov:S11-S16.


8 This paper will largely use the term vulnerable neighborhoods to describe those places where challenges to successfully raising children are greatest. These neighborhoods also have been referred to as “distressed,” “disinvested,” “poor, tough,” or “poor, immigrant, and minority” neighborhoods in the field. This paper also will use the term children of color to refer to all children who are not identified as white, non-Hispanic, although Hispanic is considered in the census as a descriptor of origin or ethnicity and not race—and many Hispanics select their race as “white.”


9 Horowitz, C., and E. Lawlor. 2007. Community approaches to addressing health disparities. Paper for the Institute of Medicine’s Roundtable on Racial and Ethnic Health Disparities. See also Best, A., D. Stokols, L. Green, S. Leischow, B. Holmes, and K. Buchholz. 2003. An integrative framework for community partnering to translate theory into effective health promotion strategy. American Journal of Health Promotion 18(2):168-176.

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