SECOND OPINION

Creating a Positive Impact on Child Poverty

This year marks the 50th anniversary of the launch of President Lyndon B. Johnson's "War on Poverty." In your opinion, what health issue related to child poverty should pediatricians and pediatric specialists focus on most to have a positive impact?

4 Responses
Seth Alpert, MD
January 6, 2016

The most important health issue related to child poverty that we see in a pediatric specialty clinic may be access to appropriate medical care, whether that means finding a primary care physician that is conveniently located to the family and accepts Medicaid; having reliable transportation to make it to healthcare appointments; or finding specialists in underserved areas who will see patients for medical and/or dental issues.

While we live in a wealthy country with a very advanced healthcare system, often your ability to receive adequate and convenient healthcare depends directly on your ability to pay. While the various government assistance or charitable programs that are available can bridge this gap to some degree, they can be overused, misused or, conversely, offer bureaucratically limited care such that the general public may only hear about the negatives of these programs rather than the many positives.

Unfortunately, child poverty is a multi-factorial, socioeconomic condition for which there are no simple fixes, but hopefully both individuals and society as a whole can continue to seek the complex roots of the problem and work toward its solution.

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Paul Casamassimo, DDS, MS
January 6, 2016

Poverty brings with it a host of social determinants of health that do not often accompany children outside of poverty in the same constellations or amounts. We are challenged with dealing with organic disease that, in many cases, is the easy part of care. Managing the socioeconomic factors that support disease and impede care as comorbidities is the real challenge, and one that is often grossly underestimated.

The greatest challenge is not only offering comprehensive care that encompasses the medically sound approaches to addressing disease, but also those elements of lifestyle that can impact prognosis, recurrence and compliance. In terms of oral health, we often deal with low health literacy, advanced disease at an early age, limited resources that affect diet and dental fatalism as a result of generational poverty or cultural influences. For clinicians working with families in poverty, it is important that we understand its impact in each individual situation and not prejudge and categorize them.

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Benjamin T. Kopp, MD
January 6, 2016

It would be easy for me as a pediatric pulmonologist to focus on asthma risk factors or the outrageous cost of preventative medications as key issues for impoverished children, but I think obesity remains our greatest challenge going forward.

The food options in the United States that most low-income families can easily access and afford are often not the same ones we advocate for every day, such as fresh fruits and vegetables. I believe the lack of access to adequate nutrition is spurring on the obesity epidemic we are facing, leading to a multitude of downstream health effects. Long-term health issues related to obesity can include social stigma, diabetes, heart disease and worsened asthma control, so this health issue directly affects every pediatrician and sub-specialist. Therefore, it is an issue that everyone can address.

The war on poverty is about access: access to care, counseling, medical monitoring and affordable foods and medications. One of the important aspects of poverty-related obesity is the impact that early interventions can have on preventing obesity. With a keen eye on targeting obesity prevention in young children in low-income families, we might have a shot at ending this war before the casualties of escalating obesity continue to rise.

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Kelly Kelleher, MD, MPH
January 6, 2016

The great triumphs of pediatrics, healthcare and public health in improving infant mortality, infections, injury and chronic disease have not been shared equally in our society. Our poorest children have rates of disease and death similar to those of children from 50 years ago. Poverty mocks our best clinical efforts, even though many pediatricians and specialists struggle individually to provide better care to low-income patients.

Poverty takes its toll through the rapid accrual of multiple risk factors or the “social determinants of health” aimed at young children and their families. Violence, hunger, drugs and exposure not only affect developmental, psychological and health problems, but also the acceptance of health-risking behaviors like smoking and lack of exercise.

Traditional health services by themselves are not adequate to address these problems, nor can they work effectively for many chronic conditions in the face of these problems. Instead, community collaborations that engage multiple sectors like education, employment, justice and healthcare simultaneously in our most difficult neighborhoods will be necessary to make a dent in child and young family outcomes. In fact, there are promising data from cities like New York and St. Louis about how much child health improves for poor children when the requisite willpower is engaged.

Pediatricians and their healthcare institutions hold high moral, political and financial standing in most communities. Thus, they are well positioned to address what I believe is the single biggest issue related to poverty: the need for broad political, health and educational coalitions to change our highest-risk neighborhoods through a refusal to accept that poverty, with its concentration in very specific geography, is a permanent sentence against our most vulnerable children.

About Writer

Dr. Kelleher is a pediatrician whose research interests focus on accessibility, effectiveness and quality of health care services for children and their families, especially those affected by mental disorders, substance abuse or violence. He has a longstanding interest in formal outcomes research for mental health and substance abuse services. Dr. Kelleher is director of the Center for Innovation in Pediatric Practice and vice president of Health Services Research at The Research Institute at Nationwide Children’s Hospital. Dr. Kelleher is also professor in the Department of Pediatrics of The Ohio State University College of Medicine.

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