INTRODUCTION: How healthy are the children of Marin County?

Steve Osborn

How healthy are the children of Marin County? According to the articles in this issue of Marin Medicine, not as healthy as they could be. Like their adult counterparts, they suffer from obesity, asthma and infectious diseases, to name only a few. They are also prone to developmental conditions, mental illness, and perhaps worst of all, abuse at the hands of their elders.

The news is not all grim, however. Betwixt and between the various appalling statistics, a few rays of sun shine through. More light may appear if medical science and art continue to make the progress described in some of the articles. A key element of that progress will be recognizing the problems that currently exist and identifying possible solutions.

One of the biggest problems may come as something of a surprise. As noted by Dr. Rodney Erwin, a child & adolescent psychiatrist at Kaiser Petaluma: “Mental health and developmental conditions now surpass physical conditions as the top five leading causes of disability in children in the United States.” Twenty years ago, respiratory diseases topped the list, but they’ve since been displaced by speech problems, learning disabilities and ADHD, among others. Coping with these “new morbidities” is a daunting task, writes Dr. Erwin, and it will require a coordinated approach from all concerned.

Another problem in need of a coordinated approach is childhood overweight and obesity, which now affects a quarter of the children in Marin. Dr. Tracey Hessel, the lead pediatrician at Marin Community Clinics, reports some individual successes in treating obesity, but she believes that truly impacting the epidemic “will require more than any of us can offer through individual counseling in the office setting. It will require changes in our schools, our neighborhoods, and our public policies.”

As witnessed by the burgeoning soda wars in New York City and elsewhere, public health departments are trying novel strategies to address rising childhood obesity. Even as they do so, they may need to revise their approach for one disease that used to be falling: pertussis. As detailed in a pair of articles, Marin County was at the epicenter of California’s 2010 pertussis epidemic, and the repercussions are still being felt.

The first article, by Dr. Michael Witte and David Bunnett, gives an inside view of the epidemic in West Marin, where Dr. Witte directs the Coastal Health Alliance. That area has a particularly high rate of Personal Belief Exemptions from parents who choose not to vaccinate their children. For parents unfamiliar with the deadly history of pertussis, writes Dr. Witte, “Fears of disease have been replaced by a fear of hurting their most precious responsibility, their baby, with a perceived unnecessary danger of immunizations.” Physicians, he believes, will need to use all their powers of persuasion to change parents’ minds.

The second pertussis article, by Kaiser San Rafael pediatrician Dr. Paul Katz, describes how he and his colleagues were able to trace much of the epidemic to the limited efficacy of the new acellular vaccine. They discovered that 8-12 year-olds were susceptible, even if up-to-date on their vaccines. “The unimmunized were the spark,” he observes, “and the fully immunized but susceptible preadolescents were the kindling and the fuel.”

Pertussis may rise and fall, but the incidence of asthma continues to increase at a steady pace. The disease now affects almost one-tenth of children aged 0-19, notes Greenbrae allergist Dr. Schuman Tam. He describes several important clinical trials over the past two decades that have tried to establish the most effective treatments for this complex and persistent condition.

Unfortunately, not all threats to children’s health can be solved by medications. Child abuse is an ancient scourge that lurks everywhere, even in bucolic Marin. As detailed by child welfare professionals Cyndy Doherty and Paula Robertson, physicians are legally mandated to report suspected abuse. Just one phone call is all it takes.

The picture of childhood that emerges from these feature articles is naturally skewed by the focus on disease. This is, after all, a medical magazine. But for most children, coping with disease is just a small part of growing up. A much larger part is devoted to learning skills that persist into adulthood.

In our “Outside the Office” department, San Rafael internist Dr. Joan Pont describes two such skills: weaving and horseback riding. “I am coming to realize that I can learn nothing new,” she reflects. “I am just recycling skills learned as a child.”

For this issue, then, you are invited to employ the childhood skill of reading. The words await you.

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Mr. Osborn edits Marin Medicine.

Email: sosborn@scma.org