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The Cost of Poverty and the Value of Hope
The Cost of Poverty and the Value of Hope Kristin B. Schubert, MPH; James S. Marks, MD, MPH From the Robert Wood Johnson Foundation, Princeton, NJ The authors report no conflicts of interest. Address correspondence to Kristin B. Schubert, MPH, Robert Wood Johnson Foundation, Route 1 and College Rd E, PO Box 2316, Princeton, NJ 08543-2316 (e-mail: [email protected]).
ACADEMIC PEDIATRICS 2016;16:S21–S22
THIS FAR-REACHING SET of articles brings together much of what we know about the measurement, trends, circumstances, and effects of childhood poverty. They compellingly show that the costs of childhood poverty are manifest in reduced education accomplishments and poorer health. The effect of poverty on children is large, persistent, and serious, with negative effects on almost every important contributor to a fulfilling life. Poverty is also depressingly common for our nation’s children—almost half are affected—so the urgency to address this crisis cannot be greater. What we have learned about the ways toxic stress during the first few years of life permanently affects brain development means that we must reverse our underinvestment in our families and their children. Our future as a nation is tied to the success of these children. Taken as a whole, the reports of various interventions— from direct transfers of cash to parental employment to primary care to noncash assistance—all show promising reductions in poverty and/or related consequences, especially in the short- to intermediate-term. Many interventions, including medical coverage, Supplemental Nutrition Assistance Program benefits, and subsidized housing, can directly mitigate and reduce poverty. But most of these benefits are regularly at risk for families who need it most. If they earn a little more, for example, they risk losing their support. And often the employment they do find does not provide a sense of pride or progress. This cycle leads to emotional and financial stress that repeats during a young child’s life. And that stress is felt by the child as well as the parents, with long-lasting effects on health and well-being. Good health does not just happen. It begins, is nurtured, protected, and preserved in families, neighborhoods, and schools—all the places where our children live, learn, and play. In any discussion of poverty and incomerelated interventions, the success of home visiting can seem surprising, so it is valuable to have an article that makes the case for it. It is worth reflecting on the idea that coaching and counseling (ie, emotional support, encouragement, and advice) can successfully contribute to reducing the effects of food insecurity, and inadequate housing and money, and how and why it succeeds. Perhaps home visiting operates through moderating stress,
ACADEMIC PEDIATRICS ª 2016 Published by Elsevier Inc. on behalf of Academic Pediatric S21 Association
providing an increased sense of doing well as a parent, and building hope for a better life. Let us be clear we are not saying that a poor family only needs intermittent coaching and not actual direct financial support. Rather, this emotional support helps a young mother feel more confident of her abilities and hopeful about her child’s future. The articles on home visiting, preschool, child care providers, and primary care highlight that specific interventions can be valuable, but no single intervention will be sufficient by itself. We have to promote a comprehensive vision and set of actions that address children’s needs as a whole: a stable home life; a nurturing environment with engagement by parents, siblings, and other adults; the availability of good health care, healthful food, and physical and emotional warmth. All these are needed— money alone is not enough. However, the lack of financial resources make all those other needs much more insecure. It is important to frame, if briefly, these broad aspirations during this time when so many of our children’s possibilities to have a long, healthy, fulfilling life in an increasingly diverse society are being eroded. Poverty and the concomitant family stresses are at the core of that loss. That brings us to why this supplement is in the journal Academic Pediatrics. Pediatricians, along with others in the child-caring professions, have long accepted the responsibility and the honor of being the voice and advocate for children. Science lends credence to our support for parents and our advocacy for policy that supports families’ and children’s needs. Our commitment to children other than our own gives our voice a moral standing. We have always known that what we can do within clinical care (or in schools) is helpful but not sufficient, and that no program or service can take the place of caring parents nurturing their children. However, our statistics and our children’s outcomes are making it increasingly clear that millions of parents do not have the support, resources, and time to nurture their children enough. We also know that our science and our skills will improve, but never enough, unless our nation recognizes that they are all ‘our children.’ It is not something the medical profession can solve on its own, but it can shine a light on the consequences, and be clear that we cannot succeed
Volume 16, Number 3S April 2016
S22
SCHUBERT AND MARKS
as a profession unless our communities and our nation embrace that we are all in this together. That we all, regardless of what we work on, have an important responsibility to the future. We need to make sure that all children have
ACADEMIC PEDIATRICS
the opportunity to succeed, and children whose family circumstances are more challenging need more help. This supplement on poverty aimed at pediatric leaders makes this statement.
