Recently, Perri Klass, M.D. wrote an article on the New York Times blog titled “Poverty as a Childhood Disease”. Dr. Klass shared that at the annual meeting of the Pediatric Academic Societies, there was a new call for pediatricians to address childhood poverty as a national problem, rather than wrestling with its consequences case-by-case in the exam room. To further Dr. Klass’s discussion, WECA board member Dipesh Navsaria, MPH, MSLIS, MD wrote the following blog post.
“Poverty is neurotoxic.” Yes, those words should make you sit up and take notice. I’ve been saying them for about a year now. It’s a conclusion I’ve come to after seeing the dramatic studies which show substantial deficits in learning among children who have experienced adversity early on in their lives — and with few or no strong, supportive relationships to buffer the effects of that adversity. I am proud to be part of both the American Academy of Pediatrics and the Academic Pediatric Association, who are calling attention to the concept of poverty as a childhood disease.
I’ve seen this as a problem throughout many areas of Wisconsin. I’ve noticed it in Native American populations when I’ve worked with them. I saw it in the hospital as a physician-in-training. And in my clinical practice at Access Community Health Center in South Madison, I evaluate many children for “school issues” or “behavior problems”. They are rarely straightforward cases. When I “go digging” in their histories, I find that early exposure to adversity has left a legacy we don’t want children to have: lifelong impairment in learning, thinking, and emotional skills. Even worse, if we examine the data, we find that traditional medical illnesses also may have significant roots in these issues.
In a staggeringly large study in the mid-1990s, we found that multiple adverse events as a child led to three times the risk of heart disease fifty years later, as an adult. Even more stunningly, this was not a study of a typically underprivileged, “at-risk” population, but of largely college-educated, upper-middle class adults. Adversity “bakes into the biology” changes which play out in physical health decades later. These studies have been repeated (with similar results), and there is even one looking specifically only at Wisconsin.
Given the magnitude of the task before us, what, realistically, can we do? While we work towards a goal of reducing the root causes of adversity, we can implement protective interventions which buffer against the harmful effects of poverty. In my world, we support clinics in setting up Reach Out and Read, an early literacy intervention which makes the advice to share books together a standard part of every well-child checkup, because we know that helps strengthen parental bonds with the child and establishes a routine which primes a child to be ready to learn.
What about early childhood education? Well-prepared child care providers are also a part of that relationship system which buffers young minds against adversity. When a child has a consistent, dedicated, educated child care provider, they have the benefits of a protective relationship. They gain the advantage of a responsive adult, of language stimulation, and of early learning. Child care providers are not merely “looking after” a child — they are participating in nurturing a child for many, many hours, and can have a profound impact. Home visiting programs can assist families with challenges in practical matters such as food and housing, as well as with relationship-building actions, such as interactional play, dialogic reading, and more.
Early experiences matter. We’ve known this for a long time, and now the biology backs us up. It’s time for policy to follow.
About the Author:
Dipesh Navsaria, MPH, MSLIS, MD, WECA Board Member