Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric...
Transcript of Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric...
![Page 1: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/1.jpg)
0
Great Achievements in Paediatric
Health in the Last 40 Years:
Building a Healthier Future
Tina L. Cheng, MD, MPH
![Page 2: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/2.jpg)
“the birthplace of modern pediatrics
and the future of health.”
![Page 3: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/3.jpg)
Disclosures
Acknowledgements
• The conference is funded by the USAID
Maternal and Child Survival Program.
• In the past 12 months, I have no relevant
financial relationships with the
manufacturer(s) of any commercial product(s)
and/or provider(s) of commercial services
discussed in this CME activity.
• I do not intend to discuss an
unapproved/investigative use of a commercial
product/device in this presentation.2
![Page 4: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/4.jpg)
“We live in extraordinary
times...thanks to medical
and scientific advances
that even a generation
ago would have sounded
like science fiction…An
American born today has
a projected average
lifespan 20 full years
longer than one born in
1925…”
TIME Magazine Feb 12, 2015
![Page 5: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/5.jpg)
Mortality in Children < 5 years by
Region, 1990-2017
May 28, 2019 4
![Page 6: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/6.jpg)
Global Mortality Rates and Deaths
by Age, UN-IGME-Child-Mortality-Report-2018.pdf
May 28, 2019 5
![Page 7: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/7.jpg)
Objectives
• Describe great achievements in global
child health
• Discuss future threats and opportunities
![Page 8: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/8.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
• Preventing HIV Maternal
Transmission
• Increasing Life
Expectancy for Children
with Chronic Diseases
• Saving Lives with Car
Seats and Seat belts
Aap.org/7achievementsCheng, et al. Pediatric Res Sept 2016;80:330-07
![Page 9: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/9.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
![Page 10: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/10.jpg)
Vaccine Development Timeline 1910-2013
Pickering LK, Peter G, Shulman ST. Pediatrics 2013; 132;898-908.
![Page 11: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/11.jpg)
1980
![Page 12: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/12.jpg)
Recommended Childhood and Adolescent Immunization Schedule, US 2019
![Page 13: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/13.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
![Page 14: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/14.jpg)
![Page 15: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/15.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
![Page 16: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/16.jpg)
![Page 17: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/17.jpg)
American Cancer Society, http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/
![Page 18: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/18.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
![Page 20: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/20.jpg)
Estimated Mortality Decline After
Use of Surfactant by Gestational Age
0
5
10
15
20
25
30
35
40
45
50
24 26 28 30 32
Pe
rce
nt
De
cli
ne
Gestational Age
![Page 21: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/21.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
• Preventing HIV Maternal
Transmission
![Page 22: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/22.jpg)
FDA Approval
of Zidovudine
Use
MMMR 2006;55(21):592-597
Estimated Cases of Perinatally
Acquired AIDS,* by year of Diagnosis - US
![Page 23: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/23.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
• Preventing HIV Maternal
Transmission
• Increasing Life
Expectancy for Children
with Chronic Diseases
![Page 24: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/24.jpg)
Increases in Life Expectancy in
Patients with Cystic Fibrosis
European Lung
white book.
http://www.ersw
hitebook.org/ch
apters/cystic-
fibrosis/
![Page 25: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/25.jpg)
Increases in Life Expectancy in Patients
with Sickle Cell Anemia in the U.S.
![Page 26: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/26.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
• Preventing HIV Maternal
Transmission
• Increasing Life
Expectancy for Children
with Chronic Diseases
• Saving Lives with Car
Seats and Seat belts
![Page 27: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/27.jpg)
0
10
20
30
40
50
60
1975 1980 1985 1990 1995 2000 2005 2010
<1 year
1-3 years
4-8 years
9-12years
U.S. Department of Transportation’s Fatality Analysis Reporting System
Passenger Vehicle Child Occupant
Deaths/Million Children by Age
![Page 28: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/28.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
• Preventing HIV Maternal
Transmission
• Increasing Life
Expectancy for Children
with Chronic Diseases
• Saving Lives with Car
Seats and Seat belts
![Page 29: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/29.jpg)
Objectives
• Describe great achievements in global
child health
• Discuss future threats and opportunities
![Page 30: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/30.jpg)
Future of Pediatrics
Pediatrics
Child & Family Health Needs
Cutting Edge
Scientific Advances
Health System
Changes
![Page 31: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/31.jpg)
Leading Causes of Child
Mortality, WHO
• <5 years: preterm birth, pneumonia,
birth asphyxia, diarrhoea and malaria
• Children in sub-Saharan Africa are
more than 15 times more likely to die
before the age of 5 than children in high
income countries.
