Materials for this week:
- Case discussion
- AAP Policy statement “Poverty and Child Health in the US”, Pediatrics 2016 and resources at aap.org/poverty
- Determinants of Health and Pediatric Primary Care Practices, Beck et al., Pediatrics 2016 (co-authors include our own amazing gen peds faculty Dr. Tumaini Coker!)
- Seattle area patient advocacy resources (thanks to Abby Grant and REACH team for initially compiling!)
- How many children live in poverty? Unfortunately, children represent the group with the highest poverty rates in the US, with 22% living below the federal poverty level (FPL). In 2019, the FPL is $25,750 in annual income for a family of 4. If you include those living at 200% of the FPL, or “near poor”, that represents 43% of children – almost half – I find this statistic somewhat shocking, yet so important to know. Since 2013, the majority of children enrolled in public school live in poverty. The FPL method was developed in the 1960s, and many argue that it is outdated and understates the true scope of poverty in the nation. There are major inequities in poverty rates, with children of color experiencing much higher rates of poverty. The PBS series “America by the Numbers” highlighted striking disparities in health related to poverty.
- What are the effects of poverty on health? Poverty represents one of the biggest threats to children’s health with far-reaching effects. Bauman et al. (Pediatrics 2006) stated “Poor children are almost twice as likely to be in fair or poor health, are 1.7 times more likely to be born low birth weight, are 3.5 times more likely to suffer from lead poisoning, are twice as likely to experience stunting, and are more likely to be diagnosed with severe chronic health conditions. Poor children are 1.7 times more likely to die in infancy and 1.5 times more likely to die in childhood.”
- Where can we learn more about the science of poverty and its effects on children? The Academic Pediatric Association (APA) Task Force on Child Poverty developed the U.S. Child Poverty Curriculum, a series of 4 stand-alone modules to promote understanding of the impact of poverty and other social determinants of health on child well-being, the biomedical influences of poverty, and advocacy. The AAP has many resources for pediatricians to learn about and address poverty through advocacy.
- How do we tackle poverty in the office? Dr. Benard Dreyer, past president of the AAP, helped develop the AAP’s first policy statement on poverty and recommended that pediatricians screen for poverty risk factors. As we reviewed last week, I-HELP is a screening tool to remember ways we can address concrete needs by asking and linking to resources for Income, Housing, Education, Legal (immigration), Personal & Family stability. Other screening tools including for food insecurity are reviewed here. We can also help parents develop positive relationships with their children that are protective and build resilience, such as those approaches taught in the Promoting First Relationships curriculum. It’s also hopeful to consider more sweeping structural changes including revamping primary care delivery, providing home visitation, care coordination, and parenting programs, all described by Drs. Beck et. al (see above).
- What can we do to address poverty at a policy level? We can advocate with our national organizations for policies that benefit families including benefits and tax support. Many possibilities were outlined by Dr. Dreyer in his Case For Ending Childhood Poverty.