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Thursday, November 15, 2007

The Greatest Threat to Children's Well-Being
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Snap quiz: What do you think is the greatest public health threat to children in the U.S.?

Hints:
  • Approximately 13-40 million children in the U.S are exposed to this risk (depending on how you define it).

  • The younger you are, the more likely you are to be exposed to it (43% under 3 years, 35% ages 15-17).

  • Minority children are more likely to be exposed to it (35% of black children, 29% American Indian, 28% Latino, 11% Asian and 10% white)

  • Because most kids in the U.S. are Caucasian, more white kids are exposed than any other group.

What could it be? Obesity? Drug resistant bacteria? Car accidents? TV? Sex, drugs and rock & roll? Jerry Springer?

* * * *

The answer is poverty.

Poverty is - by far - the greatest public health menace facing American children. Its victims, however, are small, powerless, and seemingly far away. It is, in large part, a silent epidemic.



I'm sure it comes as no surprise that children born into impoverished circumstances are at higher risk for any bad health or developmental outcome you can name. In fact, they experience "double jeopardy":

  1. They are more likely to be exposed to threats to their well-being (pick your poisons: inadequate nutrition, underfunded schools, overcrowded homes, lack of access to health care, family dysfunction, neighborhood and domestic violence, abuse and neglect, inadequate child care, lead poisoning...).

  2. They experience worse long term outcomes when exposed to these threats than do advantaged children.

* * * *

I have spent my professional career working in an urban, inner-city hospital and have witnessed poverty's devastating impact on children and families. But let me be clear: I'm neither a masochist nor a saint. More often than not I am inspired as I see children and families triumphing over their adverse circumstances, working with all their hearts to fashion meaningful and worthwhile lives out of the many challenges. I often wonder: would I be as courageous, as resourceful, as resilient, had I been born into such economic adversity?

Having said that, I don't want to romanticize the lives of poor families. Poverty sucks - no two ways about it. It can contaminate all aspects of a child's well-being and, subtly and tragically, prevent a child from reaching his full potential - for academic success, for rewarding work, for meaningful relationships, for good health, for happiness.

Given poverty's pervasiveness and its corrosive effect on our society, I'm distressed that the needs of poor families are pretty much off the political radar screen. That's why I hope you'll stick around my blog as I share some what I've learned about children and families living in poverty and why I think it's such an important issue to tackle.

* * * *

Let's start with a simple question: what makes a family "poor"?

Since being poor is an intensely personal experience, I'd like you to think about what would be your definition of poverty for your own family. Let's assume you are living in a family of 4 - two adults and two kids. What is the minimum income you would need to not consider yourself poor? I realize, of course, that this is totally arbitrary (as all definitions of poverty are) but go ahead and be as arbitrary and as personal as you like. What is your poverty line for a family of 4?

* * * *

Here's what Uncle Sam has to say on this matter. The established Federal poverty line for a family of 4 is $20,640.

Surprised? I suspect your personal poverty line was much higher than $20,000 (most come up with at least 2-4 x that amount). It seems so paltry. Where did this number come from?

The federal poverty line was created in the 60's to boost the War on Poverty (after all, how can you conduct a war if you can't identify the enemy?). They were looking to set an absolute income threshold below which families would "lack the resources to meet the basic needs for healthy living, having insufficient income to provide the food, shelter and clothing needed to preserve health." Fair enough.

Then they reasoned thusly: A family spends about 1/3 of their income on food, 1/3 on housing and 1/3 on other stuff. Let's estimate the minimum a family could pay for food and remain adequately nourished (called the "thrifty food plan"). Multiply that number by 3 and, presto, the federal poverty line is born.

Do the math and you'll see that in 2007 this amounts to spending about $15 a day on food for a family of four. You got a problem with that? And, as I'm sure you've realized, housing now grabs much more than 1/3 of most folk's income. And the cost of living is much higher in some areas. And non-cash benefits (like Medicaid, food stamps) are not added to the equation (as a result the "near poor" - who are not eligible for federal and state subsidies - are often in even worse shape than the poorer families who who are eligible).

