Pediatricians urged to tackle poverty head-on

For the first time ever, The American Academy of Pediatrics (AAP) has issued a policy statement on poverty.  As affirmed by AAP President Benard P. Dreyer, “research shows that living in deep and persistent poverty can have detrimental health consequences that are severe and lifelong.”  Acknowledging that “almost half of young children in the United States live in poverty or near poverty,” the AAP has emerged as a strong advocate for programs and policies that improve health and quality of life for children and families living in poverty.

Pediatricians are being asked to do more than increase their awareness of poverty.  In the context of a family-centered medical home that coordinates strategies to address social determinants of health (poverty, for example), physicians are urged to:

  • Assess family financial stability (perhaps by asking if the family has trouble making ends meet at the end of the month).
  • Screen for risks for adversity (food insecurity, maternal depression, family instability, unemployment, frequent moves).
  • Identify family strengths that protect against adversity (secure attachment to caretakers; strong family and social connections; responsive, nurturing, and consistent parenting).
  • Coordinate care with community partners (such as those providing legal aid and job training, and addressing issues like food, energy, and housing insecurity).
  • Participate in programs that integrate behavioral health into primary care (Incredible Years and Triple P) and promote literacy (Reach Out and Read and the Video Interaction Project [VIP]).
  • Link families to community resources that support and assist families in need.
  • Advocate for programs/policies that buffer children against adverse effects of poverty. Examples include:
    • Earned Income Tax Credit (EITC)
    • Temporary Assistance for Needy Families (TANF)
    • Raising the minimum wage
    • Supports for quality child care and early childhood education
    • Access to comprehensive health care
    • Nutrition support such as WIC (the Supplemental Nutrition Program for Women, Infants, and Children), SNAP (formerly “food stamps”), and the National School Lunch Program
    • Home visiting programs such as the Nurse-Family Partnership

Does this go “above and beyond” what should be expected of a pediatrician?  The AAP affirms that it’s all in the line of duty:  prevention of childhood diseases – an accepted pediatric mandate – depends in part on “early detection and management of poverty-related disorders.”

Of course pediatricians cannot tackle poverty on their own. In King County, they can expect support from a wide assortment of community-based organizations and effective programs already in place. They should also be able to tap into the expertise and community networks that continue to evolve around regional efforts such as Communities of Opportunity and Best Starts for Kids, which are already aligned with the goals of the AAP’s war against child poverty.

For data on poverty-related indicators, see Communities Count updates on food, housing, income, qualification for free/reduced-price school meals, and the relationship between adult health outcomes and adverse childhood experiences.  Communities Count has recently added several years of data on student homelessness, making it easier to look at trends (by school district) from 2007-08 through 2014-15 school years.  For data on child, maternal, and adult health, see King County’s Community Health Indicators.

Zooming in on neighborhood inequality – by county, city, and ZIP code

Recent reports paint very different pictures of health and wellbeing in King County. According to the 2016 County Health Rankings, King County is the 2nd healthiest county in Washington (San Juan County is 1st).  Looking for details behind the promising headline, however, King County’s 2016 City Health Profiles reveal deep disparities.  For example, 5% of Sammamish residents report that their health is “fair” or “poor,” compared to 23% in Burien – almost a 5-fold difference.  Similarly, average life expectancy ranges from 76.3 years in South Auburn to 86.2 years in Northeast Seattle.  Across 26 King County cities, wide disparities for everything from obesity and teen births to diabetes- and Alzheimer’s-related deaths are the norm, not the exception.

But these disparities do not occur in isolation. They develop in communities, often over generations, in a context of economic inequality. A new interactive tool, the Distressed Communities Index , enables users to zoom all the way down to ZIP codes in assessing key components of economic distress.  As shown in recent Communities Count updates on food, housing, and income, recovery from the Great Recession has been uneven at best.  Offering a closer look at economic inequality, the Distressed Communities Index is based on 7 complementary measures:

  • Adults (25 and older) without a high school degree
  • Housing vacancy rate
  • Adults (16 and older) not working
  • Poverty rate
  • Ratio of an area’s median income to its state’s median income
  • Percent change in jobs from 2010 to 2013
  • Percent change in number of businesses from 2010 to 2013

In the Auburn area, one of King County’s most distressed ZIP codes, 98002, is flanked by more prosperous neighbors – 98092 to the east and 98001 to the west.  The distress score of 80.8 indicates that ZIP code 98002 is more economically distressed than 80.8 percent of 26,000+ ZIP codes nationwide.  The much lower distress scores of nearby ZIP codes (see table) reveal that these next-door neighbors, although spatially close, are economically far apart.

Almost 1 in 5 adults in the central Auburn ZIP code (98002) do not have a high school diploma, more than double the rates of its immediate neighbors.  Similarly, the poverty rate in ZIP code 98002 (26%) is more than double the rates in adjacent ZIP codes.  Elsewhere in King County, distress scores are as low as 0.7 (ZIP code 98065) in Snoqualmie and as high as 93.3 (ZIP code 98134) in the SoDo/Harbor-Island/Duwamish industrial area south of downtown Seattle.

Distressed Communities Index and selected measures for King County ZIP codes

ZIP Code

98001 Auburn  west

98002  Auburn central

98092 Auburn  east

98065 Snoqualmie

98134 Industrial Seattle

Distress Index 






No High School diploma












Median Income Ratio (ZIP code/state)







Offering a new way to look at “spatial inequality,” this tool could prove useful to regional projects focusing their efforts on discrete geographical areas.

Anyone could be homeless

Starting March 1st, eight short videos about homelessness in our region became available on The Moth’s YouTube site.   Last year, National Public Radio’s StoryCorps team and Seattle University’s Project on Family Homelessness invited local residents to talk about their experiences with homelessness. The resulting stories briefly convey (< 10 minutes each) the broad spectrum of circumstances that can leave families without a home.  They remind us that, despite the best-laid plans, anyone could be homeless.

This message is echoed in Communities Count’s new student homelessness update.  In the 2014-15 school year, homelessness among King County public school students has increased again – to an all-time high of 7,260.  In the Tukwila district, 1 in 9 students was homeless last year.  Almost half of homeless students (3,478) were in pre-K or elementary school; more than half “doubled-up” with friends or relatives because their own family was unable to provide stable housing.

For the first time, Communities Count provides downloadable student homelessness data for the past 8 school years. Updates on housing affordability can be found in the Housing section of Communities Count.  For additional information on homelessness in King County, go to AllHome.