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Nutrition support, such as WIC and SNAP, address undernutrition, but other forms of malnutrition, such as obesity, also may be responsive to supplemental programs. For instance, a recent study in preschool-aged children found that those who participated in Head Start had a healthier BMI at school entry than did children who did not have the benefit of food provided by federal subsidy. It provides support for federal, state, and community governments to implement established and proven home visiting programs for at-risk children.

The stated goals of MIECHV are to improve maternal and newborn health; prevent child injuries, abuse, neglect, or maltreatment; reduce emergency department visits; improve school readiness and achievement; reduce crime or domestic violence; improve family economic self-sufficiency; and improve coordination and referrals for other community resources and supports. MIECHV has identified 19 evidence-based interventions that target families with pregnant mothers and children younger than 5 years.

First-time, low-income mothers are enrolled during the prenatal period and visited weekly by nurses trained in a validated curriculum beginning in the second trimester.

The benefit-cost ratio for high-risk mothers has been calculated at 5. Programs designed for the pediatric medical home provide opportunities for low-cost, population-based preventive intervention with low-income families. An awareness of the protective factors that are present in children and families can help pediatricians to build on their strengths during health promotion conversations. In a medical home adapted to the needs of families in poverty, parents have the opportunities and resources to promote resilience in their young children, giving them the capacity to adapt to adversity and buffering the effects of stress.

Healthy Steps for Young Children, a manual-based primary care strategy, and programs such as Incredible Years and Triple P, which integrate behavioral health into primary care, have been shown to promote responsive parenting and address common behavioral and developmental concerns. Another program, the Video Interaction Project VIP , combines early literacy with guided parent-child interactions that support family relationships and social development of children.

The AAP has promoted the National Center for Medical-Legal Partnerships model, which provides legal aid collocated with health services, especially to families in poverty. A pilot study of medical-legal partnerships found that addressing the social determinants of health by providing legal services and helping families negotiate safety net organizations improves child health outcomes, reduces unnecessary urgent visits, and raises overall child well-being.

Care coordination, a fundamental service of the medical home model, can link families with community resources and support interagency coordination to address basic concerns such as food and energy insecurity.

An example of a robust case management initiative is Health Leads, 77 an enhanced primary care strategy that uses college volunteers as advocates and advanced resource management techniques, which has improved coordination of care and utilization of collocated social services by low-income families with the intent of reducing the social barriers to good health. To link families to services as early as possible, pediatricians can use screening tools that have high sensitivity and specificity.

The WE CARE survey 78 is a brief set of questions that alerts the pediatrician to families experiencing stress related to poverty. Effective early identification of families in need may facilitate prevention services, including nutritional supplements for young children, preventive health services, age-appropriate learning opportunities, and socioemotional support of parents. Program evaluation has supported this multifaceted approach in multiple countries and settings.

Early childhood experiences that promote relational health lead to secure attachment, effective self-regulation and sleep, normal development of the neuroendocrine system, healthy stress-response systems, and positive changes in the architecture of the developing brain. Two-generation strategies focus on helping low-income children and their parents simultaneously through high-quality interventions.

Improved coordination of programs and services for low-income families is essential to a 2-generation strategy. Recent research suggests that noncognitive skills, such as perseverance, empathy, and self-efficacy, remain malleable during adolescence 90 and build on the cognitive skills developed during early childhood. Interventions such as adolescent mentoring, residential training eg, Job Corps , and workplace-based apprenticeship programs can increase academic achievement, employment success, and other nonacademic accomplishments over the life span.

As the health care system increasingly focuses on efforts to improve quality and contain costs, there may be new opportunities to restructure the health care delivery system in ways that can improve care for children in low-income families. Policy decisions in other countries, such as the United Kingdom, 91 also may inform these efforts.

Incentivizing care coordination and team-based care may help more children access quality health care through patient- and family-centered medical homes FCMHs. Medical homes also can help families address unmet social and economic needs by using partners, such as community health workers, within the health care team. State reforms and integrated health delivery systems in some regions are providing incentives for population health approaches, facilitating collaboration in healthy neighborhood initiatives.

