THE PEDIATRICIANS ROLE IN THE 21ST CENTURY

The world's children comprise: (i) those in wealthy, industrialized co untries; (ii) those from rapidly industrializing countries; (iii) mino rity groups including recently arrived immigrants in otherwise affluen t and healthy societies; (iv) previously traditional people in rapid t ransition to urbanized, Western lifestyles; and (V) many millions livi ng in grinding poverty in overcrowded, unhygienic conditions where chi ld mortality is high and often due to malnutrition and infections. Ind ustrialization, affluence, better housing, hygiene and nutrition, bett er clinical care and disease prevention have helped enhance child heal th in many countries over the past century. However, this is being off set by obesity, smoking, alcohol and drug abuse and social disruption, mental disease and high rates of violence including homicide and suic ide. These 'new morbidities' are worse among minorities and in populat ions undergoing rapid social change. Social pressures including unempl oyment, depression and family dysfunction are important. Pediatricians must become active in decisions about the use of public resources in disease prevention, health education and more rational and equitable u se of high technology. They should also be active advocates for childr en and their rights acid advise governments about all issues that affe ct child health, protection and well-being. This is particularly so in the poorest and developing countries. There is a need for better inte rnational collaboration, training and exchange programs involving the International Pediatric Association, United Nations International Chil dren's Emergency Fund, World Health Organization and other local, nati onal and regional organizations to help overcome these problems as the next century draws near.