Editor’s Note: Dr. Earl Chism (he/him/his) is a first-year resident physician in pediatrics at the University of California, San Francisco. He is a member of the Pediatric Leaders Advancing Health Equity (PLUS) Program, and his interests include medical education and improving health outcomes by increasing representation in healthcare. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
One of the roles of a pediatrician is to screen our patient population for potential harms. From providing counseling about safe infant sleeping practices to talking to teenagers about the rules of the road, much of our practice revolves around prevention of damage.
If all of us are doing this, why then are there disproportionate rates of preventable injuries in certain populations? Namely, why do people who live in rural areas, those living in communities that are low-income or otherwise underprivileged, or people identifying as Black or American Indian and Alaska Native face a higher proportion of preventable injury?1,2
This question does not have a simple answer. In their commentary, “A Call to Action: Addressing Socioeconomic Disparities in Childhood Unintentional Injury Risk,” being early released as an Equity, Diversity, Inclusion, and Justice article in Pediatrics this week, Dr. Joanna Cohen and colleagues from Johns Hopkins University both identify these disparities and encourage intentional effort to change them (10.1542/peds.2023-063445).
The authors begin by laying out the problem in plain language: “The risk of preventable injury is not equal for all individuals.” They then address the effect of structural racism on these outcomes and implore us to recognize the need for intervention. There are two major domains that are highlighted for targeted intervention:
- The impact of poverty: People living in poverty are more likely to experience preventable injury, and there is often a cascade of downstream effects leading to more harm when an injury occurs. For example, the authors discuss how injuries that prevent someone from attending work can further exacerbate food or housing insecurity.
- The act of implementation: It’s relatively easy to counsel patients about safe practices, and it’s another feat entirely to assure those practices are implemented. The authors identify some interventions that have been shown to be useful for implementation, including:
- Home visit programs
- Smartphone apps
- Using the electronic medical record to find patterns in injury data
- Repairing sidewalks
- Building neighborhood parks
To close the article, the authors raise a call to action, naming a few tasks for our community of pediatricians:
- Influencing policy change through advocacy
- Pushing for government programming to support implementing preventative measures for those living in poverty
- Pursuing technologically advanced solutions
- Working with community organizations focused on injury prevention
- Prioritizing investment in low-income neighborhoods
As we continue to work toward eliminating disparities in healthcare, we continue to be called to take action, in the hope that we’re able to find equitable solutions for the variety of problems that exist. The authors of this article have named an inequity, and now, again, it’s our job to step up to the challenge.
References
1. Kendi S, Macy ML. The injury equity framework — establishing a unified approach for addressing inequities. The New England Journal of Medicine. 2023;388(9):774-776. https://nejm.org/doi/full/10.1056/NEJMp2212378.
2. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. New England Journal of Medicine. 2018;379.25:2468-2475. https://doi.org/10.1056/nejmsr1804754.
