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.

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