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Welfare Reform and Children's Health

Welfare Reform and Children's Health Abstract During the ongoing national discussion of proposals to reform health care financing, effects on the health status of children emerged as a special concern. Public attention has shifted away from comprehensive reform of the health care system and toward reform of the welfare system (primarily the Aid to Families with Dependent Children [AFDC] program), but this debate with its focus on parental behavior has not attended to the effects of reform on children's health and well-being. Yet the changes proposed will have a profound effect on the lives of children. Children's health status is determined by a multiplicity of factors, among which social and economic factors are especially important.1,2 Children living in poverty have poorer health than their more affluent peers,1-16 consequently, welfare system reform carries great implications for children's health. Welfare system reforms that reduce resources for low-income families will lead to a predictable increase in adverse References 1. Starfield B. Childhood morbidity: comparisons, clusters, and trends . Pediatrics . 1991;88:519-526. 2. Wise PH, Meyers A. Poverty and child health . Pediatr Clin North Am . 1988;35:1169-1186. 3. Kogan R, Greenstein R. The New Fisca Agenda: What Will It Mean and How Will It Be Accomplished? Washington, DC: Center on Budget and Policy Priorities; 1995. 4. Duncan GJ, Brooks-Gunn J, Kato-Klebanov P. Economic deprivation and early childhood development . Child Dev . 1994;65:457-471.Crossref 5. Frank DA, Meyers A, Roos N, et al. Seasonal changes in weight for age in a pediatric emergency room: potential source of bias in the NHANES. Public Health Rep. In press. 6. Gortmaker S. Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents . Pediatrics . 1990;85:267-276. 7. Halfon N, Newacheck PW. Childhood asthma and poverty: differential impacts and utilization of health services . Pediatrics . 1993;91:56-61. 8. Hardy AM. Incidence and impact of selected infectious diseases in childhood . Vital Health Stat 10 . 1991;No. (180) :5. 9. Hunt JV, Cooper BAB, Tooley WH. Very low birth weight infants at 8 and 11 years of age: role of neonatal illness and family status . Pediatrics . 1988; 82:596-603. 10. Meyers A, Frank DA, Roos N. Housing subsidies and pediatric undernutrition . Arch Pediatr Adolesc Med . 1995;149:1079-1084.Crossref 11. Parker S, Greer S, Zuckerman B. Double jeopardy: the impact of poverty on early childhood development . Pediatr Clin North Am . 1988;35: 1227-1240. 12. Sherman A. Wasting America's Future: The Children's Defense Fund Report on the Costs of Child Poverty . Boston, Mass: Beacon Press; 1994. 13. Shonkoff J. Biological and social factors contributing to mild mental retardation . In: Heller K, ed. Placing Children in Special Education: A Strategy for Equity . Washington, DC: National Academy Press; 1982:142-171. 14. Spivak H, Prothrow-Stith D, Hausman AJ. Dying is no accident . Pediatr Clin North Am . 1988;35:1339-1347. 15. Spurlock CW, Hinds MW, Skaggs JW, Hernandez LE. Infant death rates among the poor and nonpoor in Kentucky, 1982 to 1983 . Pediatrics . 1987;80:262-269. 16. Wise PH, Rotelchuck M, Wilson ML, Mills M. Racial and socioeconomic disparities in childhood mortality in Boston . N Engl J Med . 1985; 313:360-366.Crossref 17. Citro CR, Michael RT. Measuring Poverty: A New Approach . Washington, DC: National Academy Press; 1995. 18. Adams P, Benson V. Vital and Health Statistics: Current Estimates From the National Health Interview Survey . Hyattsville, Md: National Center for Health Statistics; 1991. 19. National Center on Child Abuse and Neglect. Study of National Incidence and Prevalence of Child Abuse and Neglect: 1988 . Washington, DC: US Dept of Health, Education, and Welfare: 1988: 5-29. 20. Pilch SM, Senti FR. Assessment of the Iron Nutritional Status of the US Population Based on Data Collected in the Second National Health and Nutrition Examination Survey, 1976-1980 . Bethesda, Md: Life Science Research Office, Federation of American Societies for Experimental Biology; (August) 1984. 21. Saadi E. Children's Deaths in Kansas: 1985-1987 . Topeka: Kansas Dept of Health and Environment and Kansas Dept of Rehabilitation Services; 1989. 22. Miller J, Korenman S. Poverty and children's nutritional status in the United States . Am J Epidemiol . 1994;140:233-243. 