Social Determinants of Health Measures Must Focus on Pediatrics

Social Determinants of Health Measures Must Focus on Pediatrics

The US needs to be making more of an investment in addressing social determinants of health experienced in childhood, which are taking particular beating hit during the COVID-19 pandemic, according to three pediatric health experts from Johns Hopkins University.


The nation’s pediatric population are perhaps most affected by the stark differences made by the social determinants of health during the novel coronavirus crisis. Specifically, young patients may suffer disproportionately from the measures taken to curb the pandemic’s spread.


“The rate of serious illness among young children from the novel coronavirus is very low,” Danielle G. Dooley, MD, MPhil, Asad Bandealy, MD, MPH, and Megan M. Tschudy, MD, MPH, wrote in a JAMA Pediatrics viewpoint. “Yet to slow the spread of the virus, all states have closed schools, disrupting routines critical to learning, nutrition, and social development. Directly and indirectly, low-income children have been forced to subordinate their own well-being for the greater good.”


One in five children live in poverty, which is a greater proportion than adults, the trio reported, citing statistics from the National Center for Child Poverty. This rate is even worse for children of color.


And with that poverty has come a slate of health issues, including high risk for injury, developing a chronic illness, and having a mental health diagnosis. These risks stand to get worse as a result of the COVID-19 pandemic, which has forced children out of their schools, away from school-based social services, and the caring eyes of their teachers.


Poor educational opportunity has long beleaguered neighborhoods with high poverty rates. Individuals with lower educational quality, opportunity, and attainment are at higher risk of both remaining in that poverty and experiencing health issues down the road.


That is because poverty is a key social determinant of health, the authors said, and it can contribute to adverse childhood experiences that define patient health into adulthood.


These social risk factors did not begin during the coronavirus, but they have recently come to bear and in many cases become exacerbated.


“Restrictions imposed because of the coronavirus make these challenges more formidable,” Dooley, Bandealy, and Tschudy wrote.


“While school districts are engaging in distance learning, reports indicate wide variability in access to quality educational instruction, digital technology, and internet access. Students in rural and urban school districts are faced with challenges accessing the internet. In some urban areas, as many as one-third of students are not participating in online classes.”


This level of chronic absenteeism, defined as missing 10 percent of the school year or more, is already prevalent among children living in poverty.


What’s more, school closures have cut children off from other key social services that move beyond their education. Free and subsidized meals have gone away for the majority of children. Although many philanthropies have worked to promote access to these meals for many school-aged children, Dooley, Bandealy, and Tschudy reported that these efforts only reach a fraction of children.


What’s more, school is a safe place where children are surrounded by adults who keep a careful eye on their emotional and physical well-being.


“Schools also provide access to consistent and caring adults who can help build resiliency and offer holistic support,” the authors explained. “School-based health centers, nursing services, and mental health programs help alleviate disparities in access to health care services.”


Nonetheless, the majority of current COVID-19 strategy has centered on the health and financial consequences of the virus spread. While these are key areas of concern, the authors contended more focus is necessary for the pediatric populations so impacted by COVID-19 and social distancing measures.


“This legislation has understandably aimed to contain the pandemic and its economic fallout,” they said. “While many adults will experience months of challenges, low-income children are at risk of experiencing consequences for a lifetime. To prevent these harms, the US should commit to fully addressing the needs of children as part of its national response.”


Policy proposals may improve:


  • Expanded access to Medicaid and CHIP
  • Expanded access to SNAP and WIC, as well as expanded benefits
  • Increase of the Earned Income Tax Credit
  • Changes to the child tax credit to make it fully refundable
  • Increased funding for home visitations and Head Start programs


Those proposals work to address some current issues while also keeping growing divides from becoming worse in the future, the researchers noted.


Further efforts should also target more near-term items, like making digital and remote learning easier on low-income children and families; implementing state family and child outreach; improving access to telehealth for mental healthcare; and other investments to promote more equitable access to healthcare and education during social distancing.


Finally, the authors urged the US to commit to the National Academies of Science, Engineering, and Medicine roadmap which takes aim at child poverty. Committing to the roadmap would cost between $90 and $110 billion annually, the researchers said.


“The fact that low-income children have had no choice but to give up educational, nutritional, and social supports does not make them any less deserving of attention. It is not enough for children to survive the pandemic,” Dooley, Bandealy, and Tschudy concluded. “Their sacrifice should spur efforts to help them thrive, now and in the future.”




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