The poorer the kids, the worse their health, study says

A third of the poorest children are reported to be in less than optimal health compared with 7% of children from the wealthiest families.

By Susan J. Landers — Posted Nov. 10, 2008

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A new report by the Robert Wood Johnson Foundation found substantial shortfalls in the health of the nation's children based on their family's income and education.

The report, "America's Health Starts With Healthy Children: How Do States Compare?" was released in October.

The report was billed by the authors as the first to rank states by infant mortality and children's health status based on social factors. It shows that as parents' income and level of education rise their children's health improves.

The researchers found that in almost every state and the District of Columbia, children in the poorest and least-educated households had the worst health outcomes. Even children in middle-income families fared worse than did the children of the wealthiest families. These disparities were seen across racial and ethnic lines.

In an effort to close this gap, the AMA and other national physician groups have formed the Commission to End Health Care Disparities. The commission's most recent meeting, Oct. 21 in Detroit, featured presentations and workshops on cultural competence, physician work-force diversity and community initiatives to end disparities.

Meanwhile, the new RWJ report pointed out ongoing health disparities -- this time with a focus on the nation's youngest residents, newborns to 17-year-olds.

The authors found that nationally, a third of children 17 and younger who live in the poorest households -- or those whose families earned less than the federal poverty level, $16,079 for a family of three in 2006 -- were in less than optimal health compared with 7% of children in families who earned at least four times that amount.

And the health concerns are often serious, noted report co-author Susan Egerter, PhD, assistant research scientist at the University of California, San Francisco, Dept. of Family and Community Medicine. "They aren't just earaches but asthma and learning disabilities."

"As a physician, I can tell you there is no innate biological reason that all children should not achieve health levels seen by kids in the better-off families," added report co-author Paula Braveman, MD, MPH. Dr. Braveman is a professor of Family and Community Medicine and director of the Center on Social Disparities in Health at the University of California, San Francisco.

Looking beyond insurance status

The nation's ongoing health care debate often focuses on insurance status as a predictor of good health, and less attention has been paid to what makes people sick in the first place, said David Williams, PhD, professor of public health at Harvard School of Public Health. "Lack of availability of healthy food and places to exercise affect health. Where you live, learn, work, play and worship give you opportunities to practice a healthy lifestyle."

The researchers also found that families' education level plays a large role in health. Children in families in which no one has graduated from high school are less likely to be in optimal health than are those in families in which even one person has a high school diploma, the researchers said.

In addition, babies whose mothers have not finished high school are twice as likely to die in their first year as are babies of mothers who have graduated from college, Egerter said.

Particularly troubling is the large number of children affected, she noted. "One-third of the nation's children live in households where no one has more than a high school education."

The researchers also provide a state-by-state look at children's health by family income and education status. They show that the percent of children in less than optimal health varies widely, from 6.9% in Vermont to 22.8% in Texas. The rates also vary within states.

For example, in Texas, 44% of children in poor families are in less-than-optimal health compared with 6.7% of children in higher income families. Texas was found to have the largest income gap in children's health status among all the states.

The picture in New Hampshire differed. In that state, the researchers found that 13% of poor children are in less-than-optimal health compared with 6.4% of children in higher-income families.

The report's authors relied on four data sources: The 2006 American Community Survey, conducted by the U.S. Census Bureau, provided information on household income and racial or ethnic group; the Census Bureau's 2005-2007 Current Population Survey provided household education levels; and the Centers for Disease Control and Prevention's infant mortality information and the CDC's 2003 National Survey of Children's Health provided information on health status. The last is a large survey of parents' characterizations of their children's health.

Released with the report was a new tool from the Robert Wood Johnson Foundation letting users examine the current level of education in states and counties and observe what might happen to death rates if a larger proportion of the population attended college. The tool is available online (link).

The report and calculator are products of the foundation's Commission to Build a Healthier America, a national, independent nonpartisan group launched last February to investigate how factors beyond the health care system affect people's opportunities to live healthy lives.

The commission is co-chaired by Mark McClellan, MD, PhD, former administrator of the Centers for Medicare & Medicaid Services and the Food and Drug Administration, and Alice Rivlin, PhD, first director of the Congressional Budget Office.

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Child health gaps

[download pdf]

Children's health status can vary dramatically, even within states. Socioeconomic status is often the key, researchers from the Robert Wood Johnson Foundation's Commission to Build a Healthier America found. An Oct. 8 report comparing infant mortality and child health status by families' level of income and education found that in almost every state, shortfalls were greatest among children in the poorest or least-educated households. Even middle-class children were found to be less healthy than children with greater advantages. This socioeconomic impact is seen most strongly in Colorado, where only 3.5% of children in families with higher incomes and healthier behaviors have poor health.

Residents age 17 or younger in less than very good health
Household income
Poor, less than 100% of the federal poverty level 33.3%
Near poor, 100% to 199% of the FPL 19.8%
Middle income, 200% to 399% of the FPL 10.8%
Higher income, 400% or higher of the FPL 7.1%
Household education
Less than high-school graduate 43.3%
High school graduate 21.7%
At least some college 10.1%
Child's racial or ethnic group
Black, non-Hispanic 21.1%
Hispanic 35.6%
White, non-Hispanic 9.3%
U.S. overall 15.9%

Source: "America's Health Starts with Healthy Children," RWJ Foundation

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External links

The AMA and the National Medical Assn.'s Commission to End Health Care Disparities (link)

"America's Health Starts With Healthy Children: How Do States Compare?" Robert Wood Johnson Foundation, Oct. 8 (link)

RWJ Foundation's Education and Health Calculator (link)

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