![Page 32: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/32.jpg)
World Health Organization
10 Threats to Global Health in 2019
1. Air pollution and climate change
2. Non communicable diseases
3. Global Influenza pandemic
4. Fragile and vulnerable settings
5. Antimicrobial resistance
6. Ebola and other high-threat pathogens
7. Weak primary health care
8. Vaccine hesitancy
9. Dengue
10. HIV
![Page 33: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/33.jpg)
World Health Organization
10 Threats to Global Health in 2019
1. Air pollution and climate change
2. Non communicable diseases
3. Global Influenza pandemic
4. Fragile and vulnerable settings
5. Antimicrobial resistance
6. Ebola and other high-threat pathogens
7. Weak primary health care
8. Vaccine hesitancy
9. Dengue
10. HIV
![Page 34: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/34.jpg)
NRC IOM Model of
Children’s Health
and Its Influences
Children’s Health,
the Nation’s
Wealth. DC:
National Academies
Press, 2004.
Multiple
Influences
Life Course
![Page 35: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/35.jpg)
World Health Organization
10 Threats to Global Health in 2019
1. Air pollution and climate change
2. Non communicable diseases
3. Global Influenza pandemic
4. Fragile and vulnerable settings
5. Antimicrobial resistance
6. Ebola and other high-threat pathogens
7. Weak primary health care
8. Vaccine hesitancy
9. Dengue
10. HIV
![Page 36: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/36.jpg)
Millennial Morbidity Epidemics
• Poverty, obesity, drugs, violence, toxic
stress, adverse childhood experiences,
mental health, injuries
• Appreciation of the interaction of biology
and the environment
• Continued racial/ethnic & SES disparities
• First generation to have lower life
expectancy than their parents?Palfrey JS et al.
Pediatrics. 2005
Apr;115(4 Suppl):1121-3
![Page 37: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/37.jpg)
“Unless effective population-level interventions
to reduce obesity are developed, the steady
rise in life expectancy observed in the modern
era may soon come to an end and the youth of
today may, on average, live less healthy and
possibly even shorter lives than their parents.”
N Engl J Med. 2005;17;352(11):1138-45
![Page 38: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/38.jpg)
Future of Pediatrics
Pediatrics
Child & Family Health Needs
Cutting Edge
Scientific Advances
Health System
Changes
• Leading Causes of M & M
• Continued Infectious Diseases
• Millennial Morbidities
![Page 39: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/39.jpg)
7 Great Achievements
in Pediatric Research in the Last 40 Years
• Preventing Disease
with Immunizations
• Reducing Sudden
Infant Death with
Back to Sleep
• Curing a Common
Childhood Cancer
• Saving Premature
Babies
• Preventing HIV Maternal
Transmission
• Increasing Life
Expectancy for Children
with Chronic Diseases
• Saving Lives with Car
Seats and Seat belts
Aap.org/7achievementsCheng, et al. Pediatric Res Sept 2016;80:330-07
![Page 40: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/40.jpg)
The NEXT 7 Great Achievements
in Pediatric Research?
• More immunizations save lives
• Pediatric cancer immunotherapy improves survival
• Genomic discoveries predict, prevent and more effectively treat disease starting early
• Big life course data recognizes early antecedents of adult disease leading to early intervention
• Understanding the interaction of biology, physical and social environment leads to individual and population health prevention
• Quality improvement science creates safer systems of care
• Implementation and dissemination research to achieve health equity
Cheng, Bogue, Dover.
