The most important problem facing American children today

What is the most important problem facing American children today?

According to the Academic Pediatric Association and the American Academy of Pediatrics, it is the effects of poverty on the health and well being of young people. But, they concede, there is no sustained focus on childhood poverty, or a unified pediatric voice speaking on the problem, or a comprehensive approach to solving it.

To try to remedy that, the American Pediatric Association Task Force on Childhood Poverty is beginning a long-term effort to address the problem by looking for solutions that will be effective, sustained and “protected from retrenchment,” according to this brief about the work of the panel.

Children in America are the poorest members of society. One in five children live below the federal poverty line, and almost one in two are poor or near poor, with a disproportionate burden falling on the very young, racial and ethnic minorities, Native Americans and children from immigrant families. The task force plans to pay special attention to helping these groups of children.

The role of poverty on student achievement has been one of the flashpoints between supporters and critics of modern school reform. Supporters insist that citing poverty as a reason for lack of student achievement is “an excuse” made by people who want to support the status quo. Critics of reform say that the major reform efforts ignore the effects that living in poverty have on children and their ability to do schoolwork and perform on standardized tests.

The Pediatric Academic Societies just had a plenary session in Washington, D.C., titled “A National Agenda to End Childhood Poverty,” where calls were made for a comprehensive approach to attacking child poverty. It was noted that there are solutions, as evidenced by efforts in other developed countries, including Britain, which dramatically reduced childhood poverty with sustained national efforts.

Here’s some of the brief about the task force:

Children are the poorest members of our society, a society that knows how to use policies and programs to raise its citizens out of poverty. Thirty five percent of seniors lived below the FPL  [federal poverty line] in 1959, but due to programs like social security expansion and Medicare, only 9% of seniors are poor today. What the US does for seniors is clearly good; so why do we not also protect children from the life-altering effects of poverty?

 

The effects of poverty on children’s health and well-being are well documented. Poor children have increased infant mortality, higher rates of low birth weight and subsequent health and developmental problems, increased frequency and severity of chronic diseases such as asthma, greater food insecurity with poorer nutrition and growth, poorer access to quality health care, increased unintentional injury and mortality, poorer oral health, lower immunization rates, and increased rates of obesity and its complications.

 

There is also increasing evidence that poverty in childhood creates a significant health burden in adulthood that is independent of adult-level risk factors and is associated with low birth weight and increased exposure to toxic stress (causing structural alterations in the brain, long-term epigenetic changes, and increased inflammatory markers).

 

The consequences of poverty for child and adolescent well-being are perhaps even more critical than those for health. These are the consequences that may change their life trajectories, lead to unproductive adult lives, and trap them in intergenerational poverty. Children growing up in poverty have poorer educational outcomes with poor academic achievement and lower rates of high school graduation; they have less positive social and emotional development which, in turn, often leads to life “trajectory altering events” such as early unprotected sex with increased teen pregnancy, drug and alcohol abuse, and increased criminal behavior as adolescents and adults; and they are more likely to be poor adults with low productivity and low earnings.

 

At present, there is not a consistent and unified pediatric voice speaking out about childhood poverty, the most important problem facing children in the United States today. The Academic Pediatric Association (APA), the American Academy of Pediatrics (AAP) and the Pediatric Policy Council (PPC) all advocate for individual issues (such as Medicaid, Child Health Plus, and food supplementation) that are important programs related to childhood poverty. There is, however, no sustained focus on childhood poverty itself, which underlies many of the ills of children, and which needs to be addressed in a comprehensive manner.

The task force will focus on four strategic priorities:

* Raising families out of poverty
* Providing high-quality early childhood programs and high-quality affordable child care to poor families.
* Promoting a White House Conference on Children and Youth
* Working with Neighborhood Revitalization Initiatives

Part of the task force’s work regards education:

The Task Force has set up a subcommittee to develop educational products and activities regarding childhood poverty for medical students, residents, fellows, faculty, practitioners, and other child health providers. These efforts will promote:

1. Understanding the impact of poverty and other social determinants of health on well-being over the life course and across generations.

2. Development of the knowledge, skills, and attitudes necessary to implement the elements of the PCMHC.

3. Advocacy training toward poverty reduction in conjunction with the AAP Community Training and Advocacy Initiative (CPTI), and models of advocacy training from residency training programs across the US. We will work to build statewide and regional collaboratives uniting the pediatric voice across the nearly 200 pediatric training programs in the US. Collaboration with other organizations offering advocacy training may also be important, including efforts of the American Academy of Family Physicians, the American Medical Student Association, Physicians for a National Health Program, and others.

Valerie Strauss covers education and runs The Answer Sheet blog.
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Valerie Strauss | May 14, 2013