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April 1996, Vol 150, No. 4 >
Article | April 1996

Welfare Reform and Children's Health FREE

Paul L. Geltman, MD; Alan F. Meyers, MD; Joshua Greenberg, JD; Barry Zuckerman, MD
Arch Pediatr Adolesc Med. 1996;150(4):384-389. doi:10.1001/archpedi.1996.02170290050008.
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

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