Explore the full ebook collection and download it now at textbookfull.
com
Child health a population perspective 1st Edition
Blair
https://textbookfull.com/product/child-health-a-population-
perspective-1st-edition-blair/
OR CLICK HERE
DOWLOAD EBOOK
Browse and Get More Ebook Downloads Instantly at https://textbookfull.com
Click here to visit textbookfull.com and download textbook now
Your digital treasures (PDF, ePub, MOBI) await
Download instantly and pick your perfect format...
Read anywhere, anytime, on any device!
Child Adolescent and Family Refugee Mental Health A Global
Perspective Suzan J. Song
https://textbookfull.com/product/child-adolescent-and-family-refugee-
mental-health-a-global-perspective-suzan-j-song/
textbookfull.com
Systems science and population health 1st Edition El-Sayed
https://textbookfull.com/product/systems-science-and-population-
health-1st-edition-el-sayed/
textbookfull.com
Screening in Child Health Care Report of the Dutch Working
Party on Child Health Care 1st Edition Balledux
https://textbookfull.com/product/screening-in-child-health-care-
report-of-the-dutch-working-party-on-child-health-care-1st-edition-
balledux/
textbookfull.com
Information: A Historical Companion Ann Blair
https://textbookfull.com/product/information-a-historical-companion-
ann-blair/
textbookfull.com
Paediatrics a Core Text on Child Health Second Edition
Tony Waterston
https://textbookfull.com/product/paediatrics-a-core-text-on-child-
health-second-edition-tony-waterston/
textbookfull.com
TEXTBOOK FOR TRANSCULTURAL HEALTH CARE a population
approach 5th Edition Larry D. Purnell
https://textbookfull.com/product/textbook-for-transcultural-health-
care-a-population-approach-5th-edition-larry-d-purnell/
textbookfull.com
Public health leadership : strategies for innovation in
population health and social determinants 1st Edition
Bhattacharya
https://textbookfull.com/product/public-health-leadership-strategies-
for-innovation-in-population-health-and-social-determinants-1st-
edition-bhattacharya/
textbookfull.com
Exploring the Health State of a Population by Dynamic
Modeling Methods 1st Edition Christos H. Skiadas
https://textbookfull.com/product/exploring-the-health-state-of-a-
population-by-dynamic-modeling-methods-1st-edition-christos-h-skiadas/
textbookfull.com
Deconstructing Health Inequity: A Perceptual Control
Theory Perspective 1st Edition Timothy A. Carey
https://textbookfull.com/product/deconstructing-health-inequity-a-
perceptual-control-theory-perspective-1st-edition-timothy-a-carey/
textbookfull.com
Child Health
Child Health
A Population Perspective
EDITED BY
ALICE A . KUO
RYAN J. COLLER
SAR AH STEWART-BROWN
and
MITCH BL AIR
1
1
Oxford University Press is a department of the University of
Oxford. It furthers the University’s objective of excellence in research,
scholarship, and education by publishing worldwide.
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offices in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland Thailand Turkey Ukraine Vietnam
Oxford is a registered trademark of Oxford University Press
in the UK and certain other countries.
Published in the United States of America by
Oxford University Press
198 Madison Avenue, New York, NY 10016
© Oxford University Press 2016
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the prior
permission in writing of Oxford University Press, or as expressly permitted by law,
by license, or under terms agreed with the appropriate reproduction rights organization.
Inquiries concerning reproduction outside the scope of the above should be sent to the
Rights Department, Oxford University Press, at the address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Child health (Kuo)
Child health : a population perspective / edited by Alice A. Kuo, Ryan Coller,
Sarah Stewart-Brown, Mitch Blair.
p. ; cm.
Includes bibliographical references.
ISBN 978–0–19–930937–5
I. Kuo, Alice A., editor. II. Coller, Ryan, editor. III. Stewart-Brown, Sarah L., editor.
IV. Blair, Mitch, editor. V. Title.
[DNLM: 1. Child Welfare—United States. 2. Health Status—United States.
3. Social Determinants of Health—United States. WA 320 AA1]
RJ101
362.19892—dc23
2015009181
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
This book is dedicated to Tom Tonniges, MD,
an outstanding pediatrician and tireless child health advocate.
CONTENTS
Acknowledgments ix
About the Editors xv
Contributors xvii
Introduction 1
A l i c e A . Ku o
1. Historical and Policy Perspectives of Child Health in
the United States 9
K at h e r i n e A . H e n r y A N D M i e n a h Z u l fa c a r S h a r i f
2. Current State of Child Health in the United States 31
M i e n a h Z u l fa c a r S h a r i f, K at h e r i n e A . H e n r y, A N D B e r g e n B . N e l s o n
3. Children, Families, and Communities 49
R ya n J. C o l l e r A N D A l i c e A . Ku o
4. Social Determinants of Child Health 79
R ya n J. C o l l e r A N D A l i c e A . Ku o
5. Life Course Health Development 111
A l i c e A . Ku o
6. Immigration and Child Health 133
M i e n a h Z u l fa c a r S h a r i f A N D K at h e r i n e A . H e n r y
7. Global Child Health 157
A l i c e A . Ku o
8. Population Child Health in Practice 181
M i t c h B l a i r , S a r a h S t e wa r t-B r o w n, T o n y Wat e r s t o n ,
AND Rachel Crowther
vii
viii Contents
9. Concepts in Population Child Health 209
M i t c h B l a i r , S a r a h S t e wa r t-B r o w n, T o n y Wat e r s t o n ,
AND Rachel Crowther
10. Case Studies in Population Child Health 255
R ya n J. C o l l e r
Index 325
ACKNOWLEDGMENTS
I have been very fortunate in my career to work with outstanding trainees at
UCLA, including undergraduates, medical and graduate students, residents, and
fellows. The impetus for this book came largely from the Community Health
and Advocacy Training (CHAT) program in pediatrics, which I directed from
2000 through 2014, and my undergraduate Foundations of Maternal and Child
Health course, which I have been teaching every year in the Fielding School of
Public Health since 2009. I am proud of the fact that the US-based team for
this book is comprised of either current or former trainees. The perspectives and
approaches in this book are based on the questions asked by former students,
and I hope it will help future students understand child health.