23. Starfield B, Shapiro S, Weiss J, et al. Race, family income, and low birthweight . Am J Epidemiol . 1991;134:1167-1174. 24. Wehler CA, Scott RI, Anderson JJ, et al. Community Childhood Hunger Project: A Survey of Childhood Hunger in the United States . Washington, DC: Food Research and Action Center; 1995. 25. House of Representatives Committee on Agriculture. Hearings on the Food Stamp Program and the Community Donation Program . Washington, DC: House of Representatives Committee on Agriculture; 1990. 26. Cook JT, Martin KS. Differences in Nutrient Adequacy Among Poor and Non-poor Children . Medford, Mass: Tufts University Center on Hunger, Poverty, and Nutrition Policy; 1995. 27. Dobbing J, ed. Brain, Behavior, and Iron in the Infant Diet . London, England: Springer-Verlag; 1990. 28. Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency . N Engl J Med . 1991;325:687.Crossref 29. Centers for Disease Control. Fatal pediatric poisoning from leaded paint—Wisconsin, 1990 . MMWR Morb Mortal Wkly Rep . 1991;40:193-195. 30. Needleman HL, Schell A, Bellinger D, Leviton A, Allred EN. The long-term effects of exposure to low doses of lead in childhood . N Engl J Med . 1990;322:83-88.Crossref 31. Miller JE, Korenman S. Poverty, Nutritional Status, Growth and Cognitive Development of Children in the United States . Princeton, NJ: Princeton University Office of Population Research; 1993. Working Paper No. 93-5. 32. Kramer RA, Allen L, Gergen JP. Health and social characteristics and children's cognitive functioning: results from a national cohort . Am J Public Health . 1995;85:312-318.Crossref 33. McCormick MC, Gortmaker SL, Sobel AM. Very low-birth-weight children: behavior problems and school difficulty in a national sample . J Pediatr . 1990;117:687-693.Crossref 34. Walker D, Greenwood C, Hart B, Carta J. Prediction of school outcomes based on early language production and socioeconomic factors . Child Dev . 1994;65:606-621.Crossref 35. Jolly DL, Nolan T, Moller J, Vimpani G. The impact of poverty and disadvantage on child health . J Paediatr Child Health . 1991;27:203-217.Crossref 36. Centers for Disease Control and Prevention. State and national vaccination coverage levels among children aged 19-35 months: United States, April-December 1994 . MMWR Morb Mortal Wkly Rep . 1995;44:613-623. 37. Centers for Disease Control. Measles vaccination levels among selected groups of preschool children . MMWR Morb Mortal Wkly Rep . 1991; 40:36. 38. Newacheck PW, Hughes DC, Cisternas M. Children and health insurance: an overview of recent trends . Health Aff (Millwood) . 1995;14:244-254.Crossref 39. Butler JA, Winter WD, Singer JD, Wenger M. Medical care use and expenditures among children and youth in the United States: analysis of a national probability sample . Pediatrics . 1985;76: 495-507. 40. Butler JA, Singer JD, Palfrey JS. Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas . Pediatrics . 1987;79:89-98. 41. Beyond Rhetoric: A New American Agenda for Children and Families: final report of the National Commission on Children . Washington, DC: National Commission on Children; 1991. 42. Li J, Bennett N. Young Children in Poverty: A Statistical Update . New York, NY: National Center for Children in Poverty; 1994. 43. Bane MJ, Ellwood DT. One fifth of the nation's children: why are they poor? Science . 1988;245: 1047-1056.Crossref 44. Smeeding TM. Cross National Perspectives on Income Security Programs. Testimony for the Congress of the US Joint Economic Committee; September 25, 1991 45. Meeding TM, Torrey BB. Poor children in rich countries . Science . 1988;245:873-877.Crossref 46. Administration for Children and Families, Office of Family Assistance. Characteristics and Financial Circumstances of AFDC Recipients. FY1992 . Washington, DC: Dept of Health and Human Services; 1993. 47. Brown JL. Statement on Key Welfare Reform Issues: The Empirical Evidence . Medford, Mass: Tufts University Center on Hunger, Poverty, and Nutrition Policy; 1995. 48. House of Representatives Committee on Ways and Means. Overview of entitlement programs . In: 1993 Greenbook . Washington, DC: House of Representatives Committee on Ways and Means; 1994. 49. Acs G. The Impact of AFDC on Young Women's Childbearing Decisions . Washington, DC: The Urban Institute; 1994. 50. Ellwood DT. Poor Support . New York, NY: Basic Books, Inc; 1988. 51. Kliegman RM. Perpetual poverty: child health and the underclass . Pediatrics . 1992;84:710-713. 