In the 60 years since I (TBB) first started practicing pediatrics, medical science has made many advances possible. Today's doctors have access to new vaccines and surgical procedures that we could only dream of when I started out.
Yet science has also revealed that raising healthy children requires more than the latest medical treatments. When children grow up in poverty -- as over one out of every six in the United States do (Wimer, Fox, Garfinkel, Kaushal, and Waldfogel, 2013) -- the experience can have dire consequences.
Babies born poor face lifelong consequences for health, mental health, and success in school and in life. Asthma, obesity, diabetes, and learning disabilities are just some of the challenges that children who grow up poor are more likely to face (Center on Budget and Policy Priorities, 2015). And they are far more likely to remain poor as adults (see for instance, Greenstone, Looney, Patashnik, and Yu, 2013). This means that their babies, too, are at higher risk of being born -- and dying -- poor.
The challenges that children living in poverty face are profound and unfair. Americans of every stripe know that babies don't choose the circumstances they are born into. And they don't choose the lifelong consequences of childhood poverty either.
Our healthcare system can't treat all the effects of growing up poor on child and adult health. In order to stave off the chronic illnesses of childhood and adulthood caused by poverty, we need to start promoting economic mobility at the beginning of life.
We have federal programs that help reduce child poverty, the most significant being the child tax credit and the earned income tax credit (Center on Budget and Policy Priorities, 2015). Collectively, they lift five million children out of poverty every year, more than any other federal initiatives (Center on Budget and Policy Priorities, 2015).
But the evidence tells us we have to do even more. The incidence of poverty in our nation is higher for children than for any other age group. Children under three have the highest poverty rates of all because their parents are often poorly paid or can't work because they must stay home to provide care (see, for instance, Redd, Karver, Murphey, Moore, and Knewstub, 2011).
One major shortcoming is the limited reach of the child and earned income tax credits, which provide no support to the most vulnerable of all: the over 5 million children who live in households with no earnings (Harris, 2012). The impacts of this oversight fall hardest on young African-American and Latino children and young children in families headed by women. They are the children most likely to live in households without the minimum levels of income needed to qualify for the tax credits (Harris, 2012).
Another concern is that even for families eligible for the tax credits, the payments arrive once a year in a single lump sum. New research shows that big shifts like this in a family's income have serious negative impacts (Mullainathan and Shafir, 2013). It's not hard to see how trying to make ends meet for months on end before the money comes in can raise the stress level for parents and make it harder for them to focus on their children in all the ways they want to.
Providing a dose of economic protection for children living with poverty should be a priority for the next Administration and Congress. In the House, Rosa DeLauro, Nancy Pelosi, and Sander Levin have introduced a bill that would be a good start. It would create a new "young child tax credit" for families with children under three, providing a monthly credit of $125 per child for both middle class families and those living in the deepest poverty. In the Senate, Michael Bennet has proposed a bill to triple the current child tax credit for children under six.
These policies would be surprisingly cost-effective. Dollar-for-dollar, they would lift more children out of poverty than additional investments in the current tax credits because they help those who are too poor to benefit from today's programs (Garfinkel, Harris, Waldfogel, and Wimer, 2016). At the same time, they could save hundreds of billions of dollars each year in preventable healthcare costs, crime, and lost productivity (see for instance, Holzer, Schanzenbach, Duncan, and Ludwig, 2008).
We know these approaches work. England cut child poverty in half over ten years in large part by increasing their universal child tax credit for all kids (Waldfogel, 2010). Canada's national child tax credit has had impressive results as well.
As doctors and child advocates who care for children, we want them to have the opportunity to grow up to be healthy, productive members of our society. To help them realize their potential, healthy economics may be one of the best remedies of all.
Bennet, Michael. 2015. "Senator Michael Bennet Introduces Bill To Improve Child Tax Credit." Generation Progress. http://genprogress.org/voices/2015/11/25/41267/senator-michael-bennet-introduces-bill-to-improve-child-tax-credit/
Center on Budget and Policy Priorities. 2015. "Chart Book The Earned Income Tax Credit and the Child Tax Credit." Updated, November 2, 2015. http://www.cbpp.org/research/federal-tax/chart-book-the-earned-income-tax-credit-and-child-tax-credit
DeLauro, Rosa. 2016. "Delauro Introduces Young Child Tax Credit Act." http://delauro.house.gov/index.php?option=com_content&view=article&id=2223:delauro-introduces-young-child-tax-credit-act&catid=2&Itemid=21
Garfinkel, Irwin, David Harris, Jane Waldfogel, and Christopher Wimer. "Doing More for Our Children." The Century Foundation. 2016. https://tcf.org/content/report/doing-more-for-our-children/
Greenstone, Michael , Adam Looney, Jeremy Patashnik, and Muxin Yu. June, 2013. "Thirteen Economic Facts about Social Mobility and the Role of Education." The Hamilton Project. Brookings. http://www.brookings.edu/research/reports/2013/06/13-facts-higher-education
Harris, David. "The Child Tax Credit: How the United States Underinvests in Its Youngest Children in Cash Assistance and How Changes to the Child Tax Credit Could Help," Ph.D. dissertation, Columbia University School of Social Work, 2012, http://academiccommons.columbia.edu/catalog/ac%3A175200.
Holzer, Harry J. , Diane Whitmore Schanzenbach, Greg J. Duncan, and Jens Ludwig, "The Economic Costs of Childhood Poverty in the United States," Journal of Children and Poverty 14, no. 1 (2008): 41-61,
Mullainathan, Sendhil and Eldar Shafir. Scarcity: Why Having Too Little Means So Much. Time Books, Henry Holt and Company, LLC. New York, NY. 2013.
Redd, Zakia, Tahilin Sanchez Karver, David Murphey, Kristin Anderson Moore, and Dylan Knewstub. 2011. Two Generations in Poverty: Status and Trends among Parents and Children in the United States, 2000-2010. Child Trends Research Brief #2011-25. Washington, DC: Child Trends. http://www.childtrends.org/Files/Child_Trends- 2011_11_28_RB_PovertyStatusTrends.pdf
Waldfogel, Jane. 2010. Britain's War on Poverty. New York, NY: Russell Sage.
Wimer, Christopher, Liana Fox, Irwin Garfinkel, Neeraj Kaushal, and Jane Waldfogel. "Trends in Poverty with an Anchored Supplemental Poverty Measure."Working Paper 13-01 (Columbia University, 2013), available at https://courseworks.columbia.edu/access/content/group/c5a1ef92-c03c-4d88-0018-ea43dd3cc5db/Working%20Papers%20for%20website/Anchored%20SPM.December7.pdf
T. Berry Brazelton, MD
Joshua Sparrow, MD
David Harris, PhD