Chronic Health Conditions of Impoverished Children in America

Crystal Hewitt-Gill, MA

According to the U.S. Census Bureau, approximately 14.7 million children living in the United States were classified last year as falling under the federal poverty line (2013). While children represented 23.5 percent of the total population, they represented 32.3 percent of all people living in poverty in the country.

The health effects of chronic poverty on children are myriad. Poverty is associated with less medical and dental care, lack of access to nutritious food, and greater difficulties in school. These early-life issues have been shown to impact physiological, emotional, and cognitive development of children, and strongly contribute to health problems throughout the life span (Cook and Frank, 2008) (de Fonseca, 2014). According to a 3-year analysis of data collected from 97,206 children under the age of eighteen, there are numerous correlations between poverty and unmet medical needs (Newacheck et. al., 2000). Further, these are not problems that appear to be solved by simply increasing access to health insurance. According to the same article, while publicly insured children were more likely to receive standard medical treatment than uninsured children, they were still 50% more likely to have an unmet health need than privately insured children. Of these conditions, dental health was most likely to be the primary unmet health need; however, children from poor backgrounds face higher rates of medical issues like asthma, juvenile diabetes, obesity, and mental health disorders (Hernandez et. al., 2010) (Park et. al., 2011). Poverty and chronic health problems have also been shown to have a mutually reciprocal relationship, which indicates that untreated or under-treated medical and mental health conditions can directly contribute to later poverty and vice versa (Swartz, 2009) (Duncan et.al., 2013).

Poverty can be a difficult concept to clearly define. To be considered poor by the U.S. Census Bureau, a family must fall under the Federal Poverty Limit. However, poverty manifests in a number of different ways that are not sufficiently defined by using household income as the sole criterion, and can also strongly depend on the region and available social supports in place (Vu, 2010). Poverty is not a uniform standard. We may find it more useful, then, to look at poverty as a state of chronic deprivation of one’s basic needs, including intangible necessities like safety.

At present, there are programs in place to help give poor children better medical care. Health outcomes among poor children are capable of improvement, but the issue may be too complex to be considered immediately “curable.” One important aspect of the Affordable Care Act was the expansion of Medicaid eligibility guidelines and the ability to enroll children under the age of 18 into a healthcare plan at any time during the year; however, we must be careful to not automatically conflate access to health insurance with access to quality care (Cheng et.al., 2014). While free or low-cost medical and dental clinics exist, they are largely dependent on volunteer labor and stable financial contributions.

The origins of poverty are a matter of intense debate. On a general level, we can separate the primary theories between structural and individualistic theories (Bradshaw, 2006). Structural theories examine poverty from a macro-level perspective, and many of these types of theories fault capitalism’s emphasis on competition and its inherent favoring of the wealthy. Structural theories are most useful when we are examining poverty as a self-perpetuating social construct – that is, that poverty is a manmade condition and not the inevitable byproduct of an evolving society. However, there are some deficiencies in these perspectives when we are considering individual factors like resilience, and may not be applicable if we are using a strengths-based perspective. On the other side, individualistic theories look at poverty on a micro-level, and tend to fault dysfunctional family structures and poor work ethics as the primary cause of poverty. These individualistic theories tend to be somewhat more problematic, as the assumption in these

theories remains that our society in fundamentally meritocratic and that all people have the same opportunities to obtain resources (Elesh, 1973). As a result, poverty becomes a matter of individual responsibility rather than a social injustice. Individualistic theories also tend to overlook the cycle of poverty and the effect of the economy on overall poverty rates. Finally, there is some question as to whether these theories can be even applied to the subject of impoverished children, as they have no control over their surroundings growing up. Indeed, to blame children for their own poverty suggests a punitive element to these theories.

Using general systems theory, we can explore the numerous root causes of poverty, rather than attempting to reduce a complicated social ill to one underlying cause. The social work perspective regards poverty as a multifaceted entity, and full consideration the causes and effects of poverty must also take into account issues of race, culture, gender, wage stratification, geographical region, job availability, and the political landscape at a given time. Most poverty-alleviation efforts are focused primarily on the micro level (regional food banks, free health clinics, etc.) but the most effective means of addressing poverty is through policy change and the restructuring of welfare programs to help families obtain the necessary resources to succeed, rather than to simply survive.