I must acknowledge my mentors who taught me child health. First and
foremost is Neal Halfon, who has supported my training and career from the
beginning, and who continues to inspire me with his brilliance, optimism, and
steadfast dedication to improving systems of care for children. Frank Oberklaid
taught me about community child health while I was a med-peds resident and
encouraged me to look beyond the United States at international models for
child health. Bruce Fuller, Margaret Bridges, Alex Ortega, Mike Prelip, Deborah
Glik, and Paul Shattuck are all great research collaborators and have furthered
my thinking about children, families, and communities. Alan Fogelman has been
a wonderful mentor and department chair, and I deeply appreciate his support of
all of my endeavors. I am also incredibly grateful to Tom Tonniges, who brought
me to work on child advocacy issues at the American Academy of Pediatrics in
2004. He has been a wonderful friend.
I could not have worked on this book without the unwavering support of my
family: my parents, my parents-in-law, my husband, John, and my boys, Matthew
(age 7) and Noah (age 3). Their encouragement helps me strive to make the
world a better place for children.
—Alice A. Kuo
ix
x Acknowledgments
A myth was shattered long ago, when I realized that my successes would never be
mine alone. I have had the great privilege to work with mentors who would not
only share with me their invaluable wisdom, but would motivate and support
me to be better than I am. Here is a partial list.
I am indebted to Alice Kuo, first for training me as a pediatric resident in
the Community Health and Advocacy Training program at UCLA, second for
supporting me through my Maternal and Child Health fellowship, and finally
for working with me as a colleague and friend. Her example has always chal-
lenged me to think outside the box—I hope to develop such unyielding dedica-
tion throughout my career. Lee Miller and Kate Perkins gave me opportunities
to follow my passion before I even thought I was ready. They are educators’
educators—masterfully demonstrating how to teach child health at all levels, in
the United States and abroad. Paul Chung has provided incomparable health
services research guidance—sharing with me the answer before I even know
the question, the value of a sense of humor, and the importance of challenging
the status quo. I am thankful for the unquestioned support I have received from
Tom Klitzner and Ellen Wald, as well as early inspiration to strive to improve
health from beyond the walls of the hospital and clinic through mentors in medi-
cal school, Nancy Hutton, Alex Vu, George Siberry, and Barry Solomon.
Most important, credit for anything worthwhile that I do belongs primarily
to my wife, Karen, for her brilliance, unending patience, formidable strength,
and effortless encouragement. The most important things I know in life, she has
taught me. Finally, the most important things I have yet to learn, my daughters,
Olivia (age 2) and Penelope (our newest addition), will no doubt teach me.
—Ryan J. Coller
I feel privileged to have spent my career working in UK public health where it
has been possible to stand on the shoulders of the giants who established this
discipline and embedded it firmly in UK public services almost two centuries
ago. I have been fortunate in being able to work with many enlightened paedia-
tricians and play a key role in bringing children back to the centre of the public
health stage where they rightly belong. Amongst the many who warrant thanks
I acknowledge David Hall who did so much to bring public health principles
back into child health services in the 1980s and of course my colleagues Mitch
Blair and Tony Waterston and all the deep and challenging conversations that
went into the creation of our original book Child Public Health. It is a great
delight to know that the latter has provided the inspiration to create this new
book about child public health in the US and to be able to work with American
colleagues in bringing this to fruition. And finally I acknowledge and thank my
children Tom and Charlie and my grandchildren Jorge, Oscar and Nieves who
Acknowledgments xi
have taught me so much of what really matters about parenting, children and
many other things.
—Sarah Stewart-Brown
Ever since I was a medical student, I have appreciated the value of taking a holis-
tic view of health and disease, inspired by many including a very young Michael
Marmot and of course Geoffrey Rose, two outstanding British medical epidemi-
ologists. My journey into community paediatrics at the start of it’s development
as a specialty in the UK, reinforced that perspective, inspired by Leon Polnay,
David Hall, Tony Waterston, Stuart Logan and Nick Spencer. Amongst many
significant international influences I acknowledge Neal Halfon, Frank Oberklaid,
Neil Wigg, Garth Alperstein, Ed Shor and Lennart Kohler. I am immensely
grateful to Sarah Stewart Brown who has been a huge influence in my thinking
around health and health promotion. Finally, I should like to acknowledge my
parents Andrew and Jocelyn for giving me the freedom to experiment in science
and art as a young child and allowing me to experience so many different pos-
sibilities in life.
—Mitch Blair
Michael Anthony Reyes, a senior at UCLA, and
David Ryan Ho, a sophomore at UCLA, provided
editorial assistance for the entire book.
A B O U T T H E E D I TO R S
Alice A. Kuo, MD, PhD is an Associate Professor in the Departments of
Pediatrics, Internal Medicine, Health Policy and Management, and Psychiatry
and Biobehavioral Sciences at the University of California, Los Angeles. She is
also the Chief of Medicine-Pediatrics and Director of the Combined Internal
Medicine and Pediatrics Residency Program at UCLA. She is a national expert
in community pediatrics education and child advocacy and has been working
on committees in the American Academy of Pediatrics since 2004. She has been
the Policy Chair of the Council on Community Pediatrics since 2013. Former
director of the Community Health and Advocacy Training (CHAT) Program
at UCLA, Dr. Kuo has trained over 80 CHAT residents and 200 undergraduate
and public health graduate students in maternal and child health at the Fielding
School of Public Health. An innovative educator, Dr. Kuo has created numerous
programs for health professions students at UCLA.
Ryan J. Coller, MD, MPH is an Assistant Professor in the Department of
Pediatrics at the University of Wisconsin School of Medicine and Public Health.
He is an investigator with the UW Health Innovation Program, and Research
Director for the University of Wisconsin Pediatric Complex Care Program. Dr.
Coller’s work blends traditional health services research and quality improve-
ment science to understand and improve systems of care for children affected
by complex chronic medical conditions, their families, and the communities in
which they live.
Sarah Stewart-Brown is Professor of Public Health at Warwick Medical
School, University of Warwick. Her interests focus on two interdisciplin-
ary and closely related areas of public health practice: child public health and
public mental health. She contributed to the UK’s rationalization of childhood
screening programs in the 1980s and then focused on children’s mental health
xv
xvi About the Editors
and well-being. Her research relating to parenting has played a key role in the
development of child health policy in the United Kingdom. Dr. Stewart-Brown
chairs Public Health England’s Expert Advisory Group on Mental Health and
Well-being and sits on the Ministerial Advisory Committee implementing the
English Strategy No Health without Mental Health. She advises both Scottish
and Welsh Governments on child public health and public mental health with
a particular focus on childhood programs and approaches which prevent the
development of mental health problems throughout life. Prior to starting her
academic career she worked in the UK NHS both in pediatrics and in public
health. Dr. Stewart-Brown has published extensively with over 200 peer review
journal publications, books, book chapters, and reports.
Mitch Blair MBBS, Bsc, MSc, FRCP, FRCPCH, FFPH (hon) is FHEA
Professor of Pediatrics and Child Public Health, Consultant Pediatrician, River
Island Academic Center for Pediatrics and Child Public Health, Northwick Park
Hospital and Imperial College London.
