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

!"#$%&' ( )*&+,-.+/%&

0%#1,$%12&3#-#&!41-%/1&

5 ( 5 &6$+7$#/1 )%#8-"& 9 #/:84&!,;;+$- ( ":83&<%8=#$%

!41-%/1&>,:83:?7@&( $+11A1%.-+$&' :?B#7%&#?3&

C?-%7$#-:+?&!-$#-%7:%1

!%.-+$&D#1%3&;$+7$#/1

9 :?#?.:#8&#?3&6+8:.4&

E 8:7?/%?-

( +88#D+$#-:F%&&!41-%/1&

C/;$+F%/%?-

( +//+?&' ( )*&

E7%?3#2&

( +//,?:.#-:+?1

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?