Pediatrics May 2017;136
![Page 41: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/41.jpg)
History of Medical Progress
Adapted from E. Zerhouni, A Vision for
Transforming Medicine in the 21st Century, 9/13/06, http://www.nih.gov/about/director/slides/vision.pdf
19th
Century
20th
Century21st Century
Treat
symptoms
Treat
diseases
Predictive
Preemptive
Participatory
Personalized
![Page 42: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/42.jpg)
Cost of Sequencing a Human
Genome 9/01–7/15
$1 000
$10 000
$100 000
$1 000 000
$10 000 000
$100 000 000S
ep
-01
Ma
r-02
Sep
-02
Ma
r-03
Sep
-03
Ma
r-04
Sep
-04
Ma
r-05
Sep
-05
Ma
r-06
Sep
-06
Ma
r-07
Sep
-07
Ma
r-08
Sep
-08
Ma
r-09
Sep
-09
Ma
r-10
Sep
-10
Ma
r-11
Sep
-11
Ma
r-12
Sep
-12
Ma
r-13
Sep
-13
Ma
r-14
Sep
-14
Ma
r-15
![Page 43: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/43.jpg)
Disorders with
Known Molecular Basis
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
5500
6000
Source: Online Mendelian Inheritance in Man
![Page 44: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/44.jpg)
The Future Paradigm: 4 P’sTolerable
Into
lera
ble
Preclinical
Time
Co
st
Molecular preemption
Curativetreatment
Symptommanagement
Dis
eas
eB
urd
en
CostSavings
Zerhouni, EA. Annual Mtg of NIH Roadmap
Multidisciplinary Clinical Research Career
Dev Program, 2007
![Page 45: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/45.jpg)
History of Medical Progress:
8 P’s
19th
Century
20th
Century21st Century
Treat
symptoms
Treat
diseases
Predictive
Preemptive
Participatory
Personalized
Pediatrics, Prenatal,
Population Health,
Policy
Cheng, Cohn & Dover. JAMA 2008:299:451-3Zerhouni, EA. NIH Roadmap, 2007
![Page 46: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/46.jpg)
Precision Medicine
![Page 47: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/47.jpg)
Future of Pediatrics
Pediatrics
Child & Family Health Needs
Cutting Edge
Scientific Advances
Health System
Changes
• Leading Causes of M & M
• Continued Infectious Diseases
• Millennial Morbidities
• Genomics, Epigenetics
• Microbiome
• New Vaccines
• Dev Origins of Disease
![Page 48: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/48.jpg)
The single most effective way to improve
health and reduce disparities is to invest
in helping young people reach their full
academic potential.
—World Health Organization
![Page 49: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/49.jpg)
Children’s health and educational
success are highly interconnected
Educational Outcomes
Health Outcomes
![Page 50: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/50.jpg)
VISION: To improve the health, education
and future productivity of children and
adolescents, their families, and their
communities.
![Page 51: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/51.jpg)
Full service school clinic
to meet physical & mental health needs
Chronic illness programs
to promote disease self-management
& reduce absenteeism
School health curriculum
to promote healthy behaviors
Nutrition and physical activity programs
to promote healthy schoolenvironment Parent and Teacher
health education & wellness to support parents & educators to
support children
Wellness programs, screening & school health
campaigns to improve readiness
to learn
AcademicAchievement &
Healthfor healthy futures
![Page 52: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/52.jpg)
Health & Education Outcomes:
2 schools, 1500 students, over 3 years
• Reduced chronic absenteeism– 49% drop for children with asthma, 50% drop for
children with ADHD
• Reduced emergency department
utilization
• Increased immunization rates
• 90% screened for vision, dental, BMI
• Cost effectiveness– Despite higher staffing costs, every $1.00 invested in the Rales
Health Center returns more than $4.20 of social benefit
![Page 53: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/53.jpg)
![Page 54: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/54.jpg)
![Page 55: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/55.jpg)
![Page 56: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/56.jpg)
Future of Pediatrics
Pediatrics
Child & Family Health Needs
Cutting Edge
Scientific Advances
Health System
Changes
• Leading Causes of M & M
• Continued Infectious Diseases
• Millennial Morbidities
• New Models of Care
• Telehealth
• Genomics, Epigenetics
• Microbiome
• New Vaccines
• Dev Origins of Disease
![Page 57: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/57.jpg)
The NEXT 7 Great Achievements
in Pediatric Research?
• More immunizations save lives
• Pediatric cancer immunotherapy improves survival
• Genomic discoveries predict, prevent and more effectively treat disease starting early
• Big life course data recognizes early antecedents of adult disease leading to early intervention
• Understanding the interaction of biology, physical and social environment leads to individual and population health prevention
• Quality improvement science creates safer systems of care
• Implementation and dissemination research to achieve health equity
Cheng, Bogue, Dover.
Pediatrics May 2017;136
![Page 58: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/58.jpg)
Jose’ Luis Bayer, Chile
Children are
the message
we send to
the future.
![Page 59: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/59.jpg)
“Our children are our greatest
treasure. They are our future.”Nelson Mandela
![Page 60: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/60.jpg)
Probability of Child Death 1990-2017
Probability of Death, %
![Page 61: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/61.jpg)
% Change from 1990 to 2000 in Observed to
Expected Disability Adjusted Life Years Ratio in
Children 0-19 years
60
![Page 62: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/62.jpg)
% Change from 2000 to 2017 in Observed to
Expected Disability Adjusted Life Years Ratio in
Children 0-19 years
61
![Page 63: Great Achievements in Paediatric Health in the Last 40 ... · Great Achievements in Paediatric Health in the Last 40 Years: Building a Healthier Future ... 7 Great Achievements in](https://reader034.fdocuments.in/reader034/viewer/2022042220/5ec6936f68e9f5049457adbe/html5/thumbnails/63.jpg)
Trends in Disability-Adjusted Life Years 1990-
2017 by Socio-Demographic Index, 0-20 years