He is a general and developmental pediatrician and specialist in child pub-
lic health. Research interests include international child health indicators,
child public health monitoring, and health service evaluation. Co-author of
two books, Manual of Community Paediatrics and Child Public Health, and over
80 papers, Dr. Blair worked at the Department of Health in England to advise
on the Healthy Child Program (HCP) policy and led the production of HCP
e-learning, launched by Ann Milton, Minister for Public Health, in March 2011.
He is currently Officer for Health Promotion for the Royal College of Paediatrics
and Child Health and an honorary Fellow of the American Pediatric Association.
CO N T R I B U TO R S
Mitch Blair MBBS, MSc Bergen B. Nelson MDMS
Professor of Paediatrics and Child Assistant Professor of Pediatrics
Public Health UCLA
Imperial College, Los Angeles, California
London, United Kingdom
Mienah Zulfacar Sharif
Ryan J. Coller MD, MPH MPH Doctoral Student,
Assistant Professor of Pediatrics Department of Community
University of Wisconsin Health Sciences
Madison, Wisconsin UCLA Fielding School
of Public Health
Rachel Crowther MB BChir, MSc
Los Angeles, California
Former Consultant in Public Health
South East Public Health Sarah Stewart-Brown BM BCh, PhD
Observatory, Oxford Professor of Public Health
United Kingdom University of Warwick
United Kingdom
Katherine A. Henry
Medical Student Tony Waterston MD
David Geffen School of Medicine Institute of Health & Society
at UCLA Newcastle University
Los Angeles, California United Kingdom
Alice A. Kuo MD, PhD
Associate Professor of Internal
Medicine and Pediatrics UCLA
Los Angeles, California
xvii
A NOTE ABOU T THIS BOOK
This book is loosely based on Child Public Health, a volume first published in
2003 in the United Kingdom and now in its second edition and translated into
Swedish. Child Public Health was an interdisciplinary venture drawing from the
distinct disciplines of child health and public health as practiced in the United
Kingdom. It stimulated discussion over many years at international scientific
conferences, where the paths of the authors of this book crossed in the quest for
a better understanding of child health and its determinants. We discussed the
need for a book like Child Public Health in the United States, together with the
different challenges that the United States and the United Kingdom have had to
grapple with in trying to improve child health and the different perspectives of
practice on the two sides of “the pond.”
Child Health: A Population Perspective was born from those discussions. It was
brought together through interdisciplinary and international collaboration, but
it was written very much with a US “lens.” Children’s health issues are not so dis-
similar across the world that they cannot find a common language and concep-
tual framework, but there are significant differences in our political, social, and
administrative systems, and these have required appropriate contextualization
for a US audience. Chapters 3, 4, 5 and 7 were adapted from Child Public Health.
Chapters 8 and 9 were edited for the US market but not re-written. The remain-
ing chapters contain original content by authors in the United States.
We hope that readers will share a voyage of discovery similar to the one the
authors have taken in “flying above” the individual clinic, preschool, school, or
college to consider the whole population of children and what can be done to
protect and promote their health and well-being, and to prevent disease among
children in the United States.
xix
Introduction
A l i ce A . Ku o
Why Child Health?
Child health is an important marker of the health of a society. In the United
States, we have spent significant amounts of money (over 17% of our Gross
Domestic Product) addressing the health problems of our population. Yet we
have poorer health outcomes than many developed countries that spend less
on health. Many of the diseases and health conditions contributing to the high
cost of healthcare are the results of adult behaviors that have their origins in
childhood or adolescence. For example, the economic burden of cardiovascu-
lar disease tops $450 billion each year in the United States, and many patients
with heart disease have dietary and physical activity habits that formed when
they were children. Most adult smokers started smoking when they were ado-
lescents, and approximately two-thirds of adult mental health disorders origi-
nate in childhood. Thus, improving the health of children and young people
of the population is an important strategy for improving the overall health of
Americans. Investing in child health is also a cost-effective prevention strategy
that will decrease healthcare costs and improve health outcomes.
Despite the successes of the past in significantly reducing the levels of child-
hood mortality, children are not faring well in this country. Nearly a quarter of
all children under the age of 18 years live in poverty, with 16 million children
living in households without consistent access to food. Almost half of all par-
ticipants in the Supplemental Nutrition Assistance Program (formerly known
as Food Stamps) are children. Despite this level of food insecurity, one-third
of children and adolescents in the United States are overweight or obese. The
rates of childhood obesity have doubled in children and tripled in adolescents in
the past 30 years. Furthermore, nearly one in five children experiences a mental
disorder in a given year, and 10 million children suffer from asthma. Thousands
of children are hospitalized each year for this condition.
1
2 Child Health
The risk for suboptimal health is not confined to children from lower social
class families. Risk factors are graded and extend across the social class spec-
trum, leading to health outcomes that also follow a social gradient. These socio-
economic status gradients, with successively higher levels of income, education,
or occupational class, are associated with better children’s health in conditions
such as asthma, obesity, acute illness, and injury. For families living in poverty,
however, the disadvantages they face can hinder child health and development
in many ways. These families cope with substandard housing, unsafe neighbor-
hoods, and inadequate schools, and they experience more stress in their daily
lives than more affluent families. Research has demonstrated that this “toxic
stress” can lead to a host of psychological and developmental consequences for
the child. Parents in low-income families also lack the resources and the time to
invest in their children. They are often unable to afford high-quality child care
or to provide enriched learning experiences because they are more likely to be
raising their children alone or to be working nonstandard hours under inflexible
work schedules.
What Is Child Health?
The field of child health involves a range of ideals, activities, and academic disci-
plines. It covers the study of patterns of health and illness in children and young
people, investigation of the factors that affect their health, and ways in which
we—as individuals, organizations, professions, and societies—can modify
these factors in order to improve the health and well-being of all young people.
We define child health as the following discipline:
The art and science of promoting and protecting health and well-being
and preventing disease in infants, children, and adolescents through the
skills and organized efforts of professionals, practitioners, their teams,
wider organizations, and society as a whole.
We have chosen not to define what we mean by a child because we perceive the
process of growing up as a continuous one that different individuals undertake
at different paces. Although the patterns of ill health and the factors influencing
health shift as a child gets older, many of the important determinants of child
health and resulting health problems affect children and adolescents at several
different stages of development. This book is structured thematically, recogniz-
ing the need for action across a range of ages, sectors, and professional boundar-
ies. Its inclusive approach covers the development of children from conception
through adolescence and the transition to adulthood.
