Insights Into Global Pediatric Health Equity Research and Health Care Delivery

It is well known that several factors, including population, societal, and individual characteristics, lead to inequities in health care access, availability of resources, and quality of health care that, collectively, lead to significant differences in health outcomes for patients.1,2 Research to understand and overcome these issues is crucial to design solutions for efficient care delivery and to sustain optimal outcomes for all patients now and in the future.This supplement to Pediatrics, entitled “Insights into Global Pediatric Health Equity Research and Health Care Delivery,” showcases health services research from across the globe, highlighting modifiable factors that lead to health inequities, and innovative solutions that have been implemented to address these issues. We summarize below the 15 manuscripts in this supplement by topic area: Health care access and delivery3,4: Several articles in the supplement focus on innovative approaches to improve health care access across the globe. These innovations improved both referral to subspecialist care and outcomes. To improve access to health care and navigation of health care systems, Ostijic et al show that creating “Hubs” including health and social service integration significantly improved 6-month follow-up of child and family health care among migrant women and children in Australia. To address mental health needs, Dow et al, in collaboration with the Duke University Medical School, describe the utility of developing a peer-led, group-based intervention to understand facilitators and barriers to accessing mental care for vulnerable adolescents living with HIV in Tanzania. Access to specialist health care and cardiovascular surgical services is common in children born with congenital heart disease (CHD), especially in low- and middle-income countries. Nair et al demonstrate that a novel, open-access, virtual self-registration and tracking system implemented to improve regional access to CHD care in India improved timely referral and reduced mortality in children with CHD.Improving systems of care for effective care delivery: Walsh et al embedded trauma-informed practice and cultural competence into their clinic operations in Ireland to improve health care experiences among diverse and marginalized populations. Boerkoel et al, from Germany, performed a systematic review on characteristics of continuity of care that lend to better care in treatment of common somatic chronic diseases in children and adolescents. Wolfe et al illustrate the effect of an integrated health care model, including biopsychosocial care, prevention, early intervention, shared governance and finances, medical information sharing, and workforce training, to improve access to specialist care in the United Kingdom. Two articles from North America illustrated the benefits of health-related social needs screening during outpatient and inpatient encounters to support patient and family needs. Martin et al report that screening for social determinants of health during outpatient care encounters improved referral and active intervention to address health-related social needs in Canada. Additionally, Shah et al provide a framework for implementing health-related social needs screening and assessment for outpatients and inpatients in the United States, based on Centers of Medicare and Medicaid Services and Joint Commission requirements. Finally, Bauer et al report on the benefits of the novel use of a “patient navigator” during outpatient encounters to help address health-related social needs for families in the United States whose children have a brachial plexus birth injury.Health care cost and its impact on access to care: Brennan et al highlight some factors associated with economic barriers to health care access in a collaborative network of 9 pediatric hospitals across the United Kingdom, using the Rapid Research Evaluation and Appraisal Laboratory method.Effects of innovation in health technology on health care: In some instances, technology can lead to unintended health care inequities. Tjoeng et al, with co-authors from the United States, Canada, and Australia, illustrate these complex issues and potential considerations for technology development in the future to promote health equity among consumers. Cheung et al describe examples from their experience in applying 2 novel machine learning use cases to address population health inequities in a diverse population in the United Kingdom.Impact of neighborhood resources on health outcomes5,6: Using the Pediatric Health Information System (PHIS) database, including data from 43 US children’s hospitals, Balkin et al report that children from underresourced neighborhoods, estimated using the Childhood Opportunity Index, underwent craniosynostosis surgery at an older age, thus risking potential visual impairment and developmental delay. Another study by George et al, also using the PHIS database, shows that children in the Unites States who have complex medical needs are more often imaged with diagnostic radiological imaging using ionizing radiation.Improving pediatric clinical research participation7–9: Inequitable participation in clinical research leads to a loss of generalizability of the findings from important clinical research. The multifaceted reasons for nonparticipation require additional investigation, and such information is crucial to improve generalized applications of clinical research discoveries to benefit all children. To uncover the underpinning of decreased participation, Pena et al present a systematic review on reasons for nonparticipation in clinical research among medically underserved and underrepresented children. Based on this report, strategies to improve participation include building trust and providing better and effective incentives that are crucial to improving clinical research enrollment.In summary, the 15 manuscripts with author contributors from 8 countries that are included in this supplement showcase: (a) illustrative examples for a global awareness of health care disparities, (b) attempts at improving our understanding of factors that lend to increasing disparities, and (c) innovative solutions used to address these issues in our quest to provide equitable health care to all children. Although this supplement is not a comprehensive collection of all issues related to health services and health equity research, we hope this will be a starting point for many other works in the future. These and future endeavors will continue to highlight global scholarship and research aimed at improving health outcomes for all children and promote the sharing of ideas and findings to promote pediatric health equity worldwide.Senior Vice President, Pediatric Health Equity StrategiesPediatric Radiologist, Department of RadiologyBoston Children’s HospitalHarvard Medical SchoolBoston, MA, USAComplex Care, Department of Pediatrics and Department of Plastic and Oral SurgeryBoston Children’s HospitalHarvard Medical SchoolBoston, MA USASenior Associate and Callaghan Family Chair in Cardiac Intensive Care, Department of CardiologyBoston Children’s HospitalHarvard Medical SchoolBoston, MA USA