Portal de Periódicos da CAPES

The State of Children's Health in Europe

2019; Elsevier BV; Volume: 209; Linguagem: Inglês

10.1016/j.jpeds.2019.03.002

1097-6833

Paolo Biasci, Ángel Carrasco Sanz, Tudor Lucian Pop, Massimo Pettoello‐Mantovani, Antonio D’Avino, Luigi Nigri,

Education in Diverse Contexts

The health status of the European population is supervised constantly through the national public health agencies in their respective countries and monitored by the several nongovernmental organizations dedicated to public health active in Europe.1Jansen D. Saxena S. Azzopardi-Muscat N. Public health practice and policy to improve child and adolescent health in Europe.J Pediatr. 2017; 190: 293-294.e2Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar In particular, the European Union (EU) supervises the health of the population in its 28 member nations by means of the Directorate for Health and Food Safety.2European CommissionDirectorate General of Health and Food Safety—Public Health.https://ec.europa.eu/health/location_enDate accessed: February 25, 2019Google Scholar The Directorate bases its proposals and legislative interventions both on data from the single nations and the statistical analysis provided by Eurostat, the official statistical office of the EU, situated in Luxembourg, whose mission is to provide high-quality statistics for Europe. On February 5, 2019, Eurostat released its most recent general report on children's health in the EU.3European Commission. EurostatNews releases.https://ec.europa.eu/eurostat/news/news-releasesDate accessed: February 25, 2019Google Scholar The document, which describes the status of health of the population 0-16 years of age, includes reassuring information, which were collected from household members. This commentary briefly discusses the significant positive data reported by Eurostat. Our aim is to share the encouraging information included in the report while emphasizing the importance for pediatricians not to rely exclusively on the family members' perception to assess the quality of pediatric care. We believe that it is important to never lower one's guard on children's health and therefore to regularly follow social and legislative changes to constantly provide adequate children's care that is focused and organized around the needs and expectations of their families. European data on children's health are released by Eurostat. They are based on information collected through the "EU–Statistics on Income and Living Conditions" (EU-SILC) system,4European Commission. EurostatEuropean Union Statistics on Income and Living Conditions (EU-SILC).https://ec.europa.eu/eurostat/web/microdata/european-union-statistics-on-income-and-living-conditionsDate accessed: February 25, 2019Google Scholar which is anchored in the European Statistical Structure, and represents the EU reference source for comparative statistics on income distribution, poverty, and living conditions. EU-SILC is a consolidated methodologic instrument designed to collect timely and comparable cross-sectional and longitudinal multidimensional microdata on income, poverty, social exclusion, and living conditions. In the Eurostat document, more than 95% of children between 0 and 16 years of age living in the EU are reported to be in good or very good general health. Children whose general health was classified to be good or very good were further grouped according to age, and only slight differences were registered between those aged younger than 5 (96.5%), subjects aged 5-9 (95.9%), and those aged 10-15 (95.2%) years. Children with limitations in activities due to health problems were less than 5%, of whom 3.7% had moderate limitations and 1.2% had severe limitations. However, the percentage of children with both moderate and severe limitation of activities increased proportionally in the 3 age groups. In those aged younger than 5 years, 2.2% had moderate and 0.6% had severe limitations in activities, whereas in those aged 5-9 years, the proportions were 4.1% and 1.2%, respectively, and 4.4% and 1.6% for those aged 10-15 years. The general health of children was reported to be bad or very bad in only 1% of the subjects in the 3 age groups, and less than 1% of children younger than 5 years were reported to suffer from severe limitations in activity due to health problems. Particularly positive data were registered by Eurostat in Spain, Bulgaria, Romania, and Italy, where the percentage of children considered to be in good or very good health in the 3 age groups was reported to be greater than 98%. The data published by Eurostat are based on the statistical analysis of preliminary indicators gathered from the various nations.5European Commission, EurostatKey to European statistics. Ad-hoc modules.https://ec.europa.eu/eurostat/web/income-and-living-conditions/data/ad-hoc-modulesDate accessed: February 25, 2019Google Scholar However, we would like to emphasize that the 4 countries showing a better level of children's health reported by households are characterized by the presence of a well-structured primary care system that is efficiently coordinated with secondary and tertiary pediatric care centers.6Ehrich J. Namazova-Baranova L. Pettoello-Mantovani M. Introduction to "Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations".J Pediatr. 2016; 177S: S1-S10Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 7Bienkowska-Gibbs T. King S. Saunders C.L. Henham M.L. New organizational models of primary care to meet the future needs of the NHS. RAND Corporation, Santa Monica (CA) and Cambridge (UK)2015Google Scholar Pediatric care in the 53 European countries is provided variously. A study by the European Paediatric Association/Union of National European Paediatric Societies and Associations6Ehrich J. Namazova-Baranova L. Pettoello-Mantovani M. Introduction to "Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations".J Pediatr. 