Int roduc tion 3
Although children and adolescents themselves are the focus, it is essential
to see them in context—within their families, communities, environments,
and wider social and political settings. All these constitute layers of influence
on the individual child, the child population, and spheres of activity for child
health population practice as we describe later in this book. We cannot hope
to improve the health of children and adolescents now or in the future without
addressing social policy, family relationships, environmental concerns, and com-
munity structures.
Who Is This Book For?
Child health involves promoting the health and well-being of children and
adolescents in the widest sense. It requires the commitment and coopera-
tion of a wide range of individuals and organizations: not only those working
in health, social services, and education (including professionals and policy
makers) but also local and national governments (including departments of
transportation, housing, and commerce); philanthropists at local, national,
and international levels; the police force and legal and criminal justice sys-
tems; and, of course, children and adolescents themselves, their parents,
families, friends, and caregivers. This book is for all these people. It aims to
support all healthcare professionals interested in the well-being of children
and adolescents, especially those working or training in the fields of pub-
lic health, primary care, and pediatrics. It also provides an introduction to
the principles and practice of child health for everyone with an interest in
the subject—from doctors, nurses, and public health practitioners to social
workers and teachers, government officials, politicians and policymakers, and
parents and families.
For people working in child health in both community and hospital settings,
this book aims to explore the preventive aspects of clinical practice, demonstrat-
ing the importance of public health principles both in everyday practice and in
the planning of future services. For the public health professional with a wide
portfolio to address, it seeks to highlight some common public health issues
specific to children that are amenable to the approaches described in its later
chapters. Primary healthcare teams are being given an increasingly important
role in the “accountable care” era with regard to health needs assessment and
the demonstration of quality. This text will appeal to primary care professionals
wishing to further develop their expertise in children’s health, and it will help
them with these responsibilities. Mental health is a key issue for child health
today, and this book will also be of value to professionals working in child and
adolescent mental health services, who have an interest in prevention.
4 Child Health
Some of the material will be familiar to some readers, but our aim has been
to bridge a number of divides between branches of the medical profession, dif-
ferent professions and disciplines, and the professional and lay perspective. We
hope that there will be something here to interest and inform every reader.
Defining a Common Interest
The challenge of addressing child health is that often the solutions facing the
problems of an individual child require a population approach; a simple pre-
scription will not suffice. An individual overweight child, for example, requires
a multi-level approach that involves parents, schools, and community resources
including the availability of fresh produce, parks and recreation, and the walk-
ability of the neighborhood. Thus, the health providers caring for children must
understand not only how to treat medical problems but also how to apply pub-
lic health principles, recognizing the social and environmental determinants of
health and collaborating with community partners to advocate for and develop
appropriate policies and programs.
Public health and clinical approaches are often presented as qualitatively dif-
ferent ways of responding to health and disease. The former is seen to focus on
populations and the latter on individuals—or one is “upstream,” concerned with
the causes of ill health, and the other is “downstream,” dealing with the conse-
quences. In practice, however, many child health workers combine individual and
population perspectives in their day-to-day work and share a similar aim—that
of optimizing the health and well-being of all children and adolescents.
Now, more than ever, there is a need to draw together all these perspectives
into a coherent movement that tackles the health and health-related problems of
children. People working with and for children across different disciplines need
to act together on the broad determinants of child health. This means acquiring
new knowledge and skills and working in new ways. This book aims to provide
some of the necessary information and tools.
Understanding and Responding
to Changes in Child Health
A key objective of child health is to explore and elucidate changes in health and
disease in children, to provide professionals with the tools needed to assess the
health needs of their child population, and to provide guidance on appropri-
ate ways of meeting those needs. A major shift in the patterns of morbidity and
Int roduc tion 5
mortality (ill health and death) has occurred over the past century in developed
countries, and it is important to understand the reasons for these changes and
to respond to them. As the burden of perinatal and infant mortality, infectious
disease, and malnutrition has declined, there has been an increase in multifacto-
rial disorders and conditions that require a more complex preventive approach.
These include mental, emotional, and behavioral problems; physical and neu-
rodevelopmental disabilities; and problems like obesity and asthma, which are
attributable to changes in the ways people live and the environments in which
they find themselves. These are often referred to as “millennial” morbidities, and
changes in these contexts require an eclectic approach and a diverse set of skills
in the people who seek to tackle them.
Child Health as an End in Itself and as
a Major Determinant of Adult Health
Children deserve the best possible health and maximal protection from harmful
influences. The United Nations Convention on the Rights of the Child (CRC)
encompasses many important principles of child health, including the right of
children to health, safety, identity, to be heard and listened to, and to participate
in their healthcare. As a society, we have a responsibility to ensure that children
have as good a start in life as we can give them and that they can enjoy their early
years as free as they can be from disease, disability, and distress—all with their
wishes and needs being understood and respected.
In particular, we have a responsibility toward disadvantaged children in this
country and in other countries where children’s rights are more likely to be
infringed and whose health, development, and self-expression is more likely to
be compromised. Disparities in child health are common; those from the lowest
social class have twice the chance of dying before their first birthday as those
from the highest social class, and almost all illnesses and causes of death are
more common among low-income and socially excluded children. The collec-
tive endeavor of child health has a crucial role in safeguarding children’s rights,
tackling health disparities in children, and ensuring that children’s health is kept
at the forefront of social policy, healthcare planning, and the national (and inter-
national) conscience.
Recent research has illuminated the contribution that physical and emo-
tional factors in infancy and childhood have on adult health and disease. This
has added additional impetus to research on child health and to the develop-
ment of disease prevention and health promotion initiatives among children as
future adults.
6 Child Health
The Structure of This Book
This book is divided into 10 chapters. The first chapter describes the history of
child health in the United States. This historical review depicts how the national
attitude toward children has evolved and how the patchwork of social policies
and programs has developed in our country as a result. The second chapter gives
a snapshot of the current state of child health and children’s issues. With these
two chapters, readers can gain an understanding of where we have been with
child health and how we arrived at the state of child health that prevails in the
United States today.
Chapters 3, 4, and 5 are conceptual chapters, focusing on major principles
behind a better understanding of the context, determinants, and trajectories of
child health. Chapter 3 describes children in the context of their families and
communities, with particular attention paid to the importance of the attachment
relationship between children and their primary caregivers (usually parents).
Chapter 4 describes the major social determinants of child health, reflect-
ing on major changes in recent decades and setting out the key challenges for
child public health today. Chapter 5 presents the concept of Life Course Health
Development and discusses how this theory can be used to understand how
social and environmental determinants of health can affect the developmental
trajectory of individual children and how programs and policies should be orga-
nized to optimize the health of entire populations of children.
