Reducing Intergenerational Poverty (2024) / Chapter Skim
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5 Child and Maternal Health
5 Child and Maternal Health
Pages 109-138
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From page 109... ...
It then presents evidence on the importance of child health as a key determinant of adult earnings. In so doing, the chapter is organized around three main determinants of child health: access to medical care (i.e., family planning services, health insurance coverage, mental health care, and 109
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From page 110... ...
The rate of preterm and low-birthweight births is 50% higher among Black families relative to White families and 30% higher for Native American families (Figure 5-3)
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From page 111... ...
is consistent with racial/ethnic differences in the prevalence and severity of this condition but also in access to care. One measure along which Black children fare better than White or Latino youth, and much better than Native American youth, is suicide, as discussed later, though rates of suicide among Black youth have recently grown more quickly.1 These racial/ethnic differences in child health translate into adult disparities in health, with significant labor market consequences.
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From page 112... ...
Child health insurance coverage does not differ appreciably for Black and White children, largely because of the Medicaid program. Rates of uninsurance are much higher for the Native American and Latino population.2 Other important sources of disparate access to medical care include differences in geographic access, distrust of the medical system based on past injustices, and racial discordance between patient and provider (Alsan & Wannamkaer, 2018; Alsan et al., 2019)
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From page 113... ...
HOW HEALTH AFFECTS THE ECONOMIC MOBILITY OF CHILDREN There are many reasons why child health might vary with parental income that would not necessarily imply the causal relationship needed to establish that health is a driver of intergenerational poverty. To isolate the causal impact of parental income on child health, researchers have relied upon natural experiments, including changes in policy that can raise or
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From page 114... ...
A direct route runs from child health to adult health, which in turn affects future earnings via disability, employment, and wages. That is, healthy children grow up to become healthy adults who are more productive in the labor market, generating greater earnings and reducing reliance on public programs.
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From page 115... ...
ACCESS TO HEALTH CARE: FAMILY PLANNING, MEDICAID, INDIAN HEALTH SERVICES, AND MENTAL HEALTH SERVICES Access to Family Planning Services Low-income families currently have the highest fertility rates, the lowest use of contraception, and the highest unmet need for family planning services. Eighteen percent of sexually active low-income women (below 200% of the Federal Poverty Line [FPL]
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From page 116... ...
. This reduction in poverty caused by access to family planning services operates in part through improved economic outcomes for mothers.
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From page 117... ...
Among children who lack health insurance, two-thirds are eligible for Medicaid but not enrolled, suggesting that efforts to increase health insurance coverage by targeting the already eligible and simplifying enrollment and re-enrollment processes are likely to be highly effective. Indeed, increases in the uninsurance rate of low-income children between 2018 and 2020 have been linked to changes in federal guidance that increased administrative requirements for reenrollment (Arbogast et al., 2022)
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From page 118... ...
. Given the established causal relationship between newborn health and future economic outcomes, it is not surprising that researchers have also linked these Medicaid expansions in childhood to higher school attainment and earnings later in life (Brown et al., 2020)
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From page 119... ...
. Native American children are unique in that they are also served by the IHS, a direct provider of health care services.6 However, according to the U.S.
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From page 120... ...
Multiple studies have linked attention deficit hyperactive disorder and other mental health conditions in childhood with worse adult economic outcomes, including employment, earnings, and welfare use (Currie et al., 2010; Fletcher, 2014; Smith & Smith, 2010)
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From page 121... ...
Though low-income children are not more likely to be exposed to a school shooting, they are more likely to be exposed to violence and to have mental health conditions. We draw upon the research on school shootings in order to highlight the likely causal relationship between low-income children's greater exposure to violence, mental health conditions, and worse future economic outcomes.
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From page 122... ...
Two important mechanisms include access to family planning services and health insurance coverage in pregnancy and childhood, both of which are key to improving the short- and long term health and economic outcomes of children. Yet many low-income families are still without health insurance coverage or access to family planning services.
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. Multiple federal policy efforts have been shown to have effectively reduced pollution and improved child health.
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Recent research has taken advantage of naturally occurring variation in exposure to lead -- as a result of federal and local policies that have sought to reduce exposure -- to generate causal impacts. It has found that providing incentives to landlords to remediate lead in homes reduced children's blood lead levels and increased child test scores in reading and math, especially among low-income and racial/ethnic minority households (Aizer et al., 2018)
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From page 125... ...
However, this has not yet been directly established. Finally, children in families living below poverty and Black children are more likely to live near one of the 300,000 facilities that emit toxic chemicals, known as toxic release inventory sites (Perlin et al., 1999)
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From page 126... ...
Researchers have identified racism and discrimination as additional sources of stress faced by Black, Latino and Native American families in the United States (Collins et al., 2014; Nam et al., 2022; Paradies et al., 2015; Sawyer et al., 2012)
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From page 127... ...
that were nearly six times higher than the rates among White children and three times higher than those among Native American children in 2021 (Kaiser Family Foundation, 2022)
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From page 128... ...
. To the extent that exposure to violence leads to premature death as well as stress to those indirectly exposed, thereby contributing to intergenerational poverty, we discuss interventions to reduce violence in Chapter 9, which discusses crime and the criminal justice system.
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From page 129... ...
As compared with White children, Black children are 3.5 times more likely and Latino children almost 3 times more likely to live in a household that has experienced food insecurity. Food insecurity during childhood is associated with worse physical health (Gunderson & Kreider, 2009; Thomas et al., 2019)
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. Examining the initial roll-out of the federal Supplemental Nutrition Assistance Program (SNAP)
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The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) , the other major federal food program for children, is also associated with better nutrition, dietary intake, food security, and health, including birth outcomes.
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From page 132... ...
Evidence from the introduction of the Supplemental Nutrition Assistance Program (SNAP) program in the 1960s and 1970s suggests that food supplements for children in low income families, both in utero and during childhood, can contribute to intergenerational mobility, improving child health and ultimately future adult health and earnings.
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From page 133... ...
We also considered evidence to be direct if strong post-1990 evidence of impacts on pre-adult mediators is coupled with strong pre-1990 evidence on long-run adult impacts in the same domain. Increasing Access to Health Care Based on Direct Evidence Family Planning The main sources of funding for family planning are private health insurance, Medicaid, and the Title X Family Planning program.
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From page 134... ...
Medicaid Strong direct evidence has shown that Medicaid expansions during the prenatal period and childhood lead to better health, greater educational attainment, and higher earnings later in life. With 2.8 million children currently eligible for Medicaid but uninsured, enrolling those already eligible through outreach and continuous enrollment requirements is the most effective way to increase health insurance coverage for low-income families (Kaiser Family Foundation, 2024)
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From page 135... ...
HEALTH INTERVENTIONS BASED ON INDIRECT EVIDENCE Increasing Access to Medical Care Among Native American Families There is no direct evidence linking the IHS to adult poverty, However, the direct evidence on Medicaid likely applies to IHS as both operate by increasing access to medical care. In order to meet the considerable unmet
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From page 136... ...
Increasing Access to Mental Health Care Given the established link between child mental health and reduced educational and labor market outcomes and the evidence showing significant barriers to receiving care among youth, the CDC could pilot multiple ways to increase child and adolescent access to mental health care, including these: • Establish and/or expand school-based health clinics so that they include more mental health providers. • Pilot telehealth access for children and youth in underserved areas.
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From page 137... ...
• Strengthen EPA monitoring of Toxic Release Inventory (TRI) sites and consider regulating them to reduce children's exposure to toxic chemicals.
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