52. Bureau of the Census. Income and Poverty, 1993 . Washington, DC: Bureau of the Census; 1994. 53. Fuchs VR, Reklis DM. America's children: economic perspective and policy options . Science . 1992;255:41-45.Crossref 54. Dept of Health and Human Services. Fiscal Year 1996 Budget Summary . Washington, DC: Dept of Health and Human Services; 1995:5. 55. Williams LA. The abuse of Section 1115 waivers: welfare reform in search of a standard . Yale Law Policy Rev . 1994;12:8-37. 56. Salkind N, Haskins R. Negative income tax: the impact on children from low-income families . J Fam Issues . 1982;3:165-186.Crossref 57. Venti SF, Wise DA. Income Maintenance and the School and Work Decisions of Youth . Cambridge, Mass: Harvard University; 1984. 58. Mallar CD. The educational and labor-supply responses of young adults in experimental families . In: Watts HW, Rees A, eds. The New Jersey Income Maintenance Experiment . New York, NY: Academic Press; 1977:2. 59. Bradbury KL. In discussion: Hanushek EA. Non-labor-market responses to the income maintenance experiments . In: Munnell AH, ed. Lessons From the Income Maintenance Experiments . Boston, Mass: Federal Reserve Bank of Boston; 1986. 60. Baumol WJ. An overview of the results . In: Watts HW, Rees A, eds. The New Jersey Income Maintenance Experiment . New York, NY: Academic Press; 1977;2:5. 61. Blendon RJ, Altman, DE, Benson J, Brodie M, James M, Chervinsky G. The public and the welfare reform debate . Arch Pediatr Adolesc Med . 1995;149:1065-1069.Crossref 62. Caughy MO, DiPietro J, Strobino D. Day care participation as a protective factor in the cognitive development of low-income children . Child Dev . 1994;65:457-471.Crossref 63. Ross JL. Child Care: Recipients Face Service Gaps and Supply Shortages. Testimony before the US Senate Committee on Labor and Human Resources . Washington, DC: US Senate Committee on Labor and Human Resources; 1995. 64. Rosen DM. Paralysis of response to poverty . In: Karp RJ, ed. Malnourished Children in the United States: Caught in the Cycle of Poverty . New York, NY: Springer Publishing Co; 1993:250-252. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

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American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
1072-4710
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1538-3628
DOI
10.1001/archpedi.1996.02170290050008
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Abstract

Abstract During the ongoing national discussion of proposals to reform health care financing, effects on the health status of children emerged as a special concern. Public attention has shifted away from comprehensive reform of the health care system and toward reform of the welfare system (primarily the Aid to Families with Dependent Children [AFDC] program), but this debate with its focus on parental behavior has not attended to the effects of reform on children's health and well-being. Yet the changes proposed will have a profound effect on the lives of children. Children's health status is determined by a multiplicity of factors, among which social and economic factors are especially important.1,2 Children living in poverty have poorer health than their more affluent peers,1-16 consequently, welfare system reform carries great implications for children's health. Welfare system reforms that reduce resources for low-income families will lead to a predictable increase in adverse References 1. Starfield B. Childhood morbidity: comparisons, clusters, and trends . Pediatrics . 1991;88:519-526. 2. Wise PH, Meyers A. Poverty and child health . Pediatr Clin North Am . 1988;35:1169-1186. 3. Kogan R, Greenstein R. The New Fisca Agenda: What Will It Mean and How Will It Be Accomplished? Washington, DC: Center on Budget and Policy Priorities; 1995. 4. Duncan GJ, Brooks-Gunn J, Kato-Klebanov P. Economic deprivation and early childhood development . Child Dev . 1994;65:457-471.Crossref 5. Frank DA, Meyers A, Roos N, et al. Seasonal changes in weight for age in a pediatric emergency room: potential source of bias in the NHANES. Public Health Rep. In press. 6. Gortmaker S. Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents . Pediatrics . 1990;85:267-276. 7. Halfon N, Newacheck PW. Childhood asthma and poverty: differential impacts and utilization of health services . Pediatrics . 1993;91:56-61. 8. Hardy AM. Incidence and impact of selected infectious diseases in childhood . Vital Health Stat 10 . 1991;No. (180) :5. 