Global Emergencies in Child Health: Challenges and SolutionsViewpoint and Recommendations from the European Paediatric Association and the International Pediatric Association



## Global emergencies in child health: challenges and solutions-viewpoint and recommendations from the european paediatric association and the international pediatric association
Naveen Thacker, MD 1,2,3 , Enver Hasanoglu, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Looking at the future, learning from the past: current activities and upcoming..., Pettoello-Mantovani [/bib_ref] , Joel Dipesalema, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] COVID-19 pandemic: knowledge and perceptions of the public and healthcare professionals, Parikh [/bib_ref] , Leyla Namazova-Baranova, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] , Aman Pulungan, MD 1,3,10 , Errol Alden, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] , Abdulsalam Abu-Libdeh, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] , Juan Jos e D az, MD 1,13 , Hilary Hoey, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] , Louise Kyne, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] , Mehmet Vural, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] , Sergio Riestra, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] , Yldz Camco glu, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Looking at the future, learning from the past: current activities and upcoming..., Pettoello-Mantovani [/bib_ref] , Aida Mujkic, MD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] , Angel Carrasco-Sanz, MD [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] , and Massimo Pettoello-Mantovani, MD, PhD [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] [bib_ref] Internet addiction: starting the debate on health and well-being of children overexposed..., Ferrara [/bib_ref] G lobal emergencies, including natural disasters, epidemics, drought, armed conflicts, and the SARS-CoV-2 pandemic, have affected populations on five continents, causing devastating socioeconomic effects. [bib_ref] Integrating and rationalizing public healthcare services as a source of cost containment..., Pettoello-Mantovani [/bib_ref] Children are a most vulnerable and defenseless group. [bib_ref] Child abuse and neglect and its psycho-physical and social consequences: a review..., Ferrara [/bib_ref] In tense situations, they feel overwhelmed and insecure and are often left to their own devices. Their rights to protection and integrity are threatened. [bib_ref] Fostering resilience in children: the essential role of healthcare professionals and families, Pettoello-Mantovani [/bib_ref] The European Paediatric Association, Union of the National European Paediatrics Societies and Associations and the International Pediatric Association, representing the national pediatric societies from 149 countries, held a joint conference on October 9, 2021, in Zagreb, Croatia, to discuss the issue of global emergencies in pediatrics and their significant economic and social impact. [bib_ref] Looking at the future, learning from the past: current activities and upcoming..., Pettoello-Mantovani [/bib_ref] Delegates discussed the challenges posed by a wide variety of emergencies in the context of increasing global complexities, while also exploring possible solutions. This commentary, prepared by the European Paediatric Association, Union of the National European Paediatrics societies and Associations-International Pediatric Association working group, includes the viewpoint and recommendations from the conference available at www.jpeds. com). The group strongly recommends that countries develop, reorganize, and strengthen their health systems to address the social and environmental issues caused by global emergencies to enable more efficient and effective allocation and use of available resources for disaster preparedness and emergency response resources in communities. The statement emphasizes the importance of active involvement of all stakeholders, including governments and healthcare professionals. Their joint effort should focus on developing strategic partnerships with key international constituencies, such as the diplomatic, nongovernmental, legal, and academic communities, and the media with the aim of providing adequate support to infants, children, and adolescents affected by adversities. [bib_ref] COVID-19 pandemic: knowledge and perceptions of the public and healthcare professionals, Parikh [/bib_ref] Pediatricians and their professional societies across the world must collaborate and share their experiences with new and emerging challenges in child health and together mitigate against inequalities within and between countries and between continents and together strongly and courageously advocate for the health and well-being of children. 7,8 n Global emergencies in child health: challenges and solutions. Viewpoint and recommendations from the 2021 joint conference of EPA/UNEPSA-ECPCP-IPA Diversities, variations, and heterogeneities characterize healthcare services throughout the 5 continents. Cultural and economic complexity and a large disparity in availability, affordability, and accessibility of pediatric care has been shown by pediatric services and community care across the world. The adoption of international aims and objectives relating to services for children including standards of care, education, training, quality improvement projects, research programs, robust outcome measures and socioeconomic goals, are required in order to ensure the effective management of healthcare and the well-being of infants, children, adolescents and their families. Child health and well-being challenged by emergencies New emergencies, including the effects of a devastating global economic crisis, random cyberattacks and the SARS-CoV-2 pandemic, were added to the long list of issues that chronically afflict children and impact their health and well-being. The consequences of such socioeconomic turbulence raise serious concerns regarding the sustainability of healthcare systems and their ability to provide effective childcare to ensure that essential and optimum medical attention and health care services are provided from infancy, through childhood and adolescence.

## Turning crisis into opportunities
In a world of increasing economic interconnections the challenges are greater, but so too are the opportunities. Crisis may become an opportunity if interventions for recovery are well-planned and managed. It is of fundamental importance to carefully explore a number of possible solutions to counteract the negative effects of global emergencies and assist countries and their administrators in their efforts to develop cost-effective solutions, while ensuring that the goal of balancing budgets does not decrease the basic quality standards for public health.