The bottom line is an unrealistically low poverty threshold. If used alone as a measure of poverty, it vastly underestimates the number of poor families in the U.S. That's why many programs (like Medicaid, food stamps) allow an income 2-3 times the federal poverty line to gain eligibility. (The current debate over children's supplemental health insurance has to do with how much income a family must have to be eligible. Some states want 3-4 times the poverty line, but the president nixed that as too much income to qualify and a step to socialized medicine).

So, when you hear the about the numbers of kids in poverty ask yourself: how is "poverty" being defined and how many more kids and families could be considered poor if the criteria for poverty were changed (for example, if your personal poverty line were used)?

So much for Poverty 101. In the next post, I'd like to talk about why poor families are poor, why poverty has such a negative effect on some kids but not on others, and perhaps what we might try to do about it.

In the meantime, I'd be interested in your thoughts:

  • What is your definition of family poverty and by what income threshold would you consider your own family "poor"?

  • Whose fault is it - society's or the individual's - that the poor are poor in this rich nation, so full of opportunity?

  • Why do some poor families and children do well, while others fall down the well?

  • What do we as a society owe (if anything) to our poorest citizens - the children?

* * * *



Related Topics: Technorati Tags: , , ,

Posted by: Dr. Parker at 11/15/2007 08:21:00 AM

22 Comments:

Blogger Nancy Lee said...

This is the best article on child poverty in US that I've come across. Thank you for cutting through all the talking points designed to hide the facts and putting them out there straight. I wish all would read and understand the seriousness of this issue. Unfortunately, I think most people prefer to ignore this and other child-abuse related issues. Easier to sleep at night, waste food, support those who benefit most off keeping the working poor underpaid and overworked, pretend the US doesn't have these problems,and so forth, if you don't face the facts. Thank you again.
A Child is Waiting,
Take care...be aware.
Nancy Lee
ChildPersonFromTheSouth

11/16/2007 09:02:00 AM  
Anonymous Anonymous said...

I'll say this, it's not just the
lack of money that causes trouble. My family grew up poor but loved. I look back happily on my childhood and all my siblings and I have done OK even
if we couldn't afford a lot of things.

11/16/2007 12:08:00 PM  
Anonymous Anonymous said...

I am a family of 4 with an income of $47,000. Am I poor? I'm not sure how to answer that, but I'll say this, we definitely aren't rich and often have to do without some things we would like. Fortunately we have good health insurance or else for sure I'd be singing the blues.

11/16/2007 03:23:00 PM  
Blogger oddharmonic said...

I'd say $50,000 would be the poverty line for a family of four in the Dallas suburb where I live. The cost of rent and utilities in our neighborhood is close to $20,000 annually.

I think poverty has myriad causes. In some (but not all) of them, both society and the individual are caught in a self-reinforcing cycle.

I think that some families escape the cycle of poverty by a determined commitment to education. Neither of my paternal grandparents graduated from high school. My grandmother only had the equivalent of a third-grade education, but she was adamant that her children graduate from high school and continually try to improve themselves. One of her children did well (he was the first to graduate from high school and earn a bachelor's degree, lives comfortably and instilled the same work ethic in his children) but one did not and it clearly began a self-reinforcing cycle in her children and grandchildren. I don't know what to do for them.

I think that as a society we do have an obligation to make sure all children are fed, clothed and have a safe, dependable place to call home. I just don't know how to implement that.

11/17/2007 10:44:00 PM  
Anonymous Anonymous said...

Here's my suggestion: Let's turn up the heat on deadbeat dads to contribute to their family's financial well being. With two incomes instead of one, a lot of families would move out of poverty.

11/18/2007 10:33:00 AM  
Anonymous Anonymous said...

I'm tired of hearing about all of the problems of the poor. What about us hard working middle class families who are getting the shaft in many ways, without the benfit of government handouts?

11/19/2007 11:19:00 AM  
Anonymous Anonymous said...