Given our nation’s past and the importance and impact of immigration on
our history, Chapter 6 focuses on the issues of culture and immigration and how
they affect the health of millions of children. Chapter 7 provides an overview of
global child health and how children are faring in other parts of the world.
The last three chapters move the reader from theoretical to practical mat-
ters. Chapter 8 addresses techniques and resources for assessing health needs,
comparing the clinical and public health process of making a “diagnosis,” and
describes the sources of information available to support public health prac-
tice. It also considers approaches to evaluation and the generation of evidence
in public health, and it shows how these differ from approaches appropriate to
clinical care. Chapter 9 gives a brief overview of some essential concepts and
definitions in child public health practice. We explore the nature of health and
disease, the epidemiological notions of causality and risk, and some of the key
activities of public health, including health promotion and disease prevention.
This chapter aims to summarize these topics for readers new to public health.
It should also be a useful refresher for those trained in public health, offering a
child health perspective on familiar concepts.
Finally, Chapter 10 presents an overview of the community diagnosis process
in practice through 10 child health scenarios, each of which considers a different
Int roduc tion 7
issue. The aim of these case studies is to illustrate a range of “real” problems
in child health and possible approaches to tackling them. The topics covered
are these:
• Asset mapping—a public health approach to a community
• Addressing the vaccine debate
• Obesity
• Social media
• Early childhood education
• Mental health services
• Unintended consequences of high risk
• Cyberbullying
• Gangs and teen violence
• A policy approach to child malnutrition
Each scenario aims to demonstrate the approaches and techniques described
in earlier chapters, applying them to key child health issues with practical descrip-
tions of child health in practice. It is hoped that they will help practitioners from
a range of disciplines address the problems they face in their own practices.
Exploring the Variety of Random
Documents with Different Content
C. G. Schillings, phot.
BEARERS MAKING THEIR WAY THROUGH HIGH GRASS.
My former companion on my travels, Alfred Kaiser, describes, not
without a certain feeling of sadness, how he saw them once more,
not long, ago, under these new conditions, already to a great extent
changed by European influence—and changed in a way that was not
at all to their advantage. Using, instead of the beautiful Masai
dialects, some mangled fragments of English, they scornfully refused
objects of barter that were eagerly coveted ten years ago, and
insisted on coined money. They no longer wore their native
ornaments, but were dressed in European second-hand clothes. In a
word they were stripped of all the wild and primitive beauty that had
once distinguished them.
It is a hard fate, when a rude aboriginal people is all of a sudden
brought into touch with those of a high degree of civilisation.
As the former lord of the land5 was deprived of his rights, so the
same fate, more or less, befalls the splendid animal world that lends
its charm to these solitudes.
But then—ten years ago! I had been given back to life after sharp
suffering, and all that I was now allowed to see in such rich
abundance spoke to me in a more than ordinarily impressive
language, a language that seemed to me to have an enduring
charm.
And how clearly must this language have sounded in the times of
the primitive past!
So we may here attempt a picture of the wild life of the lake margin
in former days, on the lines of the sketches I have already traced out
of the life and activity of the wild herds of the plateau, as I still could
see them....
Out of the many memories of those days, that still work on me like
magic, there is one above all that has a special meaning, for me:
“Elelescho!”
But what is “Elelescho”? the reader will ask. “Elelescho”6 is the name
of a peculiar plant, perhaps it would be more correct to say a bush,
that has in many ways set its mark on the flora in the very heart of
the Masai region. Ranges of hills covered with silvery-leafed
Elelescho, the spicy smell of Elelescho, the water at the camping
place redolent of Elelescho—and also, in consequence, tea, coffee,
cocoa tasting of Elelescho—that is a memory that remains fixed
firmly in one’s thoughts of this home of the wild herds and of the
Masai. It Was these disappearing nomads who gave the bush its
beautiful name.
Possibly the musical sound of the name has not a little to do with
reconciling us in memory to the plant. For the bush itself has in
process of time monotonous effect not very to the senses, but for
this very reason all the stronger and more enduring. Its character is
connected by strong links of memory with our experiences of those
days, and the sound of its name awakes rose-coloured recollections.
For just as it is not given to man to remember exactly the nature of
intense bodily pains, so fancy, looking backwards, kindly blots out
much that was hard and little that was pleasant in the life we have
led. Thus it is that this strange bush, with its silver-grey leaves and
aromatic odour, is capable, as hardly anything else is, of awakening
in the mind of the traveller a kind of nostalgia—nostalgia for the
wilderness, to which he is drawn by so much of beauty and of
hardship. We have gained very little by learning that botanists
recognise our plant as one of the Compositæ, and name it
Tarchonantus camphoratus, L. It is to be found also in other parts of
Africa; and Professor Fritsch reported, as early as 1863, that he
found it growing in Griqualand, then still an unsettled country, where
it was called the “Mohatla.” It would be a pity if its beautifully
sounding Masai name were not preserved for future times, and I
must do my best to save “Elelescho” from such oblivion.
C. G. Schillings, phot.
THE CARAVAN ON THE MARCH.
One must have learned the word with its sweet-sounding
pronunciation from the lips of a proud, handsome, slender Masai
warrior in order to understand how so seemingly slight a thing can
imbue one’s impression of a whole land.
The Elelescho is as prominent in those regions as the oak and beech
or fir in Germany, or as the juniper, the heath, and the broom, and
has the same influence on the landscape. But it has a greater and
deeper influence upon the imagination, because it so dominates
those solitudes, that to him who has long travelled in them the mere
memory of it evokes a vivid picture of their once familiar aspect. The
strong scent of the Elelescho plant leads the Masai to wear the
leaves of the bush as a decoration round their ears for the sake of
its perfume. It belongs thus to the plants that because of their scent
are used as ornaments by warriors and maidens: “Il-käk ooitaa ‘l
muran oo ‘n—— doiye ‘l—— orôpili.”7 So there pass before us Masai
maidens, and Masai warriors decked with Elelescho leaves and
Elelescho branches, and received with sympathetic smiles by the
caravan leaders—who, however, unlike the Masai, think very little of
it. Very simple and naïve are the relations of these natives with
nature around them. Only the obvious, the actually useful, comes
into their thoughts, and for my black companions the Elelescho
always recalls only memories of poor desert regions of the waste—
regions in which they must often endure hunger and suffer many
hardships. Far different is the influence of the Elelescho region on
my feelings. For me this bush is symbolically linked with the plunge
into uninhabited solitudes, with self-liberation from the pressure of
the civilisation of modern men and all its haste and hurry.
