Page 8 - Mecklenburg_Medicine_September-2016

Feature
The Impact of Poverty on Health
and Education
ABy Lee McCracken, Contributing Writer
9-month-old child gets his height and weight measured.
His doctor talks to the mother about immunizations,
nutrition and the trajectory of his physical development. parental engagement — even possibly emotional and physical abuse.
All is well.
But what if he were the youngest of three children to a single mother
who’s lost her home? Embarrassed to say she’s fallen on hard times
and staying with a friend — some nights even sleeping in the car —
the mom gives the physician a quiet, strained smile.
More than 16 million children in the United States — 22 percent
“We want to share with of all children — live in
families with incomes
physicians and nurses below the federal poverty
how to listen to and level, according to the
National Center for
talk with parents who Children in Poverty. The
are going through a physical, psychological and
emotional stress on families
homeless crisis without and children caught in
embarrassing them.” poverty, and perhaps
homelessness, is significant.
“The main aim of
— Susan Hansell, A Child’s Place pediatrics is prevention
… of diseases, injury,
emotional problems,
developmental and intellectual delays,” says Daniel R. Taylor, DO,
an associate professor at the Drexel University College of Medicine
and the director of community pediatrics and child advocacy at St.
Christopher’s Hospital for Children. The American Academy of
Pediatrics online linked to an op-ed piece by Taylor in the April 25
edition of the Philadelphia Inquirer. In “A Doctor’s Call for Action on
Childhood Poverty,” Taylor charges physicians to add “screening our
young patients for health and emotional problems related to poverty”
to their prevention toolkit.
Susan B. Hansell, executive director of A Child’s Place in Charlotte,
agrees. She says that just as physicians are on the front lines of
uncovering situations of domestic violence, emergency department
docs, pediatricians and other physicians can help look and listen for
signs of instability and, perhaps, homelessness.
“There’s a physiological reason why some students are very slow
in learning to read and why they act out at school,” says Hansell,
emphasizing that those with young developing brains adapted for
chaotic, unpredictable environments need deliberate and consistent
intervention.
Head and Heart
The deficits of poverty on children are numerous and permanent.
Articles in JAMA Pediatrics have cited studies proving that the more
adversity children encounter, the more likely they are going to grow
8 | September 2016 • Mecklenburg Medicine
up to be sick adults, often developing hypertension and heart disease.
Beyond poor nutrition, the stressors of poverty are unsafe/unstable
housing, family turmoil (yelling, swearing and violence) and a lack of
Sheldon Cohen, PhD, the director of Carnegie Mellon University’s
Laboratory for the Study of Stress, Immunity and Disease, says
poverty-induced stress can begin shrinking the protective protein caps
of chromosomes during early childhood. His 2013 study, published in
Brain, Behavior and Immunity, showed a direct association between
low socioeconomic status and shortened telomeres.
“There are lots of possible pathways that may link low
socioeconomic status in childhood to adult disease,” says Cohen.
The brain size of children ages birth-3 also is impacted by poverty.
Documented scans prove children’s brains can double in size in the
first year, and by age 3, most brains have reached 80 percent of their
adult size.
Not so for poor children. “Poverty is one of the most powerful
predictors of poor developmental outcomes for children,” says Joan
Luby, MD, the Samuel and Mae S. Ludwig Professor of Child
Psychiatry and director of Washington University’s Early Emotional
Development Program. Her 2013 study published in JAMA Pediatrics
proved poverty is tied directly to structural differences in several
areas of the brain — hippocampus and amygdala, as well as smaller
volumes of white and cortical gray matter — associated with school
readiness skills.
Language, Reading
Experts are beginning to ask that if physicians already are
discussing physical development, nutrition and safety in the home
with mothers, shouldn’t they also be talking about the trajectory of
brain development?
“In a perfect world, there would be time during a visit to
pediatricians’ offices to learn how the baby spends his or her time and
how the mother may need guidance and support,” says Hansell, of A
Child’s Place. Comments such as, “Let me tell you why it’s important
to talk to your baby in full sentences,” “Do you have books in your
home?” and “Do you read to your children?” are just as important as
medicine, she advocates. But in poverty and homelessness situations,
there often is no family physician and children are taken to the
emergency room or move from clinic to clinic.
Marion Bish, the executive director of Student Services with
Charlotte-Mecklenburg Schools, says her 32 years of working in
public education — from elementary school to middle school, and
with federally-funded preschool programs — as well as being a
grandmother, has proven to her the language deficit among poor child
is very real. Bish not only speaks, but also teaches graduate-level
classes education/administration at UNC Charlotte, about children’s
brains and the achievement gap.