To the Person who said "I'm tired of hearing about all of the problems of the poor. What about us hard working middle class families who are getting the shaft in many ways, without the benfit of government handouts?"
What about all the poor people getting "the shaft"? Many people who have never been on public assistance do not know that you are expected to do community service, in most cases. I was 18 (I found out that I was pregnant on my 18 B-day) when I got pregnant for my son, his father literally said "see ya" and walked out the door, and never really came back(he changed so much that his own family was bewildered). I could not find a job in my area even before I was pregnant, let alone after. I was forced to go and get "benefits from the government," at first I received a whopping 115$ a month, until I was 7 months pregnant, then I was expected to do 140 hours of community service, for a HUGE and luxurious total of 257$ a month(I could support everyone in my extended family with that). They tried to make me shelve books at the local library, for 8 hours a day. about 1 1/2 hours into it I passed out and quickly came to. The librarian refused to let me work there. I reported this to the welfare department, and they told me that I would have to go back and do community service, even though I had a librarian that said she could not, with a clear conscience, which, needless to say, I never went back.
2 kids since then(total of 3) I only receive food stamps, which, since my children are under 6 I do not have to go work off, only because my 2 daughters father passed away. They expect people to do "full time community service" which I lovingly call it since it would be rude to call it "full time community screwing." I live in public "housing," which is a nice way to say "isolation for mostly drug addicts and criminals that we do not have enough evidence on to imprison", where the police patrol nearly constantly. I am book educated very well, and I am currently persuing a college education, even in the position I am in. It is mostly single parents that are on welfare here, and most are poor because they want to be, but some have no other alternative (what would be the point of me making about 20$ a day after paying a questionable babysitter?). It is not like I like being poor, having to depend on good ole Bush for my food and housing, not to mention the quality health care provided by the state of Ohio(which would not pay for the anesthesia my 5 year old son needed for a root canal).
I may not be the typical poor person, but I hate being dependent on anyone but myself. I would love to go find a wonderful job where I could afford to hire a reliable babysitter, and still afford to live, but it is not possible. So, instead, I will sit here on my uneducated, fat, lazy, welfare, handout a** and leach the system dry.
To those of you more sympathetic with the epidemic of poverty, thank you for having your eyes and hearts open. The above is not meant for people to feel sorry for me, it was just my background and justification for the last sentence, in the last paragraph.
Thank You Very Much,
Sarah

11/19/2007 11:58:00 PM  
Anonymous Anonymous said...

We are a family of 6 living on 30,000yr. I know we don't have a lot of money but, I feel our kids will look back with good memories on their childhood. We live in the country (lots of room to play), have health insurance (through state), homeschool (excellent education), strong ties to our church community, and most importantly we are a close family. I don't consider us an impoverished family because we have so much. I think the deffinition of poverty needs to include more than just income.

11/23/2007 05:19:00 PM  
Anonymous Anonymous said...

I am a family of four with an annual income of 45,000 and I can say we are poor. My daughter is on medical assistance (medicaid), thank God, b/c we could not afford to add her to our medical plan. Our mortgage and other bills add up to 1700 a month. At times I don't know how we make it, but we do. Although we can classify ourselves as financially poor, we are rich in other areas like love, family values, and academic success. To my family our rich values out weigh our financial status.

11/28/2007 03:09:00 PM  
Anonymous Anonymous said...

I JUST READ ALL THE COMMENTS AND HAVE TO ADD MINE.WE'RE FROM A SMALL TOWN IN KENTUCKY.MY DAUGHTER & I LIVE IN THE SAME HOUSE AS SHE IS DIVORCED & I TO AM SINGLE. SHE HAS 2 CHILDREN. SHE WORKS HARD FOR HER LITTLE $5.85 AN HR AND GETS VERY LITTLE HELP FROM THE GOV. ASST. PROGRAMS. THE KIDS DAD IS ON DISABILITY SO NO CHILD SUPPORT HELP THERE. SHE TAKES CARE OF ALL THEIR NEEDS AS WELL AS HER OWN. TO SAY WE ARE POOR, YES WE ARE, AND THE BIGOTS IN THIS TOWN WON'T ALLOW INDUSTRY TO MOVE IN AS THEY WANT TO KEEP THIS A RETIREMENT COMMUNITY. MAYBE IF THE GOVERMENT WOULD MAKE TOWN LEADERSHIP OFFICIALS ALLOW BETTER PAYING JOBS IN SMALLER AREA'S, SOME PEOPLE (THOSE WHO WILL WORK) WOULDN'T HAVE SUCH A STRUGGLE????

12/01/2007 09:11:00 AM  
Anonymous Anonymous said...

