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Physicians Urge More Attention to Health Education

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Chicago--Pediatricians and child psychiatrists from across the country last week urged educators to increase the level of health education in the schools to combat new diseases and "morbidities" affecting growing numbers of American children.

The incidence of child abuse, eating disorders, drug addiction, teen-age pregnancy, and sexual exploitation, as well as of infant mortality, suicide, and fatal accidents is increasing throughout the nation, the physicians said. The causes, they said, are changes in social values, family structure, and eating habits--and a lack of education.

"Some health problems have reached epidemic proportions," said Frank J. Jirka Jr., president of the American Medical Association (ama).

In light of that situation, he said, the national conference, "The Impact of Lifestyles on Child and Adolescent Health Problems," was convened by the ama to inform doctors about the causes of the diseases and possible cures. Co-sponsored by the Illinois State and Chicago Medical Societies, the meeting attracted 150 health professionals.

Cooperation of Society

The participants were in agreement on one point: They cannot cure these illnesses by themselves; they need the cooperation and understanding of the society as a whole.

The physicians illustrated their problems with these statistics:

Immunization rates for preschoolers have gone down each year since 1978, with more than half of inner-city and minority children receiving no polio vaccine;

Infant-mortality rates in some sections of the country are higher than in Honduras, the poorest nation in Central America;

One million children a year are abused, and one thousand a year die from physical abuse;

Some 500,000 children a year are separated from their homes and in foster-care programs;

Six-million children under the age of 13 receive no day care while their mothers work;

Smoking among teen-agers is at an all-time high, as is their use of alcohol and marijuana.

In addition, 11,000 American children die each year due to the conditions of poverty, and since 1980, 2.5 million more children are reported living in such conditions.

The suicide rate for teen-agers has more than tripled in the last 20 years and is now the third leading cause of death among teen-age boys and the fourth leading cause among teen-age girls.

Moreover, Derek Miller, chief of the adolescent program at the Institute of Psychiatry at Northwestern Memorial Hospital here said he sees many more students playing a kind of "Russian roulette" as they sit in the suicide seats of cars driven by drunk friends, climb mountains alone, and starve themselves to be fashionable.

Dr. Miller offered several possible reasons for such danger-seeking actions: the high unemployment rate among teen-agers; the fragmentation of the nuclear and extendedntinued on Page X


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family; undiagnosed physical ailments that lead to depression and drug or alcohol abuse; an increase in the number of working mothers, with its resulting "latch-key" children; and the school environment.

"We are obsessed with our failing educational system," Dr. Miller said. "But learning involves feelings. You can't have one without the other. Yet we have devised junior high- and high-school systems where chldren constantly shift classes and exchange teachers at a time when they need constant relationships.

"There is no respect for the needs of children. We make it difficult to learn and to respect one another. We need to increase our human relations in the schools and make sure poeple feel valued and wanted."

The growing health problems of children are by no means limited to the poor, the physicians pointed out. In noting that the parents of her patients included physicians, Domeena Renshaw, professor of psychiatry at Loyola University in Maywood, Ill., said shifts in the nation's whole social structure are forcing all physicians and teachers to confront these new health issues.

Incest is one such issue, said Dr. Renshaw. She described the case of an 8-year-old girl referred to her recently when a teacher noticed the child acting strangely.

The girl had been raped by her teen-age uncle, Dr. Renshaw explained.

Because of the high divorce rate, said the psychiatrist, who is the author of the recent book Incest: Understanding and Treatment, "40 percent of the children in the United States today are living in a reconsti-tuted family. And the mother who has children growing in a home like this has to be very alert to provide sex education and an open line of communication between her child and herself so she can be protective."

Dr. Renshaw urged the schools to increase their level and amount of sex education for children. She asked physicians to work with their local schools to provide information, expertise, and workshops for teachers and parents. "We've got to educate the educators," she said, "as well as respect the rights of anti-sex groups who have a right to keep their kids back from a particular class."

Wendy Baldwin, chief of the social and behavorial sciences branch of the Center for Population Research at the National Institute of Child Health and Human Development in Bethesda, Md., said that the schools' sex-education programs in the schools have made some impact on teen-agers, but that more research and more programs are needed. Half of the teen-agers arriving at community-health clinics are already pregnant, she said, and this is largely due to "ignorance."

The health risks to the pregnant teen-ager and her child are substantial, she noted. Of the one million teen-agers who get pregnant each year, 450,000 have abortions. Pregnant teen-agers are more likely to have prenatal deaths and premature births, and they may be more susceptible to abusing their infant due to a lack of knowledge about child development, she said.

Physicians prescribed a number of possible cures for the new health problems, including parenting classes for teen-agers in the schools, increased funding for school nurses, and an income-tax write-off to fund health programs for children.

Some physicians suggested that states adopt tests for health education such as those that now exist for reading and mathematics. Others urged state legislatures to raise the drinking age for teen-agers.

Kenneth Schonberg, director of adolescent medicine at Montefiore Hospital in New York City, concluded: "The average physician will have spent 10 hours with a youngster during his growing years. But by the time a student graduates from high school, he will have been alive 157,000 hours. Society gets two organized cracks at that child. One is television, and the other is school.

"We can have an enormous influence on what is going to be the outcome of that child," Dr. Schonberg continued. "But we need to increase partnerships in ways we have not done to this point. I look to the schools to provide the profound, positive influences if we use them right."

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