The stress of poverty is a serious disease for Philly kids | Opinion

"Casserian engeri?" ("And how are the children?") — Traditional Masai greeting

The most serious, non-infectious  disease in childhood, and the most common, is poverty.

Despite economic gains in the last few years, children remain the poorest age group in America with nearly one in five living in poverty. That's 13.2 million children.

A recent study by the Children's Defense Fund illustrated an even bleaker picture, with three million children living in families surviving on $2 a day per person. Child poverty is also related to age, race/ethnicity, and the lottery of geography, with the youngest, most vulnerable children affected the most, and children of color almost three times more likely to be poor.

Estimates of the cost of childhood poverty approach $500 billion a year in lost productivity, worse health outcomes, and increased crime. Patrick Harker, president of the Federal Reserve Bank of Philadelphia, has written: "It is not just a moral imperative to ensure everyone has a fair shot at success, but there is also a practical argument: Regions are best off when all their communities do well."

But what about being a child who is "Broke in Philly?"

As the Inquirer's new collaboration on economic justice launches,  reporting on the most impoverished large American city, we must be reminded of the potentially devastating health and educational effects on the youngest of our citizens. How living in poverty at a young age, when early life experiences have the most impact on a child's health and development; where critical windows of opportunities start to close as a child ages, must be addressed first.

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All discussions about being "Broke in Philly" must start with the foundation of society, the future of society, of our city. It must begin with the smallest of our citizens, our children. It must begin with the question, "And how are the children?"

Recent advances in scientific literature reveal that growing up in poverty and under toxic stress is associated with much higher rates of developmental, learning, and poor health consequences. The stress of poverty can program a child at an early age to have pro-inflammatory tendencies that can disrupt normal growth and development, and can adversely affect a child throughout their lifetime. For example, MRI studies over the last few years show smaller brain volumes in areas responsible for learning, development and self-control in impoverished children — with the most impoverished the most affected.

Poverty and the stress of living with constant worry gets under children's skin and can cause immediate health and safety problems, such as higher rates of Sudden Infant Death Syndrome, worse asthma, and higher rates of accidental trauma. But the long-term effects of early exposure to poverty and its associated stressors  partly explain the increases in cardiovascular disease, diabetes, drug addiction, and cancer rates in adults who grew up in poverty and early stress. These help contribute to the 20-year life expectancy difference between those born and living in Fairhill vs. those born in Society Hill, just 2½ miles away though worlds apart.

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A January 2018 article in the Journal of Diabetes demonstrated a much higher rate of diabetes in adults who were exposed to early adversity. Another study, in the journal Hypertension from 2014, looked at 221 healthy teens and young adults and revealed that exposure to early adversity in childhood caused significant increases in detrimental cardiovascular measurements that set these young adults on a trajectory to early cardiovascular disease.

So, how many children in Philadelphia are at risk for poverty-related consequences? A November 2017 Pew Trusts  report titled "Philadelphia's Poor" found that  126, 521 children under 18 years old live in the world of poverty. The largest numbers are among children less than 5 years old, children whose developing brains and bodies are the most vulnerable .

So, what works to buffer the effects of child poverty? Programs that raise families out of poverty such as the earned income tax credit and Temporary Assistance for Needed Families, and Social Security income, are vital. Ensuring health care access to both children and their families is essential. Quality, affordable early childhood education is a great investment. Housing and employment vouchers for families can also change a family's trajectory out of poverty by increasing stability. Having a stable, supportive, nurturing adult in a child's life has been proved to make a huge difference in a child's outcomes.

Screening for benefits and linking families with resources by using tools like those listed on cap4kids.org/philadelphia can help families and providers find resources to meet their needs.

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As the "Broke in Philly" collaboration develops, as the science behind the effects of childhood and toxic stress, as well as the science behind resiliency and mobility from poverty, accelerates, until we can honestly answer the Masai greeting with "All the children are well," we must continue to push for and fund evidence-based, trauma-based, dignity-based programs to help families overcome the toxic weight of poverty.

Daniel R. Taylor, D.O., is an associate professor in the Drexel University College of Medicine, and director of community pediatrics and child advocacy at St. Christopher's Hospital for Children.