The Most Important Problem Facing Children in the US Today

In the early 1950's, polio crippled tens of thousands of people in the United States each year, shut down public facilities, and struck fear among parents everywhere. But thanks to a massive public health effort that reached into every community, by 1979 polio had been eliminated from the U.S.

What if we tackled child poverty with the same determination and commitment that we put into eliminating polio? At a time when one in five children lives in poverty, income inequality is growing, and the severe negative long-term consequences of childhood poverty are known, the analogy is not farfetched.

This week, the Academic Pediatric Association (APA) Task Force on Childhood Poverty declared that childhood poverty is "the most important problem facing children in the US today" and issued a Strategic Road Map for addressing it as a public health issue. The APA Task Force commits to raising the voice of pediatricians to build public support for policies that will both reduce childhood poverty and address the negative effects of poverty on children's physical and mental health and development. This builds on similar statements from the American Academy of Pediatrics.

While there is not a vaccine that prevents poverty, we do have a range of strategies for combating it and its effects. The APA Task Force highlights four new areas for policy work, on top of their existing efforts in support of Medicaid and CHIP:

• Raising children out of poverty, through raising the minimum wage, increasing access to quality jobs, and improving income and work supports such as the Temporary Assistance for Needy Families (TANF) program, the Earned Income Tax Credit (EITC) and the Child Tax Credit.
• Providing high quality early childhood programs and high quality affordable child care to poor families, in order to both support early childhood development for all children and allow low-income parents to have access to reliable quality child care while they work.
• Supporting place-based initiatives, in recognition that poverty and its ill effects are not evenly distributed among communities. APA recognizes that neighborhood characteristics such as poverty, crime, housing characteristics and lack of employment opportunities can all have negative impacts on poor children's health and well-being.
• Promoting a White House Conference on Children and Youthto draw attention to the needs of this population and build public support for further investments. 

In addition, the APA Task Force calls for additional research on childhood poverty, especially on the negative effects of poverty -- and the toxic stress associated with it -- on early brain development, and on the evidence base for interventions. The APA Road Map also commits to supporting improvements in health care delivery and medical education.

Polio could not have been eliminated if we had only treated those who were already infected, or only vaccinated some children, in some neighborhoods. It required a sustained, national investment. Similarly, combating poverty will require both substantial investments and commitment. However, many critical programs that support America's most vulnerable children have received funding cuts under the sequester, with additional cuts threatened. Congress must take action to undo these cuts, as well as to make additional investments in fighting poverty. These should include moving the President's proposed early childhood initiative, which boosts funding for home visiting, child care, and preschool services known to reduce the impacts of poverty and promote economic stability for families. It should also include strategies to ensure that parents have the financial resources to support their children, including subsidized jobs to ensure that low-income parents and youth are not left out of the recovery.

Neither the evidence of the detrimental impact that poverty has on child health nor the proposed solutions are new; yet, APA's Road Map underscores the magnitude of the problem the country is facing and the critical need to engage all allies. Pediatricians for years have been treating the effects of poverty. Today we salute pediatricians for their leadership in calling for us all to work together towards preventing poverty in the first place.

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