9. Hunt JV, Cooper BAB, Tooley WH. Very low birth weight infants at 8 and 11 years of age: role of neonatal illness and family status . Pediatrics . 1988; 82:596-603. 10. Meyers A, Frank DA, Roos N. Housing subsidies and pediatric undernutrition . Arch Pediatr Adolesc Med . 1995;149:1079-1084.Crossref 11. Parker S, Greer S, Zuckerman B. Double jeopardy: the impact of poverty on early childhood development . Pediatr Clin North Am . 1988;35: 1227-1240. 12. Sherman A. Wasting America's Future: The Children's Defense Fund Report on the Costs of Child Poverty . Boston, Mass: Beacon Press; 1994. 13. Shonkoff J. Biological and social factors contributing to mild mental retardation . In: Heller K, ed. Placing Children in Special Education: A Strategy for Equity . Washington, DC: National Academy Press; 1982:142-171. 14. Spivak H, Prothrow-Stith D, Hausman AJ. Dying is no accident . Pediatr Clin North Am . 1988;35:1339-1347. 15. Spurlock CW, Hinds MW, Skaggs JW, Hernandez LE. Infant death rates among the poor and nonpoor in Kentucky, 1982 to 1983 . Pediatrics . 1987;80:262-269. 16. Wise PH, Rotelchuck M, Wilson ML, Mills M. Racial and socioeconomic disparities in childhood mortality in Boston . N Engl J Med . 1985; 313:360-366.Crossref 17. Citro CR, Michael RT. Measuring Poverty: A New Approach . Washington, DC: National Academy Press; 1995. 18. Adams P, Benson V. Vital and Health Statistics: Current Estimates From the National Health Interview Survey . Hyattsville, Md: National Center for Health Statistics; 1991. 19. National Center on Child Abuse and Neglect. Study of National Incidence and Prevalence of Child Abuse and Neglect: 1988 . Washington, DC: US Dept of Health, Education, and Welfare: 1988: 5-29. 20. Pilch SM, Senti FR. Assessment of the Iron Nutritional Status of the US Population Based on Data Collected in the Second National Health and Nutrition Examination Survey, 1976-1980 . Bethesda, Md: Life Science Research Office, Federation of American Societies for Experimental Biology; (August) 1984. 21. Saadi E. Children's Deaths in Kansas: 1985-1987 . Topeka: Kansas Dept of Health and Environment and Kansas Dept of Rehabilitation Services; 1989. 22. Miller J, Korenman S. Poverty and children's nutritional status in the United States . Am J Epidemiol . 1994;140:233-243. 23. Starfield B, Shapiro S, Weiss J, et al. Race, family income, and low birthweight . Am J Epidemiol . 1991;134:1167-1174. 24. Wehler CA, Scott RI, Anderson JJ, et al. Community Childhood Hunger Project: A Survey of Childhood Hunger in the United States . Washington, DC: Food Research and Action Center; 1995. 25. House of Representatives Committee on Agriculture. Hearings on the Food Stamp Program and the Community Donation Program . Washington, DC: House of Representatives Committee on Agriculture; 1990. 26. Cook JT, Martin KS. Differences in Nutrient Adequacy Among Poor and Non-poor Children . Medford, Mass: Tufts University Center on Hunger, Poverty, and Nutrition Policy; 1995. 27. Dobbing J, ed. Brain, Behavior, and Iron in the Infant Diet . London, England: Springer-Verlag; 1990. 28. Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency . N Engl J Med . 1991;325:687.Crossref 29. Centers for Disease Control. Fatal pediatric poisoning from leaded paint—Wisconsin, 1990 . MMWR Morb Mortal Wkly Rep . 1991;40:193-195. 30. Needleman HL, Schell A, Bellinger D, Leviton A, Allred EN. The long-term effects of exposure to low doses of lead in childhood . N Engl J Med . 1990;322:83-88.Crossref 31. Miller JE, Korenman S. Poverty, Nutritional Status, Growth and Cognitive Development of Children in the United States . Princeton, NJ: Princeton University Office of Population Research; 1993. Working Paper No. 93-5. 32. Kramer RA, Allen L, Gergen JP. Health and social characteristics and children's cognitive functioning: results from a national cohort . Am J Public Health . 1995;85:312-318.Crossref 33. McCormick MC, Gortmaker SL, Sobel AM. Very low-birth-weight children: behavior problems and school difficulty in a national sample . J Pediatr . 1990;117:687-693.Crossref 34. Walker D, Greenwood C, Hart B, Carta J. Prediction of school outcomes based on early language production and socioeconomic factors . Child Dev . 1994;65:606-621.Crossref 35. Jolly DL, Nolan T, Moller J, Vimpani G. The impact of poverty and disadvantage on child health . J Paediatr Child Health . 