## Cultural heritage as a strength for cooperation
Cultural heritage is a fundamental category of tangible and intangible values characterizing all aspects of a community, which are continuously remodeled by the political, economic and social concerns. The concept of diversity, as a direct expression of cultural heritage, has become progressively perceived as a resource, helping societies to identify the best solutions to confront and respond to challenges encountered by the different communities throughout the world. The importance of dialogue within diversity and between diverse cultures has emerged as a strong element of cohesion between cultures, in addition to the contribution that diversity can provide for solutions of common problems.

## Establishing effective cooperation platforms among countries
The presidents of the national pediatric societies, were convened by the EPA/UNEPSA, in collaboration with the IPA and the European Confederation of Primary Care Pediatricians (ECPCP) in Zagreb on October 9, 2021. One conclusion-effective cooperation between countries throughout-is based on the acknowledgement that diversity is a factor of strength and not of weakness. This key factor may create the basis of an effective cooperation in all fields of public interest. Contribution to the efforts of creating an effective platform for cooperation and a multidisciplinary approach to common issues in public health may reduce fragmentation of pediatrics and tackle the legal, economic, and organizational challenges of child healthcare throughout the world. Natural, economic disasters and public health emergencies Natural and economic adversities and public health crises have often revealed a low degree of self-sufficiency and a high degree of unpreparedness by nations. Natural, economic disasters and public health emergencies are interconnected phenomena. Disasters and distressing natural events need to be met with rescue and recovery interventions, including adequate health approaches. The nature and effects of these disasters are progressively more complex because they are influenced by several factors including climate change, population movement, economic interdependence, and the general phenomenon of globalization. Tackling emerging and re-emerging infections of major importance in child health A complex interplay of environmental and human factors, including ecological, genetic, political and socioeconomic factors, interact to result in the emergence of infectious diseases with unique impacts on children as the most vulnerable members of our society These emerging infections can have unique impacts on younger populations in terms of both physical and mental health, as well as social well-being. In order to best protect them from the impact of emerging and re-emerging infectious diseases, it is imperative to understanding how factors that determine disease emergence and emerging diseases themselves can affect the young.

## Mitigating harm to children directly and indirectly involved in armed conflicts and gun violence
All children should be guaranteed the right to live, learn and grow up safely-free from violence and fear. Each year, thousands of children are either killed or severely injured in armed conflicts around the world or involved in episodes of domestic and community violence characterized by the use of guns. Although concerns are raised worldwide about the use of explosives, the protection of children often lacks practical solutions. Focus on challenges and practical steps on how to strengthen the protection of children in such conflicts should be further implemented at national and international level.

## Meeting minor refugees' basic needs
Around the world, millions of families and their children are fleeing their homes owing to adverse events. Protracted conflicts, persistent violence, extreme poverty, and disadvantage press for action to protect children from conflict and to address the root causes of violence and poverty that displace children from their homes. Unaccompanied minors traveling across the world seeking protection is a related increasing phenomenon, which poses a significant challenge to the authorities and the social and healthcare systems worldwide. Both short-and long-term solutions are essential in order for children to escape conflict, persecution and poverty. These must include increasing access to education, strengthening health and child protection systems and social safety nets, expanding opportunities for family income and youth employment, and facilitating peaceful conflict resolution and tolerance. A multitude of children currently face danger, detention, deprivation, and discrimination. The global pediatric community must stand up for them, work collectively in order to identify issues of concern and strongly advocate with local and international stakeholders. The importance of developing reliable and effective coordinated strategies A nation's ability to prepare for, respond to, and recover from disaster/emergencies, especially in regard to children, should not depend on a single level or agency of government, and cannot be tackled with fragmented approaches, but by integrated strategic plans. RECOMMENDATIONS
An effective system for disaster management should depend on well-planned, coordinated, interactive strategies and reliable methodologies, based on a shared responsibility, centered on each team member doing what it does best and leveraging the expertise and strengths of others. Most importantly, it must be relevant and applicable to the needs of the country and community. The many threats posed to global health have emphasized the importance for countries to accelerate the development of guidelines for short-, medium-, and longterm preparedness, to be applicable to different situations, and to enhance the ability to develop adequate strategies and target resources. Effective strategies should guide states and their local authorities to better identify impediments, which at any level may delay timely distribution of funds, identify best practices, and make recommendations to overcome these complications. Effective strategies established to tackle emergencies should include an integrated competent communication system that is able to reach both local administrators and populations, in order to keep them informed as to program requirements and opportunities for assistance. Sharing knowledge, expertise and recourses will be key to success. Caring for children after an emergency event should be a priority, as the amount of trauma/damage caused by a disaster can be overwhelming and affect children physically and mentally. Separation from school, family, and lack of peer support from friends can create additional stress and anxiety for children.
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