Although all children may benefit from greater collaboration between health care organizations and community resources, children and in poor and low-income families may experience even greater gains.

Public policy efforts are needed to protect the health of children affected by poverty and to help families become economically secure. The specific recommendations made in this and the following section are based on positive outcomes in peer-reviewed literature or preliminary studies that show sufficient promise that rigorous long-term evaluations are underway. Invest in young children. Funding quality early childhood programs can have a significant financial return on investment, but more importantly, making healthy development of young children a national priority while addressing social determinants of health helps families and communities build a foundation for lifelong health.

Protect and expand funding for essential benefits programs that assist low-income and poor children. Streamline enrollment and renewal processes for public benefit programs. Support 2-generation strategies that focus on helping children and parents simultaneously.

Promote the coordination and alignment of adult- and child-focused programs, policies, and systems. Support and expand strategies that promote employment and that increase parental income. Support policies that help parents increase family income, including higher minimum wages, education and job-training programs, and the EITC, child tax credit, and child and dependent care tax credit.

Support policy measures that improve community infrastructure, including affordable housing and public spaces. Ensure that all children have safe outdoor play areas as well as healthy, safe, and affordable housing.

Improve access to quality health care and create incentives to improve population health with the goal of reducing health disparities. Strategies to improve quality and reduce costs should include care coordination and team-based care that help families address nonmedical health-related concerns, such as food, housing, and utilities.

Pediatricians and health care systems should be encouraged to partner with other stakeholders to advance community-level strategies that improve health and reduce disparities among populations of varying income levels. Enhance health care financing to support comprehensive care for at-risk families. All benefit plans should include coverage for enhanced services in the medical home for families in poverty. Care coordination, team-delivered care, and coverage for mental health services provided by pediatricians are examples of these enhanced services.

Make a national commitment to fully fund home visiting programs for all children living in low-income or poor households. Both Medicaid and education funding agencies should provide support in the medical home for parenting and literacy promotion.

Improve national poverty definitions and measures. The SPM is an improvement, but more research is necessary to quantify the extent of poverty in the United States and its effects on children and families so that effective responses can be developed and promoted.

Support a comprehensive research agenda to improve the understanding of the effects of poverty on children and to identify and refine interventions that improve child health outcomes. Research is needed to identify better ways to measure how poverty affects children, what works to help families in poverty, and how to translate the information gained into real solutions for the poor. The following recommendations address how individual pediatricians can support the health and well-being of children living in poverty.

Adaptations of the medical home to acknowledge the complex challenges that confront poor families require surveillance on the part of the practitioner of both risk and protective factors that characterize each family. Create a medical home that acknowledges and is sensitive to the needs of families living in poverty. Although every family wants to provide the best resources and care to their children, economic barriers can stand in the way.

All members of the care team and practice should become familiar with some of the common challenges faced by poor families. Recognizing problems such as transportation barriers, difficult work schedules, and competing financial issues can help practices effectively communicate and partner with families. An enhanced medical home providing integrated care for families in poverty is informed by the understanding that emotional care of the family, including recognizing maternal depression, is within the scope of practice for community pediatricians and that the effects of toxic stress on children can be ameliorated by supportive, secure relational health during early childhood.

Screen for risk factors within social determinants of health during patient encounters. Practices can use a brief written screener or verbally ask family members questions about basic needs, such as food, housing, and heat. Screening for basic needs can help uncover not only obvious but also less apparent economic difficulties experienced by families.

As patient-centered medical homes continue to develop, care coordinators will fulfill the role of community liaison for families in poverty, connecting them with needed resources. These programs help parents develop the capacity and confidence to build resilience in their children and improve the ability of the family to cope with adversity. Bright Futures guidelines provide the most comprehensive recommendations for health supervision and are enhanced by strategies to advance behavioral health care into the pediatric medical home and to address the social determinants of health.