I would say I am "poor", as my disability income is $650 a month. I live near a college town and AF base, which of course makes the housing outrageous. I do get $57 food stamps a month. I raised my son with an absent father who was requred to pay (get this) $22.78 a week, and wouldn't. Am still trying to get it. I worked my butt off when I could, even with medical problems. I worked 3 jobs just before I got hurt on the job, which of course, with my lazy attorney, only brought me a minimal settlement. I boughta mobile home, spent 8 months remodeling it. I rent my lot for $100 a month, which is only by God's grace it's so cheap.
I have utilities, insurance, food, a car to keep up, and barely make it, and don't some months. I worked all my life for this. yes, I am financially poor, with little help from the sources. I am, though, rich in my beliefs, which immensely help with the situation. I had started tech school, to be able to make it, but that got stopped short also when I got hurt. Sometimes it's circumstances, sometimes it's choices. I don't think we can judge that. I think this country needs some better healthcare plans implemented for children and disabled or seniors. It's a shame when you work your hind end off all your life, and when things happen beyond your control, you get the shaft from your government who you have so lavishly supported! Amen.

12/01/2007 12:18:00 PM  
Anonymous Grandma from Commack said...

My father always said "charity begins at home!" It's time we took care of our own, first, before we feed the rest of the world or put more money into a war that should never have been! Our Country needs to rethink our priorities!!!
Grandma from Commack

12/01/2007 01:57:00 PM  
Anonymous Albert_13 said...

To whom it may concern:

My home where I come from, I lived from an income from one single parent househould, in housing, and paying for everything pretty much.

Household of 3 kids besides my mother, she doesn't have an education, I guess that is where I had to step up to the plate, and make the difference. For the Income info, I would say less than $20,000 a year.

This is on my mother's income, what can you expect. Raised by a single parent. Without an education. Its sad, and life risking everyday what we have to live on, and facing no help except food stamps.

And the help with utilities in the Winter. That's what I lived on in my mother's household. She denied help from any one besides the help she had no choice of trying to get.

She has done this since we were born, and thanks to her, I am trying my hardest to staying committed to my education as much as possible. Where would we be at, without an education.

Alot of schools waste alot of food when that can be donated to the children across the globe that are dieing everyday to hunt around for food all day like animals. We are not animals. We are human beings.

The people that have posted their comment(s) on this issue. Thanks to them and others that have consideration on something serious like this.

We need to find some way to help each other, but like it has been said, and common sense, we need to think of what we have to do in our homes before we think about any body else also.

There is not enough money to go around for everyone. We all have to work one way or another to earn a living.

Yes, we may not have the money to support everybody, but in the same way, the government is also helpful in ways that we won't be able to help or support ourselves. Poverty, in my opinion is the deadliest threats we face everyday in our lives.

I apologize but, someone mentioned, Unfortunately, I think most people prefer to ignore this and other child-abuse related issues.

Easier to sleep at night, waste food, support those who benefit most off keeping the working poor underpaid and overworked, pretend the US doesn't have these problems,and so forth, if you don't face the facts. Who will?

A Child is Waiting,
Take care...be aware.
This is true, what can we do about that? ! !!!

12/01/2007 09:07:00 PM  
Anonymous yaya said...

Well, let's see if I can organize my thoughts enough to convey my experiences without seeming to prattle.
I am the product of welfare.
I am and have been for 25 uears, a Registered Nurse.
From the beginning, the main problem was and , as I can see by these posts, is waste. The Government throws money in scant amounts at people then lets them scramble to survive.
St Reagan did away with one of the best programs for welfare recipients. It was called CETA. This program paid tuition, books, supplies, needs, groceries, and a small salary...I thinkl it was $30/week beyond everything else. I am a gradutae of that program and can truly say I do not know where my family and I would be today had I not been Blessed into the very last CETA class. More over, this Government needs to include the true basics in it's support of the poor. Soaps, an expensive item in any form, as one example. I believe if they would develope programs whereby the poor could be supported in entirety, for one year or eighteen months, then gradually reduce the support over time, taking in whether or not the recipient is participating in a school/work skill program, we would see a vast improvement. I so clearly remember having graduated Nursing School only to find out that because I did graduate there was absolutely nothing available to assist me...I was no longer eligible for any type of assistance, save for the medical card...which does NOT feed, or shelter your 5 and 18 month old kids. It was "Congratulations and Good Bye!" I struggled for the next five years to get some sort of stronghold. Since then I have been living at the poverty level, the true level where everything you make goes to bills, and educating the kids, now 33 and 29.
My plan is to offer everyone a way, of their chosing and talent, off the dole. If they refuse then adios, keeping the needs of the children, alone,well covered. If they can send a man to the moon they should be able to tighten their own belts and apply the tax money stolen from us to better uses than excess.

