Poverty and the Future of America: Transforming ... · Transforming Communities for Young...
Transcript of Poverty and the Future of America: Transforming ... · Transforming Communities for Young...
Poverty and the Future of America: Transforming Communities for Young
Children!
!
! Neal Halfon MD MPH UCLA Center for Healthier Children Families and
Communities
Child Poverty Symposium
Luskin School of Public Affairs
Friday May 11, 2012
Optimizing Healthy Development
Summary !
•" 20+% of kids are poor, 20+% near poor = 40+% Low Income !
•" Low income kids concentrate in low income, under-
resourced communities!
•" Inequalities in health and development begin early
and compound rapidly!
•" Need to worry not only about levels but the gradients!
•" Our current investment strategy for children make
little economic sense !
!" Penny wise and Trillion dollar foolish!
•" Need Transformation Strategies!
!"Whole child, whole family, whole community !
Family Income and Child Outcomes !
•" Born early, smaller, more fragile, and at risk !
•" Worse physical, cognitive, emotional health!
•" Hospitalized more, more obese, more asthma, more mental health problems, more disability !
•" Lower health trajectories, greater brain drain !
•" Carry the burden of their social status into adulthood !
•" Programmed into how their biology – an how their
immune, endocrine, neurological systems develop,
function and perform !
Barriers to Educational Achievement Emerge at a Very Young Age
16 mos. 24 mos. 36 mos.
Cu
mu
lati
ve V
ocab
ula
ry (
Wo
rd
s)!
College Educated Parents!
Working Class Parents!
Welfare Parents!
Child"s Age (Months)!
200
600
1200
Source: Hart & Risley (1995)
400
800
1000
Birth
Early Infancy
Late Infancy
Early Toddler
Late Toddler
Early Preschool
Late Preschool
Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs
Rea
dy t
o lea
rn
Health Development: Reducing Risk and
Optimizing Promoting and Protective Factors
#At Risk$ Trajectory
#Delayed/Disordered $ Trajectory
#Healthy$ Trajectory
Parent education Emotional Health Literacy
Reading to child
Pre-school
Appropriate Discipline
Poverty
Lack of health services
Toxic Stress
Health Services
Adverse childhood events and adult depression#!
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
0
1
2
3
4
5+
Odds R
atio
Adverse Events
Chapman et al, 2004
Adverse childhood events and adult ischemic heart disease #!
0
0.5
1
1.5
2
2.5
3
3.5
0
1
2
3
4
5,6
7,8
Dong et al, 2004 Adverse Events
Od
ds R
atio
2nd Decade!
3rd/4th Decade!
5th/6th!
Decade!Old Age!
•" School Failure!
•" Teen Pregnancy!
•" Criminality!
•" Obesity!
•" Elevated Blood!
Pressure!
•" Depression!
•" Coronary Heart Disease!
•" Diabetes!
•" Premature Aging!
•" Memory Loss!
Life Course Problems Related to Poor Early Life Circumstances !
From Hertzman
He
alth D
evelo
pm
ent
Age (Years)
0 20 40 60 80
Optimal Health Trajectory
Low Health Trajectory
Higher LT Costs
Lower LT Costs
Co
sts
Symptomatic
Life Course Health Development: How Risk and Protective Factors Influence Health Trajectories!
1.0 3.0 2.0
Families in Poverty by Family Structure: Percent Families with Children Under 18 in
Poverty!
Sources: Map – Healthy City
www.healthycity.org
Data – US Census
ACS 2005-2009 5 Year Estimates
Road File: NavTeq
LA: Tale of Two Cities!
!
!
!
poverty!%!
!
White!%!
!
Latino #%!
!
AA !%!
!
APA!%!
!
SPA 5!
!
11.7%!
!
62!
!
16!
!
6.4!
1!
0.8!
SPA 6! 31.5%! 2.6! 59.7! 34.7! 1.6!
Tale of Two Cities: Behaviors!
TV viewing!
(1-2 y.o)!
hrs/day!
TV viewing!
(3-5 y.o)!
Hrs/day!
Library visits!%!
!
!
SPA 5!
!
1.54!
!
0.86!
!
77!
!
SPA 6!
!
2.19!
!
3.26!
!
36!
Tale of Two Cities: SR!
!
SPA 5!
!
SPA 6!
!
!
Language Skills!%!
49!
49!
2 !
10!
64!
26!
!
Math Skills!%!
36!
42!