Identify and build on family strengths and protective factors. Although families in poverty face many challenges, each family has strengths, capabilities, and protective factors. Pediatricians can strive to identify and build on protective factors within families, such as cohesion, humor, support networks, skills, and spiritual and cultural beliefs.

Collaborate with community organizations to help families address unmet basic needs and assist with family stressors. When unmet basic needs and poverty-associated risks are identified, pediatricians can refer families to appropriate community services and public programs.

Key partners may include local and state public health departments, legal services, social work organizations, food pantries, faith-based organizations, and community development organizations.

Some communities also may have innovative financial literacy programs that are helpful. Engage with early intervention programs and schools to promote learning and academic achievement. Education professionals are often very involved in efforts to help children from low-income backgrounds with academic achievement and also may participate in initiatives focused on basic needs, such as feeding programs, clothing drives, and health screenings.

Pediatricians can actively participate with these efforts as well as early intervention programs, after-school programs, tutoring programs, and social services provided through the school district.

Pediatricians should be familiar with local MIECHV programs and how to connect their patients with home visiting programs on the state and local levels. Opportunities for enhanced communication between the FCMH and home-visiting programs may be explored, including the possibility of collocation of visitors in the FCMH as an integrated service model.

Support community programs that enhance the involvement of fathers in the lives of their children. Pediatricians can be an important support resource and advocate for community-based fatherhood initiatives. When possible, nonresidential fathers should be involved in all aspects of pediatric care.

Advance strategies to address family and child mental health and development. Pediatricians are strongly encouraged to include routine screening for maternal depression at every health supervision visit during the first year of life and to be able to provide an appropriate referral for treatment when depression is suspected. Pediatricians can advocate for increased resources to address mental health and behavioral issues in poor communities, including separate payment for screening for parental depression and for care coordination activities.

Advocate for public policies that support all children and help mitigate the effects of poverty on child health. Pediatricians can serve as important advocates for policies that help children and families in poverty. Pediatricians can add a unique voice to poverty-related advocacy by reframing poverty as an evidence-based health concern with lifelong health, social, and economic consequences. Poverty and other adverse social determinants have a detrimental effect on child health and are root causes of child health inequity in the United States.

Knowledge is expanding rapidly, especially regarding the neurobiological effects of poverty and related environmental stressors on the developing human brain as well as the life course of chronic illness. Understanding the causative relation between early childhood poverty and adult health status should inform and influence the decisions of policy makers, researchers, and community pediatricians.

The evidence strongly suggests that the FCMH with its enhanced capabilities is an essential asset in efforts to ameliorate the adverse effects of poverty on children. The AAP considers child poverty in the United States unacceptable and detrimental to the health and well-being of children and is committed to its elimination. The AAP calls for concerted action by its state chapters as well as governmental, private, nonprofit, faith-based, philanthropic, and other advocacy organizations to reduce child poverty by supporting and expanding existing programs that have been shown to work and to make efforts to develop, identify, and promote other potentially effective policies and programs.

Together, these 2 pieces of legislation have greatly reduced and nearly eliminated poverty in the elderly. It is time to enact similar reforms to eliminate child poverty.

By embracing the policies and enacting the recommendations in this statement, the AAP joins with governmental, philanthropic, private, and other health care organizations in a concerted and dedicated effort to eliminate child poverty in the United States.

We acknowledge the following University of California—Los Angeles pediatric and med-peds residents for their research contributions to this policy statement: Klein, MD, Ashley E. Maufe, MD, Colin L. A companion to this article can be found online at www. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics.

Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal AAP and external reviewers.

However, policy statements from the American Academy of Pediatrics may not reflect 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 of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

This measure does not take into account government benefits eg, SNAP , income tax credits, or family expenses eg, child care, income taxes and has not fundamentally changed since except for annual adjustments for food price inflation.

