It has been well described that poverty is associated with poor health, starting from time in the womb all the way into adulthood. Poor children have higher rates of infant mortality, low birth weight, food insecurity, and unintentional injuries. They also have a higher incidence and worse severity of chronic diseases such as asthma and obesity. As these children grow older, they are at higher risk of poor educational achievement, teen pregnancy, and inability to escape poverty. Finally, most poor children unfortunately grow into poor adults with higher rates of diabetes and cardiovascular disease, depression, substance abuse, and ultimately shorter life expectancy. Lately, a growing body of evidence has shown that toxic stress experienced by developing children fundamentally changes their biology – altering brain development, the immune system, hormones, and metabolism in ways that predispose to illness. As pediatricians, we should understand that addressing the effect of poverty on our patients’ health requires more than seeing families individually in the office. It will require our voices in broader social institutions.

The causes of poverty are myriad and complex and involve long term economic changes in the types and locations of jobs, the suburbanization of white America made possible by federal housing policies and large highways through the urban core, and a history of systematic racism and housing segregation that has created pockets of concentrated poverty in the inner city. No matter what the cause, the unfortunate reality is that a vicious cycle exists in many American cities, and poor children are statistically unlikely to escape poverty. Poor neighborhoods today are unattractive to higher income families and businesses, so lower tax revenues are collected. Accordingly, crucial services such as good schools and public safety are underfunded. Without access to adequate education and job opportunities, young residents are unable to move out of poverty, and the cycle continues.

While the problem of poverty may seem too daunting for pediatricians to tackle, there are many ways in which our voice as trusted advocates of child health can be harnessed and utilized. First, we can educate our families, educators, and policy makers about the biological and epidemiological evidence that concentrated poverty has on developing children. We should also seek to scientifically study what interventions are proven to prevent or treat the negative physical and mental health effects of poverty. This will require both funding as well as a broader concept of what medical research entails beyond the laboratory or hospital setting. Finally, we should loudly voice our support for public policies that will address the root causes of poverty such as improved public education, better wages for low-paying work, and fair housing policies that actively combat segregation. Such policies that improve the quality of life for low income children and eventually reduce families’ reliance on public assistance can enjoy bipartisan support and should be championed by pediatricians. While these types of activities may seem beyond the scope of practice or training for many physicians, it is important to realize that the real change necessary to improve health outcomes for children sometimes requires a broader perspective.

Andrew Yu, MD

For more information, please see the following resources:

AAP Poverty and Child Health: https://www.aap.org/en-us/about-the-aap/aap-facts/AAP-Agenda-for-Children-Strategic-Plan/Pages/AAP-Agenda-for-Children-Strategic-Plan-Poverty-Child-Health.aspx

AAP Policy Statement on Toxic Stress: http://pediatrics.aappublications.org/content/129/1/e224.full.pdf+html?sid=1ac1e530-4470-400e-939e-12253f8fdd74

NYT Income Gap, Meet the Longevity Gap: http://www.nytimes.com/2014/03/16/business/income-gap-meet-the-longevity-gap.html