Minnesota Chapter of the American Academy of Pediatrics

Charles Oberg, MD, FAAP

By Charles N. Oberg. MD, FAAP, Program Director of Maternal and Child Health at the University of Minnesota’s School of Public Health; pediatrician at Hennepin County Medical Center; District VI Vice Chair for the American Academy of Pediatrics
In 2013 the AAP added poverty and child health to its strategic plan as a key priority calling for further investigation as well as action. Its agenda reads in part, &#8220;When families can’t afford the basics in life, it negatively affects their health. Poverty can inhibit children’s ability to learn and contribute to social, emotional, and behavioral problems. Furthermore, poverty is a contributing factor to toxic stress, which has been shown to disrupt the developing brains of infants and children and influence behavioral, educational, economic and health outcomes for years.&#8221; As poverty affects children from minority communities at higher rates, the resulting disparity in toxic stress results in disparities of health.

At the start of the Millennium, the overall poverty rate in the United States was at 11.3 percent as compared to the higher rate of 16.2 percent for children. By 2012, the overall poverty rate had increased to 15 percent and 21.3 percent for children, representing a significant increase over the first decade of the 21st Century.
The poverty rate among minority children is especially concerning. An estimated 37.9 percent of black children and 33.8 percent of children of Hispanic descent lived below the poverty threshold in 2012 compared to 12.3 percent of white, non-Hispanic children. Minnesota’s income disparity between children of Caucasian descent and those of color is even more striking and of major concern. The overall child poverty rate for the state was 14.6 percent, significantly less than the overall United States. But the poverty rate for white children was 8.2 percent contrasted to 30.4 percent for Hispanic children and to an alarming 46.1 percent for our African American children.
How does poverty contribute to persistent health disparities? It is not just through the lack of access to health care. The AAP in 2012 released a policy statement entitled Early Childhood Adversity, Toxic Stress, and the role of the Pediatrician: Translating Developmental Science into Lifelong Health. It documents how intense, frequent, and prolonged activation of the physiological stress-response systems has a lasting impact on the developing physiological endocrine, immunological, inflammatory, and neurological functioning regulatory systems. In turn, these disruptions place the child at risk for a myriad of health and mental health problems over the lifespan, such as atopic conditions (e.g., asthma; allergies), hypertension, chronic infections, and emotional and behaviors problems. Hence, persistent health disparities linked to poverty and toxic stress contribute to the manifestation of a variety of childhood health problems and persistent health disparities.
Please join us on Friday, June 13 for the 2014 Hot Topics in Pediatrics Conference with the afternoon session focused on &#8220;Eliminating Health Disparities: Pediatric Challenges and Successes.&#8221; During the afternoon session, the keynote speaker will Minnesota Department of Health (MDH) Commissioner Edward Ehlinger, MD, who will discuss the department&#8217;s recent report on advancing health equity in Minnesota. Remain for our annual dinner to hear former national AAP president Dr. Renee Jenkins, a renowned adolescent health expert from Howard University and a member of the newly formed AAP Task Force on Poverty and Children’s Health, discuss what pediatricians can do about the link between child poverty and health.

Poverty, Toxic Stress and Health Disparities

By Charles N. Oberg, MD, FAAP, Program Director of Maternal and Child Health at the University of Minnesota’s School of Public Health and pediatrician at Hennepin County Medical Center&#8230;
Minnesota prides itself on being one of the finest places to raise a family and has frequently been ranked as one of the healthiest states in the country. In 2004, the Annie E. Casey Foundation ranked Minnesota first overall in the well-being of its children using 16 measures of child well-being in the four major domains of economics, education, health, and family. But in its 2013 report, Minnesota had slipped to fourth overall and 15th in the health of children category. This decline in our state ranking is resulted in part to persistent disparities in health outcomes for minority children in Minnesota. Infant mortality and immunizations are two health outcomes that epitomize these disparities.
The Infant Mortality Rate or IMR is considered by many as a pre-eminent marker of the overall health of a community. Minnesota’s IMR is 4.61 infant deaths per 1,000 live births&#8211;better than the national average of 6.39. But this is largely the result of Minnesota’s IMR for non-Hispanic, white-infants, which is at is 4.14. For African Amerian infants, Minnesota is worse than the national average&#8211;at 7.44. Minnesota is similarly worse than the national average for American Indian children&#8211;at 8.6.
Minnesota’s overall high ranking also holds true for immunization. Overall, Minnesota ranked seventh in the nation among children fully immunized at 19-35 months old. But stark differences in Minnesota’s immunization rates emerge based on a child’s race and ethnicity. The percent of children fully immunized was 85 percent for white, non-Hispanic toddlers but only 73 percent for American Indians, 66 percent for Asian/Pacific Islanders, 65 percent for Hispanics, and 63 percent for non-Hispanic African Americans.
These are just two of the measures. Others similarly demonstrate the disparities in health care across the state varying by race and ethnicity.
Minnesota pediatricians take pride in the access and quality of care we deliver to our children and their families. However, there is a danger when we, as Minnesotans, consistently see the overall health of our children held up as an example to the rest of the nation. We must celebrate the success but realize that the gradual slippage of our overall state as well as persistent disparities indicate that there is still work to be done.

