Assessing Health Risks in Children and Adolescents in Pediatric Care: Let’s Not Forget Social Determinants of Health

Within the practice of pediatric medicine, a family and social history has historically been a part of the assessment of children. However, the scope of said history was usually limited to understanding the family composition, family health history and developmental behavior and activities of the child. Ongoing advances in basic and clinical sciences have increased knowledge of underlying disease etiology, including the role of genetics and genomics, brain physiology and immune functioning in disease origins and development, have led to the discovery of new and effective pharmacological agents and have informed the development of evidenced based treatment protocols. These advances have clearly improved treatment of existing diseases and conditions. There has also been advances in understanding the role of social factors as contributors to both immediate and long term health outcomes for patients throughout childhood and reaching into adulthood. Medical care as well as genetics, social circumstances, behavior, environmental and physical influences have been defined as the major determinants of health [1]. While access to medical care and clinical care contribute to health outcomes, more than 80% of the health outcomes are attributable to health behaviors as well as social and environmental factors [2]. Pediatrics is well situated to take the lead for including a broader and more robust social history to deepen our understanding, assessment and treatment of these risk factors.