Jarret Patton MD
We must work together to combat the ill effects of poverty on our children.
Today marks an event that draws attention to child poverty, Red Nose Day. This event was started in the mid 1980’s as a comedic fundraising event to raise awareness and funds to help children. Annually, this event takes place affecting the lives of millions of children globally while raising over $1 billion since inception. With busy personal and professional lives, taking a moment to be grateful for all of our fortunes including independence, health, food and shelter can put everything in perspective. I have this unhappy reminder often as I take care of many children who are in unfortunate circumstances.
The basic necessities of food, shelter and clothing are not a given for all. 19% of children in the United States live at or below the Federal Poverty Guideline. Currently, this means that a family of four makes less than $24,600 annually. This is hardly enough to provide reasonable basic needs to children in the Northeast or any major metropolitan area across the country. 41% of children in the US live in low income families ($49,200 or less for the same family of four annually).
Social needs can be more important than the medical needs of children as the health effects of childhood poverty lasts a lifetime. Insufficiency of resources has an incredible adverse impact on structural brain development further impairing academic functioning (1). Having little school success will lead to lower paying jobs in the future, thus continuing the cycle of poverty. There is also a higher likelihood of dying from cardiovascular disease, asthma or type 2 diabetes. Furthermore, behavioral or mental health issues may persist through adulthood. All of this is compounded by living in a state of toxic stress (2).
Often during the hustle of our busy days, we may forget that someone may have taken over two hours and three busses to get to their appointment when we turn them away for being 15 minutes late. We may not realize that children, or their parents, may act out or seem agitated as a result of food deprivation or inaccessibility to behavioral health services. Taking a moment to understand the circumstances may go a long way to improving both customer relationships and health outcomes.
Across the nation, municipalities have taken advantage of food banks, communal gardens, medical-legal partnerships, community exchanges and other neighborhood based interventions to help temper the effects of poverty. These collaborations have made some headway to create healthier residents by addressing both medical and social needs (3). These civic alliances develop goals and objectives, take a plan of action, and determine funding streams to build a sustainably healthier society (4).
Some hospital systems are taking it upon themselves to help bend the curve towards health while lowering the costs of care. They are deploying teams of employees into the community. These workers can include care managers, social workers, clinical pharmacists and behavioral health specialists that work with clinicians and practices. For instance, asthma navigators can help parents understand the effects of the disease within the context of their own home while enabling the child to take better care of herself.
The need to take care of our patients is greater than simply dispensing clinical care, writing prescriptions and performing interventional procedures. Community interventions in conjunction with episodic clinical care have demonstrated success in cities across the nation. Entire neighborhoods and communities must be involved to combat the ill effects of poverty on our children. Take a stand against child poverty and get involved in your community.
(1) Hair NL et al. Association of Child Poverty, Brain Development, and Academic Achievement. JAMA Pediatrics 2015. 169:9
(2) Raphael D. Poverty in childhood and adverse health outcomes in adulthood. Maturitas 69. 2011
(3) Bachrach et al. Addressing patients’ social needs: An Emerging business case for provider investment. The Commonwealth Fund. May 2014.
(4) Heinze AW et al. A Roadmap to Address the Social Determinants of Health Through Collaboration. Pediatrics. September 2015. 136:e993