ACADEMIC PEDIATRICS 2016;16:S21–S22
THIS FAR-REACHING SET of articles brings together much of what we know about the measurement, trends, circumstances, and effects of childhood poverty. They compellingly show that the costs of childhood poverty are manifest in reduced education accomplishments and poorer health. The effect of poverty on children is large, persistent, and serious, with negative effects on almost every important contributor to a fulfilling life. Poverty is also depressingly common for our nation’s children—almost half are affected—so the urgency to address this crisis cannot be greater. What we have learned about the ways toxic stress during the first few years of life permanently affects brain development means that we must reverse our underinvestment in our families and their children. Our future as a nation is tied to the success of these children. Taken as a whole, the reports of various interventions— from direct transfers of cash to parental employment to primary care to noncash assistance—all show promising reductions in poverty and/or related consequences, especially in the short- to intermediate-term. Many interventions, including medical coverage, Supplemental Nutrition Assistance Program benefits, and subsidized housing, can directly mitigate and reduce poverty. But most of these benefits are regularly at risk for families who need it most. If they earn a little more, for example, they risk losing their support. And often the employment they do find does not provide a sense of pride or progress. This cycle leads to emotional and financial stress that repeats during a young child’s life. And that stress is felt by the child as well as the parents, with long-lasting effects on health and well-being. Good health does not just happen. It begins, is nurtured, protected, and preserved in families, neighborhoods, and schools—all the places where our children live, learn, and play. In any discussion of poverty and incomerelated interventions, the success of home visiting can seem surprising, so it is valuable to have an article that makes the case for it. It is worth reflecting on the idea that coaching and counseling (ie, emotional support, encouragement, and advice) can successfully contribute to reducing the effects of food insecurity, and inadequate housing and money, and how and why it succeeds. Perhaps home visiting operates through moderating stress,
ACADEMIC PEDIATRICS ª 2016 Published by Elsevier Inc. on behalf of Academic Pediatric S21 Association
providing an increased sense of doing well as a parent, and building hope for a better life. Let us be clear we are not saying that a poor family only needs intermittent coaching and not actual direct financial support. Rather, this emotional support helps a young mother feel more confident of her abilities and hopeful about her child’s future. The articles on home visiting, preschool, child care providers, and primary care highlight that specific interventions can be valuable, but no single intervention will be sufficient by itself. We have to promote a comprehensive vision and set of actions that address children’s needs as a whole: a stable home life; a nurturing environment with engagement by parents, siblings, and other adults; the availability of good health care, healthful food, and physical and emotional warmth. All these are needed— money alone is not enough. However, the lack of financial resources make all those other needs much more insecure. It is important to frame, if briefly, these broad aspirations during this time when so many of our children’s possibilities to have a long, healthy, fulfilling life in an increasingly diverse society are being eroded. Poverty and the concomitant family stresses are at the core of that loss. That brings us to why this supplement is in the journal Academic Pediatrics. Pediatricians, along with others in the child-caring professions, have long accepted the responsibility and the honor of being the voice and advocate for children. Science lends credence to our support for parents and our advocacy for policy that supports families’ and children’s needs. Our commitment to children other than our own gives our voice a moral standing. We have always known that what we can do within clinical care (or in schools) is helpful but not sufficient, and that no program or service can take the place of caring parents nurturing their children. However, our statistics and our children’s outcomes are making it increasingly clear that millions of parents do not have the support, resources, and time to nurture their children enough. We also know that our science and our skills will improve, but never enough, unless our nation recognizes that they are all ‘our children.’ It is not something the medical profession can solve on its own, but it can shine a light on the consequences, and be clear that we cannot succeed
Volume 16, Number 3S April 2016
S22
SCHUBERT AND MARKS
as a profession unless our communities and our nation embrace that we are all in this together. That we all, regardless of what we work on, have an important responsibility to the future. We need to make sure that all children have
ACADEMIC PEDIATRICS
the opportunity to succeed, and children whose family circumstances are more challenging need more help. This supplement on poverty aimed at pediatric leaders makes this statement.