First, we must continue to be cognizant of persistent disparities and translate that knowledge into action. This includes the ongoing promotion of &#8220;Back to Sleep,&#8221; smoking cessation, and breast-feeding in our practices as primary prevention strategies to reduce infant deaths. We know that the adoption of these strategies are not evenly utilized by communities of color due to access, poverty, non-financial barriers, and cultural differences.
With regard to immunizations, we must remain vigilant in the promotion of the efficacy of vaccines for children. We must also encourage participation in the Vaccines for Children program as well as Medicaid, MinnesotaCare, and MNSure. It will be through such efforts that we will be able to achieve the equity we as pediatricians strongly embrace.

Persistent Disparities Causing Health of Minnesota Children to Slip

By Charles Oberg, MD, FAAP, program director of the Maternal and Child Health program at the University of Minnesota and practicing pediatrician at Hennepin County Medical Center
In the June issue of Pediatrics, the AAP Committee on Community Pediatrics released a policy statement titled “Providing Care for Children and Adolescents Facing Homelessness and Housing Insecurity.” The statement provides an important framework for thinking about the context of homelessness in our practices. It outlines both the antecedents of homelessness as well as the health, developmental, educational and social adverse outcomes of a child being raised in a transitory or less than permanent home environment. The statement concludes with a series of recommendations for the pediatrician to be cognizant of resources that might assist them in the care and management of these children.
What is the magnitude of this problem? The National Center on Family Homelessness recently released a report titled “America’s youngest outcasts 2010” and places the number of homeless children at 1.6 million children or close to 1 in 45 children. The center estimates that Minnesota had 15,898 homeless children. This is substantially less than the 337,105 in Texas, the state with the largest number of homeless children. However, for each of these children this housing instability can severely affect their life trajectory. A more recent study was conducted by the Amherst H. Wilder Foundation in 2012, which intermittently surveys the homeless population in Minnesota. It estimated there were 10,214 homeless adults, youth, and children statewide in 2012. This was a 6 percent increase over the 2009 survey. Surprisingly, the results show that nearly half (46 percent) of all homeless persons in the state of Minnesota were 21 years of age or younger. This included 3,546 children with their parents and 1,151 youth who were homeless on their own.
The table provides a listing of statewide resources designed to decrease the burden that homelessness places on a family. The list provides a description of services as well as contact information that might assist in the coordination of care for this vulnerable population.
The AAP and the Committee on Community Pediatrics should be applauded for their efforts to re-familiarize us with this most extreme form of risk for an infant, child or adolescent. The recent dialogue on Toxic Stress and Adverse Childhood Events emphasizes the importance of this risk. The contributing factor of homelessness such as parental unemployment, mortgage foreclosure, poverty, mental illness, substance abuse and/or domestic violence are magnified when a family slips into a homelessness, exponentially worsening the adverse health outcomes for children. As pediatricians, we should be familiar with these invaluable resources that might assist us in our coordination of care and to provide linkages to essential community services for these vulnerable families and their children.
References: 
Policy Statement on Care for Children Facing Homelessness and House Insecurity, Council on Community, Pediatrics, 2013; 131: 1206
The National Center on Family Homelessness, America’s Youngest Outcasts 2010: state report card on child homelessness. Available at: www.FamilyHomelessness.org
Gerrard M, Shelton E, Pittman B, and Owen G: Initial findings: Characteristics and trends of people experiencing homelessness in Minnesota, 
2012 Minnesota Homeless Study, Amherst H. Wilder Foundation, 2012
<a href="http://mnaap.org/newsletter/wp-lib/wp-content/uploads/2013/07/Article-Table.jpg"><img loading="lazy" decoding="async" class="alignnone size-medium wp-image-96" alt="Caring for Homeless Children Resource Table" src="http://mnaap.org/newsletter/wp-lib/wp-content/uploads/2013/07/Article-Table-300x110.jpg" width="300" height="110" /></a>

Caring for Homeless Children

Grand Itasca Clinic & Hospital is seeking a board certified/board eligible outpatient Pediatric Physician to join our busy and growing primary care clinic practice. Grand Itasca is a fully integrated multi-specialty clinic and hospital located in Grand Rapids, Minnesota.

Pediatric Physician

Partners in Pediatrics, Ltd. is seeking a full time BC/BE Pediatrician. The standard work week for a full-time pediatrician is 4 days a week plus a rotation of nights and weekends. Night and weekend shifts are shared equally among all providers. The salary package is competitive. You will have paid time off (PTO) and be given a CME allowance as well as CME days to further your medical education. We offer health, dental, disability and life insurance. You will also be eligible for a lucrative profit sharing 401(k). For inquiries, please contact our recruiting leads, Dr. Lisa Irvin at lirvin@pipstop.com and Dr. Megan Camerino at mcarmerino@pipstop.com

BC/BE Pediatrician

We’re excited to announce an opening for a Communications Manager at the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). This part-time, remote role is a unique opportunity for a communications professional with at least five years of experience, who is passionate about advancing child health through advocacy, education, and special projects.

Charles Oberg, MD, FAAP Category