12/02/2007 12:04:00 PM  
Blogger thomas said...

I have included a reference to this entry in the latest volume of Pediatrics Grand Rounds at Hope for Pandora. Let me know if that is a problem. If you are willing to link the carnival, I would appreciate it.

PGR V.2 Ed.12

12/02/2007 05:56:00 PM  
Anonymous Dr. P said...

Thomas:
Link away. I'm honored.

- Dr. P

12/02/2007 10:56:00 PM  
Anonymous Anonymous said...

Let me just say that the stories I have heard ( over the years ) and just read are heart wrenching. It is sad that we live in the wealthiest country in the world and can still have so many without adequate income. However I came from an impoverished background too. My mother was single, raised three kids and worked as a teacher, which we all know are grossly underpaid. All three of us finished high school, two finished college and I became a hairdresser. Thanks mostly to expectations set for us to do well. It starts in the home, tell your young ones to succeed and they will, for want of approval. I had two children and was earning around 12.50 an hour, which needless to say isn't s**t, and their dad was earning around 9.50, we made "too much" by federal guidelines for just about everything the government has to offer however. I stuck to my guns that I was going to be successful, and have the American dream.So I read everything I could, I went to free seminars, and learned many new skills and ways of thinking so I could change for the better in aspects of money, investing, exercising and relationships. I now earn 75,000 a year, I consider myself very successful and no longer "poor", and I still young enough to enjoy it. What I see and hear a lot of when it comes to dealing with the poor and underpaid middle class how sad it is. How hard it is for them, how much they want more.I hear a lot of pity being given, and not a lot of sound advice, nor do I hear anyone saying, how can help you change that?? It takes a lot of hard work to change those environments for the better. I did it, and anyone else can too. All of the experiences that led up to me being where I am came from FREE sources of learning (like the library, the YMCA 's and such). I was tired of feeling broke, and sorry for myself, circumstances are only temporary. A person has to be willing to work hard to change them for the better. I think its time we helped the "poor" learn money management, discipline, and the feeling of accompolishment that comes from knowing where you've been and seeing where you ended up, to dreaming about where you're going, instead of staying stuck, and being in a position to have to ask for help. I truly know and understand how it feels to be in need and feel as if there no where to look or turn to. That is why I chose to fix it for me and my family. Anyone else can too.

12/03/2007 12:50:00 PM  
Anonymous Anonymous said...

I came across this report today in which the Heritage Foundation denies that hunger is a problem in the U.S. because poor people have higher average BMIs. For all the talk about obesity and the threat it supposedly poses to American children, hunger is still a much more serious problem. Food banks are low this year due to increased demand, so please consider donating to your local food bank if you have the resources.

The link to the article is below.
http://www.motherjones.com/washington_dispatch/2007/12/hunger-let-them-eat-broccoli.html

12/03/2007 02:34:00 PM  
Anonymous Concerned said...

The causes of poverty include parents not having the knowledge and skills that a good education provides, lack of job opportunities, lack of free or low cost adult education opportunities, depressed parents, alcoholic or druggie parents, living in crowded conditions with only other poor families for neighbors, no encouraging mentors, not knowing any families who moved from poverty to the middle class, therefore no idea how to do it, co-dependence (where other family, friends, and neighbors don't want you to succeed for various personal reasons, and may make fun of or beat you for speaking in a more educated way), the belief that success is something that happens to you rather than believing that it is something you can influence, and the belief that intelligence is inborn rather than something you can grow by exposing yourself to mentally stimulating and educational challanges, and yes, prejudice still exists and still keeps people in poverty. These are just a few causes, there are many more. All the causes interrelate, and none of them are the kids' fault. Getting kids out of poverty-stricken neighborhoods would help. Helping the parents in all the ways listed above would help.

