Can a Single Question Help Families Confront Poverty?

Apr 13, 2016, 10:30 AM, Posted by David Krol

A new recommendation for pediatricians aims to help the one in five children in the United States who live in poverty.

During most of the week, I spend my time here at RWJF working on programs to develop leaders in health and health care and to address childhood obesity. But on Friday afternoons, I am at Eric B. Chandler Health Center in New Brunswick, N.J., seeing children and families. Eric B. Chandler is a federally qualified health center, and we serve a lot of poor, immigrant families. The children I see are more likely to have asthma or tooth decay than are children who live not too far away. They’re also more likely to be overweight, and to face adverse childhood experiences like family trauma or violence.

In some sense, this isn’t surprising. Poverty is one of the biggest health risks that children face today. One in five young people in the United States lives in poverty, and it’s present in urban, suburban, and rural communities across the country. My colleagues James Marks and Kristin Schubert recently described what lasting impact poverty can have on children.

This screening is not onerous. In fact, it starts as a single question: “Do you have difficulty making ends meet at the end of the month?”

In New Brunswick, nearly 35 percent of people live in poverty, and it can touch children’s lives in many ways. Many lower-income families are living in older houses that may have lead paint. Parents often have a hard time getting to and from doctor’s appointments, or lack access to a grocery store that has healthy foods at a price they can afford. They may not have a steady job, and are almost certainly living with the stress that comes with being unsure if they’ll be able to make ends meet. Families are doing the best they can, but these challenges can spill over to kids, creating toxic stress that can increase their risk for many chronic diseases.

Seeing and hearing the challenges my patients face outside the examination room reminds me of the limitations I have as a health care provider. Immunizations and medications don’t address the everyday adversities of poverty. But I recognize how lucky I am to work where I do. Our clinic has social workers who can direct our patients to transportation assistance, after school programs or other resources nearby. We have savvy nurses who know the right people to call to get things done for a family. I’ve seen attending physicians pay a patient’s cab fare out of their own pockets.

To really help our patients grow up healthy we have to look beyond the clinic walls.

I was reminded of this a few weeks ago when I was in Schaumburg, Ill., at the annual leadership forum of the American Academy of Pediatrics (AAP). I chair the section on pediatric oral health, which includes pediatricians and pediatric dentists. There was a buzz in the air because, earlier that week, the AAP put out a recommendation that all pediatricians should screen their families for poverty. The Academy is calling on pediatricians to join with other child advocates in an effort to address child poverty, a problem we know is directly linked to their chances at a healthy, productive life. For some kids, a visit to the pediatrician is the only time they are seen by any kind of provider. Pediatricians are in a unique position to make a real difference in a child’s life.

This screening is not onerous. In fact, it starts as a single question: "Do you have difficulty making ends meet at the end of the month?" This question can help me identify families who would benefit from community resources. Then my colleagues and I can connect those families with the help they need, making sure that what happens in the clinic, the community and the home all work together.

There are a growing number of efforts across the country to address poverty by making those connections between the doctor’s office and what happens in the community. Health Leads helps patients fill prescriptions for healthier food, subsidized housing or childcare, or provides help paying their electricity bill. The Nurse Family Partnership pairs registered nurses with families in a home visiting setting to support a child’s healthy development. Medical legal partnerships add lawyers to a family’s medical team to help them navigate insurance claims or break leases if their apartments have mold. To build a Culture of Health we have to continue making more of these connections.

Pediatricians, and other health care providers, have long been working with families struggling with poverty. We now have an official policy from the AAP recognizing the importance of our role and urging us to address poverty head on in our daily work. I’m proud of my professional organization for taking this step and I encourage all of my health care colleagues, pediatrician or not, to make this part of their everyday practice. By taking this first step, we begin to reach outside the four walls of our offices, clinics and hospitals and partner with others who recognize the challenge to a Culture of Health that poverty presents. With steps like this, I’m hopeful we’ll start to make real progress in helping children lead truly healthy lives.

What do you think of AAP’s recent recommendation? If you’re a pediatrician, have you started to make this shift in your practice?

David M. Krol, MD, MPH, FAAP, is a former senior program officer who is passionate about improving the physical, mental, and social health and well-being of all infants, children, adolescents and young adults.