We wish to feel once more, and to give ourselves up fully to, the
spell of the Elelescho—the charm of the Elelescho thickets, that are
also in South Africa in the lands about the Cape the characteristic
mark of the velt, now so lonely, but once alive with hundreds of
thousands of wild herds.
A wonderful night has come on.
The moon—in a few days it will be at the full—sheds its beams in
glittering splendour over Lake Nakuro.
The little camp is soon wrapped in silence. The weary bearers sink
into deep and well-earned slumber. Only the sentries, pushed far
out, are on the alert. It was but a few days since the rebel
Wakamassia hillmen were a source of danger to us, and nightly
precautions are not yet forgotten. The moonbeams flicker ghost-like
over the lake. Night-jars give forth their songs close to the camp all
round us. Strange sounds and cries ring out from the throats of the
waterfowl on the lake margins, and not far away one hears the
snorting of the hippopotami. Jackals and spotted hyenas prowl round
the camp, betraying themselves by their voices. The hyena’s howl
and jackal’s wailing bark mingle strangely with the deep bass note of
a bull-hippopotamus. Here in the wilderness there is hardly any
sound that is louder than the mighty voice of these giants of the
water.8
C. G. Schillings, phot.
A HERD OF ZEBRAS TAKING REFUGE FROM THE HEAT OF THE
MIDDAY SUN.
C. G. Schillings, phot.
FLAMINGOES ON THE MARGIN OF A LAKE. THEY MUST BE VERY
LONG-LIVED BIRDS, SOME OF THEM NOW LIVING IN THE
COLOGNE ZOOLOGICAL GARDENS HAVE BEEN THERE THIRTY
YEARS.
A strange feeling came over me. Amid all the ever-varying
sensations of the last year my capacity for enjoyment, my
sensitiveness to outside impressions, had been developed and
enhanced. A short time since I was between life and death,
struggling with the treacherous infection of fever. Now I was well. I
was breathing the air some three thousand feet higher than the
place where I lay ill near Victoria Nyanza. I was again in a region
whose vast volcanic solitudes contrasted strongly with its abundance
of highly developed organic life, and exercised a strange influence
upon me.
Is there such a place as Europe? Is it possible that thousands of
miles away there is a centre of civilisation whose teeming millions
would fain imprint their image on the whole earth, and even lay
covetous hands on this far-off wilderness, and that in time this must
happen?
A world of which I myself am a unit! How strange that I can delight
so deeply in all this wild charm! And how quickly the wishes of men
change! A while ago, in the long nights of fever, I had but one desire
—that my heart, my heart alone, should not be buried in a foreign
soil, but be taken back to the Fatherland.
And now, only a few weeks after my recovery, how different seems
to me all I may hope for from Fate, and how much more complex,
how much more difficult to accomplish!
I yield myself up entirely to the spell of the wilderness, to the mood
of the night.
That was ten years ago, before the Europeans had banished it—
when it ached on the senses like the nocturne of some great tone-
poet. But I know well that to-day it is no longer in existence; Lake
Nakuro is now only a lake like any other, and the railway whistle
wakes its echoes.
That night the spell must have been exceptionally strong. It seemed
to me as though I were under some charm, as if I were carried back
into the far-off times. There came before my mind much of what the
lake had seen in the long vanished past. The lands around me
heaved and quaked. Mighty earth-shaping forces were doing their
work. I seemed to see before my eyes what happened here in
primeval times—how volcanic forces, strange, boundless, and
terrible, had built up and given form to the country around me here,
destroying all living things, and yet at the same time preparing the
conditions for the hotly pulsating waves of life of later days. In my
mind I saw pass before me wondrous mighty forms of the animal
world of the past, long since extinct. Then—suddenly I started up.
What was that?
C. G. Schillings, phot.
FLAMINGOES FLYING DOWN TO THE LAKE MARGIN.
ALFRED KAISER (IN ARAB COSTUME).
A loud trumpeting ran in my ears! Elephants! Were there still extant
such herds of elephants as those that I saw coming down there to
the lake to drink, rolling themselves in the mud of its banks, and
openly making friends with the hippopotami? Just as in the daytime
I had noticed the different kinds of antelopes and the zebras, so
here I saw again the elephants and hippopotami living their life close
together, moving round or beside each other without fear or
hesitation. The herd, numbering many hundred heads, was guided
to its drinking-place silently and slowly by its aged leader, a female
elephant of most exceptional size. Many young elephants were there
in company with their mothers. Some very little ones, only a few
weeks old, played with their comrades, or knowingly imitated the
movements of the older animals in the water, while the old ones
took care to prevent the tender young creatures from taking any
harm.
But it all seemed somehow impossible! Veterans among the most
experienced black elephant-hunters had assured me that such huge
herds were not to be met with. And if I saw aright in the shimmering
moonlight, what a great mass of hippopotami were moving about
there before me! And now, paying, no attention to the elephants
that were peacefully bathing farther out in the muddy water, they
clambered on to the land, and began to graze like cows on the bank
among some more of the elephants. It was exactly the same friendly
relation that I had seen between the dwarf gazelles and the zebras
during the day. Could I be only dreaming? Such a multitude of huge
creatures here close to my camp—it could hardly be a reality!
GROUP OF GNUS. HARTEBEESTS IN THE BACKGROUND.
C. G. Schillings, phot.
NILE GEESE ON THE LOW BANK OF THE NATRON LAKE (LAKE
NAKURO). DWARF GAZELLES IN THE BACKGROUND.
A HERD OF GRANT’S GAZELLES.
C. G. Schillings, phot.
CRESTED CRANES AND ZEBRAS.
And now I perceived that a second herd of elephants, some
hundreds strong, was approaching the water. In a straight line these
still more giant-like colossi came down to the lake margin—all of
them, as I now clearly perceived, bulls with mighty tusks, and
amongst them some quite enormous tuskers, obviously patriarchs of
the herd, and carrying some hundreds of pounds’ weight of ivory
that glittered afar in the moonlight.
The two herds greeted each other with their curious cries, difficult to
describe, and then the newcomers began to bathe and drink.
My attention was especially arrested by some of the elephants,
clearly visible in the moonlight, keeping apart from the rest.
Standing together in pairs they caressed each other with their
trunks, while the enormous ears which are such an imposing
decoration of the African elephant stood out from their heads, so as
to make them look larger than ever.
My wonder increases! Numerous herds of giraffes, hundreds strong,
come down to the lake, and this, too, not far from the elephants,
and without any fear.
And now there is again a new picture! A herd of innumerable
buffaloes. With their great formidable heads turned watchfully
towards the rest of the crowd, they too are coming for a refreshing
bath. Their numbers still increase. It is a sight recalling, surpassing
even, the descriptions given by the first travellers over the velt
regions of Cape Colony.
