POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Poverty and Child Health in the United States COUNCIL ON COMMUNITY PEDIATRICS Almost half of young children in the United States live in poverty or near abstract poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the fi nancial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have will improve the ability of pediatricians to address the social determinants fi led confl ict of interest statements with the American Academy of Pediatrics. Any confl icts have been resolved through a process of health when caring for children who live in poverty. Accompanying this approved by the Board of Directors. The American Academy of policy statement is a technical report that describes current knowledge on Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. child poverty and the mechanisms by which poverty infl uences the health Policy statements from the American Academy of Pediatrics benefi t and well-being of children. from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not refl ect the views of the liaisons or the organizations or government agencies that they represent. The guidance in this statement does not indicate an exclusive course STATEMENT OF THE PROBLEM of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Poverty is an important social determinant of health and contributes to All policy statements from the American Academy of Pediatrics child health disparities. Children who experience poverty, particularly automatically expire 5 years after publication unless reaffi rmed, revised, or retired at or before that time. during early life or for an extended period, are at risk of a host of adverse health and developmental outcomes through their life course.1 Poverty DOI: 10.1542/peds.2016-0339 has a profound effect on specific circumstances, such as birth weight, PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). infant mortality, language development, chronic illness, environmental Copyright © 2016 by the American Academy of Pediatrics exposure, nutrition, and injury. Child poverty also influences genomic function and brain development by exposure to toxic stress, 2 a condition characterized by “excessive or prolonged activation of the physiologic To cite: AAP COUNCIL ON COMMUNITY PEDIATRICS. Poverty stress response systems in the absence of the buffering protection and Child Health in the United States. Pediatrics. 2016; 137(4):e20160339 afforded by stable, responsive relationships.”3 Children living in poverty Downloaded from www.aappublications.org/news by guest on October 3, 2021 PEDIATRICS Volume 137 , number 4 , April 2016 :e 20160339 FROM THE AMERICAN ACADEMY OF PEDIATRICS are at increased risk of difficulties poverty during and immediately American Indian/Alaska Native with self-regulation and executive after the Great Recession of children are 3 times more likely to function, such as inattention, 2007–2009. A later 2014 report live in poverty than are white and impulsivity, defiance, and poor peer from the Organization for Economic Asian children.15 Infants and toddlers relationships.4 Poverty can make Cooperation and Development10 more commonly live in poverty than parenting difficult, especially in the ranked the United States 35th of 40 do older children. context of concerns about inadequate nations, only above Chile, Mexico, Children may be born into poverty, food, energy, transportation, and Romania, Turkey, and Israel. remain in a poor household housing. This policy statement specifically throughout childhood, or, most addresses child poverty in the United Child poverty is associated commonly, rotate in and out of States but reflects the 2015 United with lifelong hardship. Poor poverty over time. Approximately Nations’ Sustainability Goal to end developmental and psychosocial 37% of all children live in poverty poverty in all its forms everywhere.11 outcomes are accompanied by a for some period during their significant financial burden, not just According to 2014 Census data, an childhood.16 Children who are born for the children and families who estimated 21.1% of all US children into poverty and live persistently in experience them but also for the younger than 18 years (15.5 million) poor conditions are at greatest risk rest of society. Children who do not lived in households designated as of adverse outcomes. However, even complete high school, for example, “poor” (ie, in 2014, incomes below short-term spells of poverty can are more likely to become teenage 100% of the federal poverty level expose children to hardships, such as parents, to be unemployed, and to [FPL] of $24 230 for a family of food insecurity, housing insecurity/ be incarcerated, all of which exact 4*) and 42.9% (over 31.5 million) homelessness, loss of health care, and heavy social and economic costs.5 lived in households designated as school disruptions. A growing body of research shows “poor, near poor, or low income” Equality of opportunity is central to that child poverty is associated with (ie, incomes up to 200% of the FPL). the American dream and is reflected neuroendocrine dysregulation that Nearly 9.3% (6.8 million) lived in by social mobility or the potential may alter brain function and may households of deep poverty (ie, of intergenerational economic contribute to the development of incomes below 50% of the FPL).12 betterment. However, social mobility chronic cardiovascular, immune, and In 2014, an estimated 16 million is difficult to measure, because the psychiatric disorders.6 The economic children lived in families who usual method compares incomes cost of child poverty to society can received Supplemental Nutrition of 30-year-old persons against the be estimated by anticipating future Assistance Program (SNAP) incomes of their parents. Despite the lost productivity and increased benefits.13 Between 2007 and 2010, difficulties, most researchers agree social expenditure. A study compiled foreclosures affected 5.3 million that social mobility in the United before 2008 projected a total cost children.14 States has faltered as the wealth of approximately $500 billion each Demographics have a profound and opportunity gaps between year through decreased productivity influence on the likelihood that a rich and poor have widened in and increased costs of crime and family or community will experience the past decade. In comparison health care, 7 nearly 4% of the gross poverty or low income. For example, with European and other wealthy domestic product. Other studies of African American, Hispanic, and industrialized countries, social “opportunity youth, ” young people mobility in the United States ranks 16 to 24 years of age who are neither * The FPL is determined by comparing a among the lowest.17 A 2015 Pew employed nor in school, derived family’s pretax cash income to an income Charitable Trusts report documented similar results, generating cohort poverty threshold that is 3 times the cost of that the effect of parental income aggregate lifetime costs in the a minimum food diet. This measure does not take into account government benefi ts (eg, advantage is persistent over all trillions.8 SNAP), income tax credits, or family expenses levels of parental income but is Child poverty is greater in the United (eg, child care, income taxes) and has not especially strong for children born to fundamentally changed since 1969 except for States than in most countries with annual adjustments for food price infl ation. In wealthy families. Persistent parental comparable resources. In a 2012 2010, the SPM was instituted to provide a more economic advantage means that a report from the United Nations comprehensive measure of a family’s fi nancial son’s income is strongly influenced Children’s Fund, 9 the United States circumstances. The SPM includes the value by his father’s, indicating low social ranked 34th of 35 member nations of certain federal in-kind benefi ts, federal tax mobility. The result is a dramatic benefi ts, and family expenses. For additional of the Organization for Economic details on these measures, see the accompanying decline of the possibility of economic 18 Cooperation and Development, technical report, “Mediators and Adverse Effects improvement for the poor. Poor a reflection of the rate of child of Child Poverty in the United States.” children tend to remain poor and live Downloaded from www.aappublications.org/news by guest on October 3, 2021 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS in neighborhoods of low opportunity. improved understanding of the root effect of safety net programs Wealthy children continue to be causes and distal effects of poverty, has been demonstrably positive. wealthy as adults and enjoy academic pediatricians can apply interventions Longitudinal studies from 1967 to and employment advantages. in practice to help address the toxic 2012 that used the Supplemental The drag on social mobility resulting effects of poverty on children and Poverty Measure (SPM) revealed that from income and opportunity families.