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Poverty, Toxic Stress and Health Disparities

May 7, 2014

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, “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.” 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 “Eliminating Health Disparities: Pediatric Challenges and Successes.” During the afternoon session, the keynote speaker will Minnesota Department of Health (MDH) Commissioner Edward Ehlinger, MD, who will discuss the department’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.

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