How Well-Child Visits Can Advance Health Equity

Opportunities From Bright Futures' Guidelines and Tools

Jane Bassewitz, M.A., American Academy of Pediatrics
Lauren Geary, M.P.H., American Academy of Pediatric
Kathy Janies, American Academy of Pediatrics

The American Academy of Pediatrics (AAP) is committed to reducing health disparities and advancing health equity for all children.1,2,3 The AAP operationalizes this goal through policies, partnerships, and initiatives, like Bright Futures. Health equity, as defined in Bright Futures Guidelines, 4th Edition, is the "attainment of the highest level of health for all people."4 Bright Futures expands to include that "achieving health equity requires valuing everyone equally, with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities."4

Health disparities disadvantage children in unique ways, hindering their ability to reach their full potential and often leading to continued problems in adulthood. Children who are especially impacted by injustices include those living in poverty, from racial minority groups, affected by drug and alcohol use, living with violence, and uninsured or without access to health care.1

Unfortunately, these factors often occur together. Those who experience multiple injustices are more likely to have their rights ignored and needs unmet. Emerging life-course science tells us that accumulated risks can have an overwhelmingly negative effect on health through adulthood, especially if not mitigated by other protective factors.1,4 The AAP Policy Statement on Health Equity and Children's Rights (2010) states, "If health disparities in the United States were eliminated, such that all children had the same risks of adverse outcomes as those of the most economically privileged, the prevalence of poor outcomes would be reduced by 60 percent to 70 percent."1

Who Can Help?

While impacted community leaders are essential to determining what the children of their communities need in order to create a more just environment, there are many organizations and groups committed to supporting community efforts in ending health disparities. Among these are pediatricians, nonphysician clinicians, and other child care professionals at the individual, local, and state levels.  Pediatric clinicians are encouraged to involve themselves with advocacy work and support policy change that advances the health equity of children.1 In addition, child care professionals are key partners to promote health equity for children and their families.

Bright Futures and Health Equity

Bright Futures is "a set of principles, strategies and tools that are theory based, evidence driven, and systems oriented that can be used to improve the health and well-being of all children through culturally appropriate interventions that address the current and emerging health promotion needs at the family, clinical practice, community, health system, and policy levels."4 Regarded as the AAP's gold-standard for well-child health care, Bright Futures is founded upon the principles of child health equity and incorporates those principles throughout the components of a well-child visit. Particularly, this health promotion and disease prevention initiative focuses on the development and maintenance of nurturing environments for all children and adolescents. Opportunities to partner with families to address the social, economic, and environmental needs of children and their families are present throughout Bright Futures tools and resources.

Bright Futures Guidelines, 4th Edition

The first chapter of the Bright Futures Guidelines, 4th Edition, "Promoting Lifelong Health for Families and Communities," provides an overview of the social determinants of health and the impact that a child's environment can have on healthy growth and development. This chapter also highlights the protective factors needed to mitigate the effects of certain health disparities. The role of the pediatric clinician in addressing health inequities and disparities is explained in this chapter, indicating that the pediatric clinician should take time in a well-child visit to:

  • Identify strengths and protective factors,
  • Establish shared decision making with the family, and
  • Identify and build on community support.4  

While the first chapter of the Bright Futures Guidelines provides information about the importance of addressing social determinants and health disparities in well-child visits, the promotion of health equity is woven throughout the Guidelines and other Bright Futures tools and resources.4

Bright Futures Tool and Resource Kit, 2nd Edition

The Previsit Questionnaire from the Bright Futures Tool and Resource Kit, 2nd Edition provides an opportunity for a pediatric clinician to gain information about the child's life and health status before the well-child visit. One of the first questions for the parent is, "What excites you about your child?"4 This is consistent with Bright Futures' strength-based approach and helps to identify strengths and protective factors that can mitigate the effects of other risk factors that may be present. The Previsit Questionnaire also allows the clinician to screen for social-environmental risk factors that may be present in a child's life. Specifically, the anticipatory guidance section allows the clinician to gain valuable insight into the child's family life, safety, education and social capital, and opportunities for physical activity.4 With this knowledge, the clinician can start a conversation with the family about conditions that are impacting their health during the visit and beyond.

The Visit Documentation Form includes the standard components, like patient history, review of systems, physical examination, and assessment. Additionally, this form includes a section for anticipatory guidance, with a focus on the social determinants of health. In this section, clinicians are reminded to discuss relevant social and environmental factors with the family, and to provide family-centered guidance and assistance regarding living situation, food security, tobacco, alcohol, and drug use, and engagement in the community.4

For more information about all of the tools and resources that Bright Futures has to offer, visit BrightFutures.AAP.org, email us at brightfutures@aap.org, or call us at (630) 626-6783.  

References

  1. Council on Community Pediatrics and Committee on Native American Child Health. Health equity and children's rights. Pediatrics. 2010;125(4):838–849
  2. AAP diversity and inclusion statement. Pediatrics. 2018;141(4):e20180193
  3. Stein F, Remley K, Laraque-Arena D, et al. New Resources and Strategies to Advance the AAP's Values of Diversity, Inclusion, and Health Equity. Pediatrics. 2018;141(4):e20180177
  4. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017