How did all this accord with the reports I had received of the scarcity
of elephants? with the destruction of the buffalo by the cattle
plague? With my own previous experiences? The most authoritative
of my informants had assured me that in this district the elephant
was to be found very rarely, the buffalo hardly ever!
Suddenly with mysterious swiftness the night is gone, and the day
breaks. I search for and find the tracks of my giant guests of the
night. I had made no mistake. Monstrous footprints are sharply
impressed in the mud, the ground looks as it had been ploughed up,
and in the midst of the plain, not very far from the lake, there are
actually hundreds of mighty elephants standing near some ol-girigiri
acacias. As I begin to watch them, they suddenly become restless.
In their noiseless way they make off at an extremely quick rate, and
soon disappear behind the nearest ridge.
Round about me I see herds of zebras, hartebeests, and wild
animals of all kinds in vaster numbers even than those yesterday.
The deep bellow of the wild buffalo breaks upon my ear. I can see
long-necked towering giraffes in the acacia thickets. The snorting of
numerous hippopotami sounds from the lake. Some of these burly
fellows are sunning themselves on its margin; and quite close to
them several rhinoceroses are grazing peacefully in the midst of their
uncouth cousins.
I am surprised, too, at seeing a troop of lions disappearing into the
bush, after having made a visit to the water. They are so close to me
that I can plainly see by the shape of their bodies that they are
going home after having had an abundant repast.
C. G. Schillings, phot.
A CAMP ON THE VELT.
The behaviour of my people puzzles me. I had no opportunity for
questioning them as to why they were not more impressed by this
unexpected spectacle, for my attention was suddenly arrested by the
appearance of a lengthy caravan of bearers, that seemed as if it had
emerged before my eyes from the trampled ground. There is new
life and movement among the herds of wild animals. Slowly,
defiantly, or in swift-footed fear, each according to its kind, all these
wonderful creatures seek safety from the approaching crowd.
A robust negro marches at the head of the caravan. He carries a
white flag inscribed all over with texts from the Koran. Hundreds of
bearers come steadily in. Each carries a load of nearly ninety
pounds’ weight, besides his cooking gear, sleeping-mat, gun and
powder-horn. At regular intervals grave-looking, bearded Arabs
march among the bearers. Two stately figures, riding upon asses
and surrounded by an armed escort, are evidently the chiefs, and a
great drove of asses with pack-saddles laden with elephant tusks
brings up the rear. Very quickly the numerous party establish their
camp, and I now remark that hundreds of the bearers are also laden
with ivory. It is clearly a caravan of Arab ivory-traders.
After the usual greetings—“Sabal kher” (“God bless thee”), and
“Salaam aleikum,” questions are asked in the Swahili language:
“Habari ghani?” (“What news?”) I now learn that the party of
travellers set out some two years ago from Pangani on the coast to
trade for ivory in the Masai country. I am surprised to hear the Arabs
tell how, although theirs is one of the first caravans that have made
the attempt, they have penetrated far into the inhospitable and
perilous lands of the Masai. Their journey has been greatly delayed,
for they have had to fight many battles with the Wachenzi, the
aborigines of the districts through which they marched. “But Allah
was with us, and the Unbelievers had the worst of it! Allah is great,
and Mohammed is his prophet!”
Every one set busily to work. In the turn of a hand the camp was
surrounded with a thorny zereba hedge, and made secure.
And now I had personal experience of what has passed, times
without number, in the broad lands of the Masai;—armed
detachments from the caravan started on raids for far-off districts.
The timid Wandorobo, that strange subject tribe of the Masai,
brought more and more ivory to the camp to sell it to the traders,
after long and obstinate bargaining. It was remarkable how clever
were the people of the caravan in dealing with these timid wild folk,
and how well they knew how to gain their confidence.9 This
confidence, however, was not made use of in trade and barter for
the advantage of the natives. But thanks to the methods and ways
of managing the natives, as the traders understood them, we saw
that the wild folk were quite satisfied, and this was the main point.
C. G. Schillings, phot.
NATIVE SETTLEMENT WITH PALISADE AND ZEREBA (HEDGE) ON
THE MIDDLE COURSE OF THE PANGANI RIVER. (PROTECTIVE
CHARMS ARE PLACED OVER THE GATEWAY AND IN FRONT OF IT,
IN THE FOREGROUND OF THE PICTURE.)
But what patience is required in trade of this kind! A white man
could never develop such Oriental patience. Again and again a tusk
would be endlessly bargained over, till at last, often after days of
chaffering, it passed into the possession of the caravan. The natives
were of course bent on getting the tusks, sooner or later, into the
camp. At the very outset they had sent in a most exact description
of them, and then envoys from the caravan had to go and inspect
them, often at a distance of several days’ march from the camp.
Every day a great number of Masai warriors appeared in the camp.
Men belonging to many kraals, owners of great herds of cattle,
camped near the lake. There were not infrequent skirmishes,
especially at night time. The young warriors, the Moran, made
attempts at plunder, and were beaten off with broken heads. But, on
the whole, this hardly disturbed the good understanding. “It is their
testuri (custom),” thought the experienced and fatalistic coast folk,
and they accepted it as an unavoidable incident of the trade. But
festivals were also arranged, with dance and song. In the still
moonlit nights the strange chant rang out in a high treble far over
the plain, and sounded in the rocky hills, and festivity and rejoicing
reigned among the warriors, the girls, and the women.
But by day one saw their busy life displayed, all the bucolic poetry of
grazing herds of cattle with their spear-armed herdsmen. There was
a great deal to be done, and in each and every task the Masai girls
and women showed themselves, like the men, excellent guardians
and attendants of their herds.
In the neighbourhood of the Masai kraals the wild animals of the
plain mingled freely with the tame cattle of the Masai, knowing well
that the Masai folk would not shoot them. The wild animals were
exposed only to the attacks of the Wandorobo. But these latter bore
themselves very shyly in the presence of their over-lords, the Masai,
and went off to far distant hunting grounds, so that the wild animals
were hardly ever disturbed by a hunter.
The young Masai warriors also began to devote themselves to
hunting for ivory. With great courage, and often with no small
display of dexterity, they killed a large number of elephants, allured
by the high prices offered by the caravans. But they kept the
beautiful tusks carefully hidden, buried in the earth till the moment
when they had successfully arranged a sale. The buried treasure was
easy to conceal. At the place where the tusks were put away the
grass was set on fire and burned up over a considerable area, and
then no eye could distinguish the slightest indication of the buried
treasure.
