As a pediatrician, I specialize in caring for premature babies born facing impossible odds — babies that can weigh less than a ripe cantaloupe at birth, and require meticulous and deliberate care by teams of specialists to help them overcome difficulties with everything from breathing to moving. Even with all of this care, only two out of three of some of our most premature infants survive the neonatal intensive care unit (NICU).
For those who do, there are more challenges ahead. Even if we titrate their nutrients perfectly, give them the best medications, and arrange for nurses and therapists to visit their homes, we often don’t give premature babies a chance to succeed in life when we forget to consider the material circumstances of their lives outside of the hospital, and what is needed for children to thrive. That is because many of the families of these infants aren’t just up against medical misfortune, they are also up against poverty — and poverty has the power to steal hard-earned progress and diminish opportunity for children with so much potential. To improve health for our most vulnerable children, we must address poverty first.
Poverty is more than insufficient income — it is a pervasive agent of harm, which intersects with racism to attack the physical and mental health of people of color throughout their lives and across generations. In the United States, nearly 40 million people live in poverty, concentrated in geographic areas absent of opportunities, with increased exposure to chemicals, exploitation, and hard physical labor. The stress of poverty and racism both increases the likelihood of a premature birth, and increases the difficulty of raising a child. In these conditions, exhausted parents must live with the constant stress of trying to stretch dollars to feed, house, and warm their children.
We now know that people’s material needs and their environment impact 80% of their health outcomes, while their medical care only affects 20%. Because of this, we ask patients about whether they have issues paying for food, housing, electricity, or transportation, among other social needs. However, when it comes to addressing these problems we are at a loss — we have tried many band-aid solutions that sometimes deeply inconvenience those we are trying to help and fail to target root causes.
We ask families with children to wait in long lines during limited time slots for food, despite the knowledge that parents in these households often work multiple jobs; we ask parents to bring their children to “warm spaces” that have heat when they can’t afford electricity in the winter. These band-aid attempts to address social needs are disruptive and take agency away from parents who know best what they need to care for their children. Poverty diminishes the range of choices parents can make, and we must restore the option for choices among parents about how to best care for their children.
“We ask families with children to wait in long lines during limited time slots for food, despite the knowledge that parents in these households often work multiple jobs; we ask parents to bring their children to ‘warm spaces’ that have heat when they can’t afford electricity in the winter. These band-aid attempts to address social needs are disruptive and take agency away from parents who know best what they need to care for their children.”
We must abolish poverty — in the words of Matthew Desmond — to improve health. The best way to do this is to give people enough money to live, and let them decide what to do with it (also known as “cash transfer”). Helping them access cash to address their needs through tax credits is one potentially effective approach. Tax credits are cash funds that the government returns to individuals based on several criteria including income, number of children in the home, and working status. Tax credits have been shown to be among the most impactful anti-poverty policies, providing several thousand dollars annually to each family; however, they are underutilized, particularly by Hispanic/Latinx adults. If we are to end poverty, we must start by making sure that allotted funds are not left on the table. Each year $140 billion in social services and unused tax credits are left unclaimed, an amount greater than the GDP of Luxembourg and Slovakia.
If awarded the Health Equity Challenge grant, we hope to do just that — ensure that families get the money that they are due, and in doing so, increase the likelihood that families and children can flourish. Our partnership with Maternal Child Health Access, a Los Angeles community-based organization, and Lets Get Set, a financial health start-up, has the potential to help communities overcome barriers to tax filing using trusted messengers (nurses and community liaisons) and a user-friendly mobile app. As a pediatrician, I am committed to ensuring that in our efforts to care for patients, we also treat poverty, and by doing so have the possibility of eliminating racial and ethnic disparities in health, education, and wealth throughout the life course.