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Family Income Impacts Children's Health

Big gaps exist between states, and between poor, middle- and upper-class families, study finds

WEDNESDAY, Oct. 8 (HealthDay News) -- For American children, the state they live in and their family's income and education may help determine how healthy they are, a new survey shows.

Among children aged 17 and younger, 16 percent are in less than optimal health, according to the state-by-state survey from the nonprofit Robert Wood Johnson Foundation.

But that rate ranged widely by state: from 22.8 percent of children in Texas to only 6.9 percent of children in Vermont.

"Child health is a foundation for his or hers health throughout life," Dr. Paula Braveman, director of the Center on Social Disparities in Health at the University of California, San Francisco, and co-author of the report, said during a Tuesday teleconference. "So, the health of our children is not only an important concern in itself, it's a very important indicator of the health of the nation."

The report, America's Health Starts With Healthy Children: How Do States Compare?, provides new evidence that children in the United States are not as healthy as they could be, Braveman said.

"This report shows how much healthier kids in each state could be if we narrow the gap between the children of the wealthiest, most educated families and everyone else," she said.

"The report spotlights poverty as a cause of ill health in kids, and downplays the role of health insurance," said Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and co-founder of Physicians For A National Health Program. "Poverty, however, is a lack of access to resources, and one resource that many poor children cannot access is health care. Lack of adequate health insurance forces parents to go without care for themselves and their kids. While figuring out how to end poverty is complex, figuring out how to achieve universal access to health care is simple -- nonprofit national health insurance."

Children's health improves along with increasing levels of family education and income, Braveman noted. "Children in poor and less-educated families generally have the worst health, but even children in middle-class families fare worse than those at the top," she said.

Sue Egerter, co-director of the University of California, San Francisco, Center on Social Disparities in Health, and another of the report's authors, noted that in the United States a full third of children in the poorest households are in less than very good health, compared with 7 percent of children in more affluent households.

"These children are not simply suffering from earaches, these are kids with much higher rates of chronic medical conditions including asthma, respiratory allergies and learning disabilities," Egerter said during the teleconference. "These are kids who, quite simply, have more health problems than most other kids."

The same health disparities exist among middle-class children, Egerter said. "Middle-class kids are nearly one and a half times as likely as children in higher income families to be in less than very good health," she said.

Two stark examples of the disparity in children's health are found in the states of Texas and New Hampshire.

Texas has the highest rate of children in "less than optimal health." Among poor Texan families, 44 percent of these children fall into that category, compared with only 6.7 percent of children in higher-income families. This is the largest income gap in children's health of all the states.

In contrast, only 13 percent of low-income children in New Hampshire have less than optimal health, compared with 6.4 percent of children in higher-income families. This is the smallest income gap of all states, Egerter said.

Even children in middle-income families can experience shortfalls in health compared with children in higher-income families, according to the report. These differences in health are also seen across racial and ethnic groups.

After New Hampshire, the states with the smallest gaps in health between children from high- or low-income families are Virginia, Minnesota, North Dakota and Wyoming. Those with the widest gaps include Texas, Arizona, Nevada, Louisiana, Washington, D.C., and Mississippi, according to the report.

Another factor influencing children's health: a mother's education. Across the country, babies born to mothers who have at least 16 years (i.e., a college degree) of education are less likely to die before reaching their first birthday than babies born to mothers who have not finished high school.

For example, in South Carolina, infant mortality among mothers who have not graduated high school reaches 11.6 deaths per 1,000, compared with 5.3 deaths per thousand among mothers who have had at least 16 years of education. This is one of the largest gaps in infant mortality based on years of school, according to the report.

Despite this, infant mortality rates in almost every state exceed what ideally could be achieved -- a national benchmark rate of only 3.2 deaths per 1,000, Egerter said.

Other report highlights:

  • Children in poor families in most states are six times more likely to be in less than optimal health, compared with higher income families.
  • Children in middle-income families are twice as likely, in some states, to be in less than optimal health than children in higher income families.
  • Infant mortality is 40 percent higher among mothers with 13 to 15 years of schooling, compared with mothers with at least 16 years of school.
  • Children in homes without a high school graduate are more than four as times likely to be in less than optimal health as children in a home with a high school graduate, and four times as likely to be in suboptimal health as a child in a home where someone has been to college.

Improving children's health across the United States means not only improving access to the health care, but improving the conditions in which many children are raised, Egerter said.

"We need to change the conversation about health in this country," Egerter said. "We need solutions beyond the medical care system to improve the health of children in this country. Children need the right physical and social conditions to help them be healthy kids who develop into healthy adults. Focusing on health care and coverage is important, but we need to recognize that there is more to health than health care," she said.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, agreed that household income is key.

"A lot of detailed information in this compelling report distills down to a simple and rather common sense message: the fewer social and economic advantages enjoyed by a household, the worse the health of the children being raised there," Katz said. "Babies born to households deficient in education and income are more likely to die in infancy and less likely to experience optimal health," he added.

This report is a tale of trickle-down disparities, Katz said. "Disadvantaged parents raise children disadvantaged from the start with regard to both health and survival," he said.

The problem of disparities is clear, but the solution is much less so, Katz said.

"Can we get all children born in the U.S. to experience a uniform opportunity for survival and optimal health? Perhaps, but only with real dedication to a mission that will be neither quickly nor easily accomplished," he said.

More information

To see the full report, visit theRobert Wood Johnson Foundation.

SOURCES: Oct. 7, 2008, teleconference with Paula Braveman, M.D., director, Center on Social Disparities in Health, University of California, San Francisco; Sue Egerter, Ph.D., co-director, Center on Social Disparities in Health, University of California, San Francisco; Steffie Woolhandler, M.D., M.P.H., associate professor, medicine, Harvard Medical School, Boston, and co-founder, Physicians For A National Health Program; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Oct. 8, 2008, report, America's Health Starts With Healthy Children: How Do States Compare?, Robert Wood Johnson Foundation

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