- 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:
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.
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