The Elmoran also made use of a method of hunting which is
employed in other parts of Africa, namely, to slip quietly up to an
elephant, and with a single powerfully delivered sword-cut sever the
tendon Achilles. But few indeed were daring enough to attempt this,
and these were strong, brave, and well-trained warriors. Such an
exploit won for them high respect among their comrades of the clan.
C. G. Schillings, phot.
ELAND-ANTELOPES RALLIED IN A GROUP BEFORE TAKING TO
FLIGHT.
C. G. Schillings, phot.
A HERD OF WHITE-BEARDED GNUS. IN THE BACKGROUND ONE
OF THE CHARACTERISTIC HILLS OF THE MASAI UPLANDS.
While the Masai warriors thus took their share in elephant-killing,
and the Wandorobo stuck to their long, trusted poisoned darts and
poisoned spears, the caravan folk attacked the elephants with
powder and iron bullets,10 and slew whole hecatombs of them.
“Nowadays,” the leader of the caravan told me, “the chase is easier
and less dangerous, and your firearms also give the man from the
coast the power of hunting and killing the Fihl (elephant). For
example, you know, sir, that my half-brother, Seliman bin Omari, is
not a practised hunter. And yet, believe me, he and his people have
brought down many, many elephants.”
But his banker on the coast, the Hindoo Radda Damja, certainly
never hears one word of any elephant being killed by Seliman’s
people:
“No one is so clever as he is at knowing nothing about elephants
when questions are asked. The ivory is always something traded for
with the natives, far, far away in the interior,” he adds, with a
cunning wink. “The main point is that we all get pembe (ivory), and
he gets plenty of it! I would like to work the business as he does,
but, sir, I am not so clever in preparing amulets, and moreover, I
don’t know as much as he does of the ways of the elephant.
“But it’s a pity that in all parts of the country the ivory is becoming
very scarce, so one has to be going always farther into the interior,
and one must try to find new ivory districts.”
Thus my Arab informant talked a long time with me. He told me
much that was interesting and much that was new to me. He told
me of caravans that had been massacred, cut off to the last man by
the natives in remote districts: and again of caravans that had been
not one or two,—no, as long as six years on the march, that had
buried a lot of ivory and gradually got it down to the coast. Time
counts for nothing here, for the people—that is to say, those who
are not slaves—receive only the one lump sum agreed upon for the
journey, no matter how long it lasts. His friends, with caravans
mustering many hundreds, had carried hundreds and hundreds of
barrels of gunpowder into the interior, they had sought everywhere
for new districts abounding in ivory, and the result had been the
slaughter of the elephants on all sides. Nevertheless he had not
much to tell me of men having enriched themselves by this trade.
However, this did not apply to the traders on the coast, who
advanced the money. These lent money to the caravan leaders, who
went into the interior, at the high rate of interest usual in the East,
and thus became rich men. They had, of course, also many losses. It
happened not seldom that one of their debtors was “lost” in the
interior, which means that he simply did not come back, but chose to
pass the rest of his life in exile. And in that case it would be a
difficult matter for the creditor to take proceedings against him.
C. G. Schillings, phot.
A MASAI DANCE—THE PHOTOGRAPH SHOWS THE PLAITED QUEUE
WORN BY THE YOUNG WARRIORS (EL MORAN), WHO LEAP AS
HIGH IN THE AIR AS THEY CAN. THE YOUNG WOMEN, WHOSE
HEADS ARE CLIPPED COMPLETELY BARE, SING AND DANCE
ROUND THEM.
Then my informant told me how many of the elephant hunters still
living had been carrying on their business already for a long time
before any Europeans whatever thought of making a prolonged stay
in the country. He told me also much that was interesting about the
old trade routes extending far through Africa, and even to the
Congo. He had friends and relatives who had already traversed these
routes many times, and journeyed from the east coast even to the
Congo, long before any European traveller. Many of the people of his
caravan were able to tell from memory each day’s journey as far as
the Congo, and give exact information about the chiefs who held
sway in each district, and the possibility of getting supplies of
various kinds of provisions, such as maize, millet, bananas, or other
products of the country.
I cannot exactly say how long he had talked with me about
elephants and elephant-hunting, about the ivory trade, and many
other things. I only know one thing—that after some time his talk
became more and more difficult for me to understand, that I strove
in vain against an ever-increasing weariness, and that at last I saw
neither the Arab nor the caravan—in a word, saw nothing more, felt
nothing more.
I fell into a deep sleep in which, in my dreams, I had a lively
argument with some Europeans, who would not believe so many
elephants, buffaloes, and other wild animals had formerly been here,
and who kept on objecting strongly that it was impossible that all
this could have been the case so short a time ago.
When I woke up again I found myself in my lounging-chair, a
primitive piece of furniture of my own construction. My black servant
stood before me, and asked me if I would not rather go to bed.
I rubbed my eyes—it had all been a dream, then; the spell of
Elelescho must have inspired me with it. How foolish to yield to this
spell! But men will perhaps so yield to it when all this has become
“historical” and the Masai and their lives and deeds have, like the
Redskins of America, found their Fenimore Cooper.
Then may the spell of the Elelescho exert its rightful power; then
may it make famous the slender, sinewy, noble Masai ol-morani as,
amidst his fair ones, his “doiye,”11 he leads the song-accompanied
dance as he goes out to war, and reigns the free lord of the
wilderness! But to-day he bears on his brow the significant mark of
an inexorable fate—that of the last of the Mohicans.
The spell of the Elelescho has departed from Lake Nakuro, once so
remote from the world.
The lake is no longer remote.
Iron railway lines link it with the Indian Ocean. Vanished from it is
the spell that I once felt both waking and sleeping; gone is the
poetry of the elephant herds, the Masai, the Wandorobo, and the
caravan life in all its aspects; gone all that I saw there. The traveller,
if he would learn to know the primitive life and ways, whether of
men or of the animal world, if he would know the primeval harmony
that speaks to him in an overpowering language peculiar to itself,
must press on into the wilderness farther away from these tracks.
This harmony, whose special character is day by day disappearing,
day by day is in an ever increasing measure destroyed, cannot be
recalled under the new, the coming system, the system that
abandons itself to restlessness—that, in a word, which we call
modern industry, modern civilisation.
A HERD OF WHITE-BEARDED GNUS AT CLOSE QUARTERS.
C. G. Schillings, phot.
A MORE DISTANT VIEW OF THEM.
THEY SHOW THEIR DISQUIET BY SWINGING THEIR TAILS.
C. G. Schillings, phot.
FINALLY THEY DECIDE TO BEAT A RETREAT.
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade
Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.
Let us accompany you on the journey of exploring knowledge and
personal growth!
textbookfull.com