How Can We Improve Children's Health?

"Opportunities" and "challenges" were two words that came up frequently Monday as four experts described their expectations for the health of California’s kids. They shared their thoughts in a forum at Stanford’s Clark Center Auditorium.

Diana Dooley, the Secretary of California’s Health and Human Services Agency, opened the program by reminding everyone that “balancing our state budget is foundational to we do."

Paul Costello, the Chief Communications Officer for Stanford’s School of Medicine, was the moderator of the panel. He asked Dooley: “How does [Governor] Jerry Brown prioritize children’s issues?”

Dooley replied, “He is incredibly curious. He has been very committed to his two charter schools in Oakland… I would put it in the context of overall needs – social, educational, as well as health.” She continued to describe children’s health in California as a “mixed story”.

“We have a lot to be proud of but we have a long way to go," she said. "Many children don’t have routine care. There are many opportunities to look at health care reform for children.”

Paul Wise, a Stanford School of Medicine professor of pediatrics, said children's care isn't only unreliable, but also often slow to adapt to changing trends in illnesses.

"We need to change the way we’re doing things," he said. "We’re confronted with a mismatch of pediatric care.” He pointed out that we’re no longer in the 1950s and 60s when the primary focus was on infectious diseases. We now find that kids with chronic diseases represent a more prominent problem. He added that “there’s a growing disparity between Medicaid and private insurance for compensation.” He also expressed concern about a “growing stratification” in care as some hospitals refuse to accept Medicaid.

Philip Pizzo, Dean and Professor of Pediatrics at Stanford School of Medicine, noted that the preponderance of children afflicted with infectious diseases has declined primarily because of vaccines. Cancer patients, too, are in much better shape today than in the past.

"In the early 70's most pediatric oncology patients died," he said. "Now they survive, but with chronic problems."

Pizzo underlined the importance of proper care for these patients, however, cautioning that "without care they will be left with developmental disorders."

Pizzo also brought up the issue of obesity in children, saying “it doesn’t have to happen" and blaming the fast food industry for exploitation.

Costello asked Pizzo if he thought the system will crash and Pizzo replied, “We’re still without a health care system in this country. We’re still fee-for-service and disease-based. Children are often left aside in the debate”.

Costello turned to Shashank Joshi, Assistant Professor of Pediatrics and Psychiatry and Behavioral Sciences at Stanford, and asked him to comment on the suicides among Palo Alto teenagers. Joshi said there have been seven in the past two and a half years and that they are trying to understand what leads a teenager to suicide.

“We consider depression and anxiety as chronic diseases,” he said. “We’ve seen suicide attempts across the ethnic and demographic spectrum.”

The effects of California’s Proposition 63 that passed in 2004 came up for discussion. Dooley said that it resulted in the funding of new mental health programs but under-funded existing programs. She called it an opportunity to bring about parity between mental and physical health. Joshi said he’s excited that the Mental Health Services Act enabled mental health providers to be located at 200 school sites. “Schools need to help kids to be healthy enough to access the curriculum.”

Dooley advocated pay for outcome rather than pay for service, emphasizing quality rather than quantity. Pizzo agreed, saying that we’re still under a system where “doing is more important that reflecting.”  He recalled his childhood in The Bronx when doctors made house calls, but if they didn’t give a shot they didn’t get paid.

Wise said that because of cost containment “kids fall off the radar screen.” Pizzo regards the Lucille Packard Children’s Hospital and the Oakland Children’s Hospital as safety nets in an environment of too few pediatric specialists and Medicaid compensation that is below cost. Dooley asserted that while medical costs have skyrocketed California, taxes now are comparable to what they were in 1972.

Wise thinks the California Children’s Services (CCS) should be changed to protect what’s good about the program. It was originally called the Crippled Children’s Service when it was founded in 1927 to help children who suffered from polio. Dooley thinks that providers need to make the program more efficient.

Pizzo and Wise both expressed optimism that we can find better ways of delivering health care and create national leadership in linking technological advances from places like Stanford with delivery systems like Lucille Packard Children’s Hospital.