22!
0!
13!
87!
Overall Child Well-being!
Country Average rank
Material Situation
Health and
Safety
Education Children’s relationships
Subjective Well-being
Behaviour and
lifestyles
Netherlands 4.2 10 2 6 3 1 3
Sweden 5.0 1 1 5 15 7 1
Finland 7.3 3 3 4 17 11 6
Spain 8.0 12 5 16 8 2 5
Switzerland 8.0 5 9 14 4 6 10
Denmark 8.2 4 4 8 9 12 12
Norway 8.3 2 8 9 10 8 13
Belgium 10.0 7 12 1 5 16 19
Italy 10.0 14 6 20 1 10 9
Ireland 10.2 19 19 7 7 5 4
Germany 11.2 13 11 10 13 9 11
Greece 11.8 15 18 17 11 3 7
Canada 12.0 6 14 2 18 15 17
France 12.5 9 7 15 12 18 14
Poland 12.5 21 16 3 14 19 2
Czech Republic 12.7 11 10 11 19 17 8
Austria 13.7 8 20 19 16 4 15
Portugal 14.0 16 15 21 2 14 16
Hungary 14.5 20 17 13 6 13 18
United States 18.0 17 21 12 20 20
United Kingdom 18.5 18 13 18 21 20 21
UNICEF 2007!
Child Well-being by Child Poverty r=0.75!
Bradshaw, 2007
Rates of Return to Human Development Investment
Across all Ages!
6
8
4
2
0
Return Per $
Invested
Age
R
6
Pre-
School School Post School
Pre-school Programs
School
Job Training
18
Pedro Carneiro, James Heckman, Human Capital Policy, 2003
The most common pattern is an inverted U shape, with education spending dominating!
Example of United Kingdom spending in 2003. Source: OECD (2009) Doing Better for Children
Public Expenditures Children 0-17, Sweden,
1995!
Compared to UK and Sweden: US Children- Double/Triple Jeopardy !
•" Grow up in a much more unequal society !
•" More children live in poverty and low income families !
•" Their parents are less educated!
•" They receive less investment of public
dollars to address deficits and shortfall !
•" Beginning the race in a globalized world 5
meters behind their UK counterparts and 15 meters behind the kids from Sweden.!
Optimizing Healthy Development!
Addressing the factors shaping health development trajectories over the lifespan! !
Age
Current practice
At-risk child-development trajectory
without intervention
Op
po
rtu
nit
y
Transforming Early Childhood Community Systems (TECCS)!
UCLA, UWW, WK Kellogg, Cincinnati Children's Hospital !
States, Counties, Communities!
Systematic Data CollectionSystematic Data CollectionFor trackingFor tracking Health Development TrajectoriesHealth Development Trajectories
School Readiness
5 ysBirth 1yr 4 ys3 ys2 ys
Pediatric Early Child
Assessment
Birth
Certificate
Preschool Assessment
• Physical Wellbeing & motor dev’t
• Social & emotional dev’t
• Approaches to learning
• Language dev’t
• Cognition & general knowledge
EDI= Early
Development
Inventory
Hea
lth
Dev
elo
pm
ent
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27
Four Key Strategies for TECCS!
1.! Community Engagement !
•" Mobilize local EC coalitions around data collection, planning
and improvement!
2.! Measurement & Mapping !
•" Of children"s developmental outcomes using the Early Development Instrument (EDI) and related data to inform
planning & improvement !
3.! Targeted System Improvement !
•" Work with communities to identify and prioritize barriers,
test and refine specific strategies to address those barriers!
4.! Shared Learning with a Collaborative Innovation Network (COIN)!
•" Help communities share experiences, resources and
lessons learned, and harvest knowledge about effective
practices!
Systematic Data Collection "For tracking Health Development
Trajectories#
School Readiness
5 ys Birth 1yr 4 ys
3 ys 2 ys
Pediatric Early Child
Assessment
Birth Certificate
Preschool Assessment
•" Physical Wellbeing & motor dev"t
•" Social & emotional dev"t
•" Approaches to learning
•" Language dev"t
•" Cognition & general knowledge
EDI= Early
Development
Inventory
Hea
lth
Dev
elop
men
t
Early
Development
Instrument •"104 items
•"Extensive validity and reliability
data from several countries
•" Not a test
•"Teacher at age 5 is respondent
•"Five developmental domains,
with sixteen subdomains
What Does the EDI
Measure?