Poverty as a Medical Problem


Poverty affects children's ability to learn
Poverty affects children’s ability to learn

An article in Sunday’s (July 26, 2015) Star Tribune, “Brain scans show effects of poverty on kids,” is the kind of news I’m always interested in but which intrigued me especially this week. It’s a summary of a piece that recently appeared in JAMA (Journal of the American Medical Association) and was first posted online in Bloomberg Business News.

Bottom line:

Children in households below the federal poverty level — an annual income of about $24,000 for a family of four — had gray matter volumes 7 percent to 10 percent lower than what would be expected for normal development. About 20 percent of American children lived at this income level in 2013, according to census data. Smaller gaps were evident for households considered “near poor,” making up to 150 percent of the poverty level, currently about $36,000 for a family of four.

It should be noted that the study excluded children with learning disabilities, histories of premature birth and familial psychiatric problems. In other words, these are the results for what the researchers call “the healthiest, most robust children living in poverty.”

What do the researchers think is going on?

…poor children “are getting too little of things we need to develop the brain and too much of things that inhibit brain growth.” They may get less stimulation from parents, or lack things like crayons, children’s books, or games. Crowded environments or unstable homes may disrupt their sleep. Poor neighborhoods may not have grocery stores with fresh food, leading to nutritional deficits.

This take on it is, at least to me, is the most noteworthy: the researchers, in the end, were considering “poverty as a medical problem, akin to exposure to lead paint, rather than a strictly social condition.”

Poverty as a medical problem: how does that change the way we address it? Is this a possible scenario? A child is brought into the pediatrician or health clinic and it is considered a perfectly acceptable medical question to ask for family income. When a family is poor, closer attention is paid to the standard developmental questionnaire or maybe poverty is an automatic entry to the performance of a more thorough developmental assessment. When a child living in poverty is found to have even minor delays in cognitive development, a prescription is written. It might look like this:

“Intensive developmental intervention recommended based on diagnosis of poverty.”

When I worked as a developmental physical therapist, ages ago, children with documented physical and cognitive disabilities qualified for special preschool services. Now what these researchers suggest is that the qualification be extended to a child’s developmental delay even when it has no other basis than that the family is poor.

Pediatricians and pediatric nurse practitioners and developmental therapists, can we do this? Can we start making the diagnosis “poverty” ? If we call poverty a medical problem, can we find better solutions than we have had in calling it something else?

As I mentioned it earlier, the article is of particular interest to me this week because of an assignment I got in my new job as staff writer for a community lifestyle magazine. (While I am hardly engaged in hard-core investigative journalism, I work with smart women, very good writers and every day I am impressed with the professionalism with which the organization conducts itself. Fact checkers, copy editors: I had never done this kind of work before and it is a pleasure and and honor to have this opportunity.)

The assignment was to investigate and write an article about a local language-immersion preschool. The school is based on the French curriculum, which includes public schooling from age 2-1/2. You read that correctly: publicly paid-for school from age 2-1/2.

I’m not sure what I think of this, particularly in light of the needs of children of poverty. On one hand, if the quality of the universal preschool is good, it’s great, right? And the women I met who were associated with this particular preschool were stellar: highly knowledgable and respectful of everything that is unique and wonderful about preschool-aged children. On the other hand, their private, high-quality preschool is expensive. Taxpayers would balk, and rightly so, I think, at the price tag of this kind of schooling. Furthermore I doubt if, for a lot of kids, it would be significantly better than what their families currently provide via stay-at-home moms/other family members, private preschools and school-oriented day care in caregivers’ homes.

I’m not sure the answer is public preschool for everyone. If the objection is that providing special services for children of poverty is stigmatizing, I think we have to reframe our thoughts: is it stigmatizing to provide special service to children with other medical diagnoses, say juvenile diabetes?

One thing I do not doubt is that we could do this, in this great county of ours: pay for public school for children as young as 2-1/2, or even younger if that’s what we truly wanted to do. I’ll go there if we need to. Right now I’m more interested in getting services to the children who need them most. Right now I’m interested in a diagnosis of poverty allowing the most at-risk children access to developmental intervention strategies. In calling poverty what it may well be: a medical problem.

What do you think?






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