The big emotional, financial costs of childhood poverty

"The ultimate test of a moral society is the kind of world that it leaves to its children."

- Theologian Dietrich Bonhoeffer

It's spring, and once again I find myself sitting on my back porch gazing at the disparities on the two sides of our modest backyard. On the sunny side, a dozen varieties of flowers blossom in a colorful collage of reds, blues and whites, attracting honeybees and even hummingbirds. On the shady side, the ground is hard, the grass grows poorly, and the colors are bland. With the right seedlings and care, I know we can grow something beautiful there.

Much the same disparities hold across America, where 43 percent of children live in or near poverty, and the health effects of growing up that way can be life-altering.

Consider a recent day of patients in our large pediatric practice. My first patient was a 2-week-old, born to a mother, 16, who was sleeping in the same bed with her infant. The next child, a morbidly obese 9-year-old, was recently readmitted to our hospital for his third asthma attack this year. With him came his brother, 10, with ADHD and learning issues. Next up was an 18-month-old with speech delay whose parents are struggling with food insecurity. It was 9:30 a.m., and I still had nine more patients to go.

The common denominator for these patients is that they live in the First Congressional District, the third-most-impoverished for children in the United States. This epicenter of child poverty sits just four miles from the William Penn statue atop City Hall.

The effects of poverty on child health have been well-documented: Higher rates of infant death, prematurity, and low birth weight, upticks in the severity of asthma and readmissions, more childhood obesity and its many consequences, such as diabetes, hypertension, and orthopedic complications.

Poor children also have more accidental and non-accidental injuries such as those from car accidents, falls, fires, and homicides. They have more trajectory-altering events such as teen pregnancy, substance abuse, and encounters with the juvenile justice system.

Studies also show links between early childhood poverty and poor academic outcomes, as well as large increases in social and emotional problems, from ADHD to aggression.

A recent study in JAMA Pediatrics looked at brain scans of young children and the effects of poverty on brain development including the areas that control emotions, memory, and affect. Children in poverty - especially those without the buffer of a caring adult - had smaller brain volumes in these areas, so fundamental for school success.

Poor children have many more adverse childhood experiences (ACEs), including abuse and family dysfunction, before age 18. From the seminal ACE Study in San Diego (www.cdc.gov/ace), to the ongoing Urban ACE study in Philadelphia, we know that the more bad events a child experiences, the more likely they will be physically and emotionally unwell as adults. For adults who had four ACEs, half had current depression. Five ACEs doubled the risk of heart disease. Six or more ACEs led to death 20 years sooner on average than those without ACEs.

Go back 50 years, and a higher percentage of seniors were living in poverty than children. In 1959, 35 percent of those older than 65 lived in poverty, versus 27 percent of children. With the rise of Social Security and Medicare, seniors' poverty rates plummeted to 9 percent in 2010. But children's rates have stayed stubbornly high. They are now the poorest members of society, and the costs of that are staggering.

The economic effects of childhood poverty alone are estimated at 4 percent of gross domestic product, or $627 billion a year.

We know that programs such as home visits by professionals and Early Head Start have lifelong positive effects. Raising the minimum wage and expanding tax credits, including child-care credits, would also help lower poverty rates for families.

Governor-to-be, please take a hard look at our backyard filled with 850,000 children, 43 percent in low-income families. Now is the time to adequately fund early childhood programs and reevaluate tax codes that widen income disparities in Pennsylvania. The health of our children depends on it.