The SPM includes the value of certain federal in-kind benefits, federal tax benefits, and family expenses. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Search for this keyword. From the American Academy of Pediatrics. Abstract Almost half of young children in the United States live in poverty or near poverty.

Statement of the Problem Poverty is an important social determinant of health and contributes to child health disparities. What Works To Ameliorate the Effects of Child Poverty Programs that help poor families and children take many forms and often involve stakeholders from multiple communities, including governmental, private nonprofit, faith-based, business, and other philanthropic organizations.

Early Childhood Education Early Head Start and Head Start are federally funded, community-based programs for low-income families with young children. Nutrition Support The Supplemental Nutrition Program for Women, Infants, and Children WIC is a federal assistance program of the US Department of Agriculture that was first established in with the aim of improving the health of low-income women, infants, and children.

Family and Parenting Support in the Medical Home Programs designed for the pediatric medical home provide opportunities for low-cost, population-based preventive intervention with low-income families. Early Identification of Families in Need of Services To link families to services as early as possible, pediatricians can use screening tools that have high sensitivity and specificity.

Recommendations As the health care system increasingly focuses on efforts to improve quality and contain costs, there may be new opportunities to restructure the health care delivery system in ways that can improve care for children in low-income families. Opportunities for Public Policy Advocacy Public policy efforts are needed to protect the health of children affected by poverty and to help families become economically secure. Opportunities for Community Practice The following recommendations address how individual pediatricians can support the health and well-being of children living in poverty.

Conclusions Poverty and other adverse social determinants have a detrimental effect on child health and are root causes of child health inequity in the United States. Lead Authors James H.

Staff Camille Watson, MS. Acknowledgments We acknowledge the following University of California—Los Angeles pediatric and med-peds residents for their research contributions to this policy statement: The effects of poverty on children.

Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood. Early childhood adversity, toxic stress, and the role of the pediatrician: Trends in the prevalence of developmental disabilities in US children, The Price We Pay: Economic and Social Consequences of Inadequate Education.

Brookings Press ; The lifelong effects of early childhood adversity and toxic stress. The economic costs of childhood poverty in the United States. The economic value of opportunity youth. Corporation for National and Community Service ; Accessed January 11, Innocenti Report Card Organization for Economic Cooperation and Development. Current population reports, P, income and poverty in the United States: US Government Printing Office; One in five children receive food stamps, Census Bureau reports.

Accessed September 28, Kids Count Data Center. Accessed July 31, International comparisons of economic mobility. Getting ahead or losing ground: The Brookings Institution ; Economic mobility in the United States.

Accessed December 27, University of California Berkeley ; The state of working America: Childhood and intergenerational poverty. National Center for Children in Poverty ; The geography of despair. Confronting Suburban Poverty in America. Building stronger communities for better health. Accessed December 28, Council on Community Pediatrics. Providing care for children and adolescents facing homelessness and housing insecurity.

Mediators and adverse effects of child poverty in the United States. We also find that Israeli Jewish settlers who attacked Palestinians in the West Bank in the early s were overwhelmingly from high-paying occupations. The conclusion speculates on why economic conditions and education are largely unrelated to participation in, and support for, terrorism. Is There A Causal Connection? Education, Poverty, Political Violence and Terrorism: Is There a Causal Connection?

Labor Studies , Public Economics , Economics of Education The paper investigates whether there is a causal link between poverty or low education and participation in politically motivated violence and terrorist activities.

Development of the American Economy. Economic Fluctuations and Growth. International Finance and Macroeconomics. International Trade and Investment. Productivity, Innovation, and Entrepreneurship. The Women Working Longer Project.

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Poverty is the scarcity or the lack of a certain (variant) amount of material possessions or money. Poverty is a multifaceted concept, which may include social, economic, and political elements. Absolute poverty, extreme poverty, or destitution refers to the complete lack of the means necessary to meet basic personal needs such as food, . Education, Poverty, Political Violence and Terrorism: Is There a Causal Connection? Alan B. Krueger, Jitka Maleckova. NBER Working Paper No. Issued in July

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