“Is Poverty a Death Sentence?” Senate HELP Committee Holds Hearing

Testimony submitted by by Sanjeev K. Sriram, MD, MPH on behalf of the National Physicians Alliance at theSenate HELP Committee, Subcommittee on Primary Health and Aging Hearing:  “Is Poverty a Death Sentence?”  September 13, 2011

Six weeks ago, I bought 300 pencils and brought them with me on the bus ride to my clinic in southeast Washington DC.  The other doctors and nurses bought similar back-to-school supplies, as they have done every year, and together we have been distributing them to our patients as they come in for their check-ups before returning to school.  At first glance, this is a simple, kind act of charity and goodwill.  After all, school supplies are relatively cheap, and it is heartwarming to think of neighborhood pediatricians giving their patients tokens of good luck for the upcoming school year.
However, we have many mothers asking if we can spare an extra set of school supplies for their other child waiting for them at home.  They have stretched their last dollar as far as it will go, and between taking care of that month’s rent, groceries, electric bills, prescriptions, bus fare, and co-payments for medical services, there simply wasn’t enough to get each child their own new set of pencils, notebooks, rulers, markers, and so on.  To look in these mothers’ eyes is to see the exhausted extent of resourcefulness and sacrifice.
Whether the rest of the country is experiencing a good economy or a miserable one, the families I care for are constantly facing financial hardships.  They may not use elaborate spreadsheets to organize their budgets, but they are faced with heartbreaking choices about spending, costs, and investments every day.  They ask themselves questions no parent should have to ask:  do we forego eyeglasses for one child so that all the children can go to the dentist?  Can we afford the co-pays for speech therapy and the co-pays for asthma medications?  Each of these decisions cost money, time, health and dignity.
These tragic choices are just part of the surface of devastation poverty is wreaking upon American children throughout their formative years.  At birth, an infant born in poverty in America is more likely to have a lower birthweight and a higher risk of dying than an infant born to a family with a more stable income.  During infancy and toddlerhood, poverty has been found to negatively impact critical neuro-cognitive processes in brain development.  Skills such as acquiring language, organizing information, and maintaining attention are all undermined when children are raised in poverty.  During this back-to-school season, I have been disappointed but not surprised by the disparity in learning disabilities between poor and non-poor children (14.1% vs. 8.5%).  The critical brain functions established in early childhood determine not just an individual’s academic performance, but also one’s future potential to contribute to society.
Additionally, poverty is associated with what public health experts call food deserts, which are areas where affordable, nutritious food is difficult to obtain.  Families and children living in a food desert, such as southeast DC, face paradoxical perils of food insecurity and hunger on one extreme, or obesity on the other.  For the children living with hunger, one third of the children eligible for food stamps are still not receiving them.  Living with food insecurity worsens the underdevelopment of the neuro-cognitive processes described above.  At the other extreme of malnutrition, one in three children in low-income families is overweight or obese, resulting in the first generation of Americans who will have a shorter life expectancy than their parents.
These injustices of poverty fall particularly hard on minority children.  As of 2009, over one third of black children and one third of Latino children lived in poverty, as compared to a little over a tenth of white children.  Today, 1 in 3 Latino infants and 2 out of 5 black infants are born into poverty.  Over the course of childhood, minority children are far more likely to face barriers to obtaining needed medical care. Black children without health insurance are 75% more likely than uninsured white children to have gone without needed medical care because of cost.  Latino children are 50% more likely to have an unmet medical need than white children.
The dire statistics may seem endless, but the good news is that we have the tools to strengthen our children’s lives. Between the CHIP Reauthorization Act of 2009 and the Patient Protection and Affordable Care Act of 2010, poor children’s access to health care can improve.  Currently, Medicaid and CHIP cover 30 million children across the country.  The Supplemental Nutrition Program for Women, Infants, and Children (WIC) provide for just over 9 million mothers and their children.  Three quarters of the Americans currently receiving SNAP benefits (Food Stamps) are in families with children.
The American Recovery and Reinvestment Act in 2009 made improvements to the Child Tax Credit, providing up to $1,433 more for families earning wages at or just above the minimum wage.  Similarly, the Earned Income Tax Credit (EITC) was expanded for married couples and families with three or more children.  These provisions, combined with others in ARRA, kept 2.4 million children out of poverty.
The accomplishments of these policies and programs should be seen as just the beginning of the hard work ahead for all of us.  Right now there are many who question whether we can afford to build upon these efforts and to develop new innovations in reducing poverty.  My argument is that we cannot afford not to act.  Every year, child poverty costs our economy $500 billion dollars in health care expenses, lost productivity, and criminal justice.
Clearly, we have tools at hand to reduce and eliminate child poverty in America.  What we lack is not skill, but will.  The greatest obstacles in this struggle are apathy and cynicism, for it is those forces that tell us that poverty is inevitable, and therefore acceptable.  But in making poverty acceptable, we make it inevitable, and so a vicious cycle perpetuates itself.  Like many Americans, I want to trust in the institutions of medicine, public health, government, business, and others to break this cycle and eliminate poverty through shared determination and effective collaboration.  Poverty is only a death sentence if we allow it to be.