12/03/2007 03:22:00 PM  
Anonymous Ray N said...

While I will agree that $20,000 for a familhy of 4 may be too low, I will also say that we have thousands, maybe millions of people abusing the system. They claim hardships, collect any time of assistance they can get, while they talk on thier cell phone and feed their faces to the point of being obese.
I see some of our children suffering, and it is a shame for a poweful country like the United States to have this problem. Sooner or later we as the U.S. need to stop trying to save the world, and save ourselves. Celebrites need to stop adopting children overseas and look at our overcrowded foster homes and adoption centers here in the US. Maybe its not the "in" thing to adopt a American child, I dont know. But it disgust me everytime I see the media fall all over and praise these celebrites everytime they adopt a foreign kid.

12/07/2007 02:57:00 PM  
Anonymous sarah said...

I read alot of the blogs on webmd and this is the first one that really moved me to post a comment. To begin I must state that I am not a heartless person because once you're finished you may think otherwise :S. At the age of 19 I found out I was withchild. As with a previous poster the father pretty much said goodbye. He wanted me to have an abortion but that went against what I believe in, and I wanted the baby, it was mine afterall. I informed him at that time that if he left and never came back agian I would never both him with childsupport.I know have a 3 and a half year old son, and we have both kept our promises. Neither one of us have spoken to the other since that day we made that 'pact'. Thru out my pregnancy I worked full time during the week, and also waitressed part time as well. Up until two weeks before my son was born, i was working about 70 hours a week, AS A PREGNANT WOMEN!!!! Ontop of that I continued working on my college degree online. During that time I never accepted, nor would have gotten, any type of hand outs. After my son was born I continue to work at my full time job and babysit other children evenings and over nights.Since my son's birth, I have only been making about $15000 a year.YET with only making that amount, I was able to purchase my own home (granted it's a modular home and only work 78K yet it's a home) purchase a 2005 car and pay for everything we own, and yet stil have money left over at the end of each month to 'play' with. Thru the last 4 and a half years, i have never received ANY type of handout, no food stamps, heat assistance, medical insurance (accept for that thru my job), not even help paying for my college and i am a 3.8 student!!! To be honest I think the government throws their money away with welfare. What I see in my town, is once welfare is started in a family, it is passed down thru the generations. Granted my son doesn't walk around with baby gap clothes on, but instead walmart and target clothes, and we love garage sales, but at least everything we have, i have earned. I know am engaged to a wonderful man who accepts my son as his own, and my son thinks of his as his dad, and my fiance said nothing attracted him more to me than my ambition and goals to suceed regardless as to what life threw at me. I also believe childsupport is completely insane. My sons father CHOSE not to be in his life and I CHOSE to have him and I CHOSE to raise him, so why should his father, who wanted to never be a part in raising him, pay for him? Yes the only safe sex is no sex, but guys really have NO CONTROL. It takes TWO people to engage in sex, BUT I see it often around here where women say that they are on the pill, punch holes in condems to create a child THEY want but there partner does not. So why should the father be suckered into paying the child care? Not only that but most mothers who receive child care end up spending it on the wrong places. As I stated before I am not cold hearted, simply been there, done that, but suceeded without help. I am now a manager at my company and my fiance and I are both making around 40,000 a year each, yet we still live way under what we could. We stil live in my home, we both drive 2 and 3 year old cars, because we both WORKED for where we are, and nothing, not many, sucess, or fame, gives us a better feeling than the feeling of going to bed every night knowing that hard work has paid out. I hope that everyone that could be in my shoes thta I was, realizes that instead of letting your child grow up thinking it's ok to be lazy, that instead a little hard work is the way to do it. I see kids my age and can't believe how horribe their work ethic is.

Sara

12/07/2007 09:37:00 PM  
Blogger Jessica Bennett said...

This is a fantastic article. Thank you so much for writing it. And the discussion here is truly moving--and at times infuriating! It's truly shameful the way we spend so much more time pointing fingers and passing the blame rather than simply trying to make things better, or at least more tolerable, for the next generation.

Mark Winne, who worked in the Hartford, CT, food bank system for 25 years, posted at Beacon Broadside about the issue of poverty in America. I think that many of the people who read this article will find his thoughts illuminating.

1/08/2008 11:19:00 AM  

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