Children’s Health: A New Conceptual Framework

Historically, the definition of children’s health has received little consideration separate from that of adults. Although views of adult health have evolved from a focus on morbidity and mortality to consider broader aspects of health, considerations specific to children have generally been excluded. This chapter lays out a new definition and conceptualization of children’s health. It reviews the ideas that led to the committee’s definition and puts forth a model of how health evolves in children. It summarizes the principles underpinning the model and the ways that different influences operate. Finally, the chapter outlines the domains of children’s health that serve as a basis for measuring it.

Although many of the principles outlined in this chapter also apply to adults, they are particularly salient for children. The committee’s charge calls for a focus on children, an emphasis the committee thinks is warranted given the historic lack of attention to children’s health in relation to adult health. However, those involved in population health issues more broadly may want to consider the potential applicability of the definition and conceptual model outlined in this report to adults.

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The roles of children have changed throughout human history and across different levels of social organization. Children in agrarian and early industrial societies were expected to participate in the work of the family from early childhood, helping other family members in household activities and caring for one another. Many died while still very young, and those who survived were expected to contribute to the family’s economic situation and, eventually, to the support of their aging parents. There was little collective commitment to the provision of education or services to improve health and only limited knowledge of the environmental factors that influence healthy development. Modern societies generally have less urgent need for children to enter the workforce, and the technological age demands a longer period of schooling and greater skill level from its workforce.

Awareness of and commitment to protecting the health of children and to their nurturance has increased in recent decades (see Zelier, 1994). Observational and empirical research in the 20th century, led by individuals such as John Watson (behaviorism), Arnold Gesell (maturational stage theory), Sigmund Freud (psychoanalytic theory), Jean Piaget (cognitive development theory), Erik Erickson (psychosocial theory), John Bowlby (attachment theory), Urie Bronfenbrenner (ecological theory), and Arnold Sameroff (transactional theory), created the concepual basis for understanding the cognitive, emotional, and social importance of childhood and the roles played by both family and societal forces.

The social transformation of childhood in modern societies reflects a retreat from the view that parents have full and unlimited jurisdiction over their children to one in which the welfare of children is increasingly understood as a shared social responsibility which requires investments in education, health care, and other institutions. At the same time, there has been a growing body of evidence that children’s development is influenced both by their families and by the social forces and cultural norms that society produces. Thus, children’s health, development, achievements, and social attainments have come to require the interest, guidance, and protection of both families and society—not just for the intrinsic value of children but for society’s collective future. This view of childhood is embedded in the very foundation of such social institutions as schools and the health care system, which play important roles in preparing children for the challenges of modern times and ensuring that, as they grow and develop into adults, they are prepared for life in an increasingly complex world.

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