Policy in pediatric nephrology: successes, failures, and the impact on disparities
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REVIEW
Policy in pediatric nephrology: successes, failures, and the impact on disparities Jill R. Krissberg 1
&
Scott M. Sutherland 1 & Lisa J. Chamberlain 2 & Paul H. Wise 3
Received: 13 May 2020 / Revised: 10 July 2020 / Accepted: 2 September 2020 # IPNA 2020
Abstract Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease. Keywords Advocacy . Policy . Health disparities . Marginalized populations
Introduction Pediatric nephrologists have long been advocates for children with kidney disease and the policies that shape their access to high-quality care. The recent passage of the Advancing American Kidney Health Initiative and publication of the European Society for Pediatric Nephrology’s 20-year comparative analysis of pediatric kidney care represent important contributions to child health policy, heightening awareness of chronic kidney disease (CKD) in the current political landscape. Despite this progress, recent evidence suggests that profound social disparities persist in pediatric CKD and that
* Jill R. Krissberg [email protected] 1
Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room G-306, Stanford 94304, CA, USA
2
Division of General Pediatrics, Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
3
Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine;Center for Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
new clinical and policy-based strategies will likely be required to achieve greater equity in pediatric CKD outcomes [1]. A variety of risk factors have been shown to influence CKD outcomes in children, including genetic predisposition, environmental and social factors, and access to health services [2–4]. These influences can shape disparities in CKD outcomes by affecting both the emergence and progression of kidney disease. Examining disparate CKD outcomes through emergence and progression pathways is useful because they highlight different arenas of potential ameliorative interventions [5] (Fig. 1). Differences in disease emergence reflect various degrees of underlying genetic risk for kidney disease, e
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