2016; 177S: S1-S10Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar described that the spectrum of primary pediatric care systems in Europe shows a large variation between countries. However, in general at least 3 different pediatric care systems currently coexist in Europe: a pediatric system in which greater than 75% of primary care is provided by pediatricians, an intermediate system with 50/50 care provided by pediatricians and general practitioners, and the family doctor system, with 75% of primary pediatric care provided by general practitioners.6Ehrich J. Namazova-Baranova L. Pettoello-Mantovani M. Introduction to "Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations".J Pediatr. 2016; 177S: S1-S10Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 8Ehrich J. Tenore A. Del Torso S. Pettoello-Mantovani M. Lenton S. Grossman Z. Diversity of pediatric workforce and education in 2012 in Europe: a need for unifying concepts or accepting enjoyable differences?.J Pediatr. 2015; 167: 471-476.e4Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Debate exists regarding which system is able to provide better care for European children. The answer to this question depends on several socioeconomic factors,8Ehrich J. Tenore A. Del Torso S. Pettoello-Mantovani M. Lenton S. Grossman Z. Diversity of pediatric workforce and education in 2012 in Europe: a need for unifying concepts or accepting enjoyable differences?.J Pediatr. 2015; 167: 471-476.e4Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar many of them closely related to the evidence of a profound multinational diversity.9Ferrara P. Corsello G. Basile M.C. Nigri L. Campanozzi A. Ehrich J. Pettoello-Mantovani M. The economic burden of child maltreatment in high income countries.J Pediatr. 2015; 167: 1457-1459Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar However, the data by Eurostat seem to offer elements in support of the notion that an active and efficient primary care pediatrics better guarantee children's health and it is also well perceived by households. Data reported by Eurostat were collected by the EU-SILC questionnaires from the reference population living in private households and their current members, residing in the territory of the countries at the time of data collection. In EU-SILC data collection system, each country may implement the most efficient solution from a national perspective to deliver the data corresponding to each variable.4European Commission. EurostatEuropean Union Statistics on Income and Living Conditions (EU-SILC).https://ec.europa.eu/eurostat/web/microdata/european-union-statistics-on-income-and-living-conditionsDate accessed: February 25, 2019Google Scholar The EU-SILC is based on common concepts and definitions, and the evolution of some of these concepts reflect the complexity as well as the diversity of the national situations, which can be consulted in the annual methodologic guidelines.4European Commission. EurostatEuropean Union Statistics on Income and Living Conditions (EU-SILC).https://ec.europa.eu/eurostat/web/microdata/european-union-statistics-on-income-and-living-conditionsDate accessed: February 25, 2019Google Scholar The cross-sectional and longitudinal analysis is based on data from 130 000 and 100 000 households, respectively. The EU-SILC methodology is very rigorous. However, other important factors should be assessed and considered to achieve a complete and comprehensive analysis on the status children's health. For instance, these factors should include the extent to which children receive developmentally appropriate and age appropriate health care services,10Ferrara P. Corsello G. Sbordone A. Nigri L. Ehrich J. Pettoello-Mantovani M. Foster care: a fragile reality needing social attention, and economic investments.J Pediatr. 2016; 173: 270-271.e1Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar including clinical preventive services, whether children have ready access to primary and specialty pediatric care, and the assessment of the quality and accessibility of hospital structures available to children. The Eurostat report should be therefore regarded as an important component of a comprehensive multifactorial analysis on the European children's health state. Children and youth represent about 25% of the European population and 100% of the continent's future. Supporting their health from birth is at the same time a responsibility and a great opportunity to foster future generations of healthy Europeans.11Pettoello-Mantovani M. Ehrich J. Romondia A. Nigri L. Pettoello-Mantovani L. Giardino I. Diversity and differences of postgraduate training in general and subspecialty pediatrics in the European Union.J Pediatr. 2014; 165: 424-426.e2Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Many healthcare systems in Europe are undergoing significant reconfigurations toward a more population-oriented delivery model to manage old and new morbidities more adequately.12Lenton S. Namazova L. Vural M. Pettoello-Mantovani M. Improving community and primary care services for children, adolescents, and their families in Europe.J Pediatr. 2017; 185: 256-257Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Health starts outside the medical system, as supportive families and communities, education, hygiene, proper nutrition, and adequate housing and income are only a part of the multiple key determinants of health. Healthcare systems, constantly evolving and renovating to properly adapt to socioeconomic changes and scientific innovation,13Silano M. Vincentini O. Luciani A. Felli C. Caserta S. Esposito S. Villella V.R. et al.Early tissue transglutaminase-mediated response underlies K562(S)-cell gliadin-dependent agglutination.Pediatr Res. 2012; 71: 532-538Crossref PubMed Scopus (30) Google Scholar are indubitably central in this process.