1991;27:203-217.Crossref 36. Centers for Disease Control and Prevention. State and national vaccination coverage levels among children aged 19-35 months: United States, April-December 1994 . MMWR Morb Mortal Wkly Rep . 1995;44:613-623. 37. Centers for Disease Control. Measles vaccination levels among selected groups of preschool children . MMWR Morb Mortal Wkly Rep . 1991; 40:36. 38. Newacheck PW, Hughes DC, Cisternas M. Children and health insurance: an overview of recent trends . Health Aff (Millwood) . 1995;14:244-254.Crossref 39. Butler JA, Winter WD, Singer JD, Wenger M. Medical care use and expenditures among children and youth in the United States: analysis of a national probability sample . Pediatrics . 1985;76: 495-507. 40. Butler JA, Singer JD, Palfrey JS. Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas . Pediatrics . 1987;79:89-98. 41. Beyond Rhetoric: A New American Agenda for Children and Families: final report of the National Commission on Children . Washington, DC: National Commission on Children; 1991. 42. Li J, Bennett N. Young Children in Poverty: A Statistical Update . New York, NY: National Center for Children in Poverty; 1994. 43. Bane MJ, Ellwood DT. One fifth of the nation's children: why are they poor? Science . 1988;245: 1047-1056.Crossref 44. Smeeding TM. Cross National Perspectives on Income Security Programs. Testimony for the Congress of the US Joint Economic Committee; September 25, 1991 45. Meeding TM, Torrey BB. Poor children in rich countries . Science . 1988;245:873-877.Crossref 46. Administration for Children and Families, Office of Family Assistance. Characteristics and Financial Circumstances of AFDC Recipients. FY1992 . Washington, DC: Dept of Health and Human Services; 1993. 47. Brown JL. Statement on Key Welfare Reform Issues: The Empirical Evidence . Medford, Mass: Tufts University Center on Hunger, Poverty, and Nutrition Policy; 1995. 48. House of Representatives Committee on Ways and Means. Overview of entitlement programs . In: 1993 Greenbook . Washington, DC: House of Representatives Committee on Ways and Means; 1994. 49. Acs G. The Impact of AFDC on Young Women's Childbearing Decisions . Washington, DC: The Urban Institute; 1994. 50. Ellwood DT. Poor Support . New York, NY: Basic Books, Inc; 1988. 51. Kliegman RM. Perpetual poverty: child health and the underclass . Pediatrics . 1992;84:710-713. 52. Bureau of the Census. Income and Poverty, 1993 . Washington, DC: Bureau of the Census; 1994. 53. Fuchs VR, Reklis DM. America's children: economic perspective and policy options . Science . 1992;255:41-45.Crossref 54. Dept of Health and Human Services. Fiscal Year 1996 Budget Summary . Washington, DC: Dept of Health and Human Services; 1995:5. 55. Williams LA. The abuse of Section 1115 waivers: welfare reform in search of a standard . Yale Law Policy Rev . 1994;12:8-37. 56. Salkind N, Haskins R. Negative income tax: the impact on children from low-income families . J Fam Issues . 1982;3:165-186.Crossref 57. Venti SF, Wise DA. Income Maintenance and the School and Work Decisions of Youth . Cambridge, Mass: Harvard University; 1984. 58. Mallar CD. The educational and labor-supply responses of young adults in experimental families . In: Watts HW, Rees A, eds. The New Jersey Income Maintenance Experiment . New York, NY: Academic Press; 1977:2. 59. Bradbury KL. In discussion: Hanushek EA. Non-labor-market responses to the income maintenance experiments . In: Munnell AH, ed. Lessons From the Income Maintenance Experiments . Boston, Mass: Federal Reserve Bank of Boston; 1986. 60. Baumol WJ. An overview of the results . In: Watts HW, Rees A, eds. The New Jersey Income Maintenance Experiment . New York, NY: Academic Press; 1977;2:5. 61. Blendon RJ, Altman, DE, Benson J, Brodie M, James M, Chervinsky G. The public and the welfare reform debate . Arch Pediatr Adolesc Med . 1995;149:1065-1069.Crossref 62. Caughy MO, DiPietro J, Strobino D. Day care participation as a protective factor in the cognitive development of low-income children . Child Dev . 1994;65:457-471.Crossref 63. Ross JL. Child Care: Recipients Face Service Gaps and Supply Shortages. Testimony before the US Senate Committee on Labor and Human Resources . Washington, DC: US Senate Committee on Labor and Human Resources; 1995. 64. Rosen DM. Paralysis of response to poverty . In: Karp RJ, ed. Malnourished Children in the United States: Caught in the Cycle of Poverty . New York, NY: Springer Publishing Co; 1993:250-252.

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Apr 1, 1996

References