Fanning the flames of child health advocacy?

You are never at your best at 4 am, and when the intensive care unit calls to say that the 7 year old girl with smoke inhalation is showing desaturation despite 100% oxygen it takes you a while to recall the ventilator settings. Admitted earlier that day, she was lucky to escape with her life after a house fire in one of the poorer parts of town. Few paediatricians are surprised by the steep social class gradient in childhood mortality and morbidity resulting from residential fires.1 The link with poverty can be made intuitively on the basis of repeated exposure to scenarios like this.

Poverty is both a private trouble and a public issue. Between 1979 and 1987 the number of people living in relative poverty (with less than half the national mean household income) increased from five million to 10 million.2 But in some cases the links are less obvious, and bedside intuition may be unreliable. A principal task when monitoring population child health is to link the private troubles in children's lives with the public issues that engender them. …