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As trying conditions add up, health risks multiply, data show
By Ronald Kotulak
Tribune science reporter
Published May 2, 2006
The more social disadvantages children have, such as being poor or having a single mother who is a high school dropout, the greater their chances of becoming sick, regardless of race or health insurance coverage, a nationwide study of more than 57,000 children has found.
Sociologists long have known that growing up in physically or mentally impoverishing conditions is bad for children, but this is the first study to show that piling up these social disadvantages increasingly magnifies the health risks children face.
Children having three main social disadvantages--poverty, low parental education and single-parent household--were four times more likely than children with none of these risk factors to be in poor, fair or good health, as opposed to very good or excellent health, said Dr. Ruth Stein, a pediatrician at Albert Einstein College of Medicine/Children's Hospital at Montefiore in Bronx, N.Y.
Children with all three risk factors were twice as likely as children with none to have a chronic health condition such as asthma, diabetes or mental retardation.
Children who had two of the risk factors were three times as likely to be in poor, fair or good health as those with none, and youngsters with one risk factor had twice the health risk, Stein reported in the April issue of Pediatrics, a journal of the American Academy of Pediatrics.
"Our children are in rather grave situations because so many of them do have these risk factors and many of them have multiples of these risk factors," Stein said. "If we want healthy kids to grow up to be healthy adults we need to be attacking all of these problems."
The researchers estimated that 6.2 million American children have all three risk factors, 9.6 million have two and 18.9 million have one.
Paul Newacheck, professor of health policy and pediatrics at the University of California, San Francisco, who was not involved in the study, said the findings represent "a new concept that shows we need to look beyond single issues like poverty or minority status.
"We need to think more broadly about what the determinants of health are, and we should be careful not to label certain racial and ethnic groups as having poorer health outcomes because of something intrinsic in them," he said. "Rather, it's their other disadvantages they face in life, lower incomes, family structure issues and things like that that may be the underlying reasons for worse health outcomes."
The study involved an analysis of the social conditions and health of 57,533 children younger than 18 who were interviewed as part of the National Health Interview Survey on Disability Supplement for the years 1994 and 1995.
The study found that the three social disadvantages outweighed the availability of health insurance, either private insurance or the publicly financed Medicaid, as factors determining a child's health condition.
"Health insurance is absolutely necessary," said Laurie J. Bauman, Albert Einstein College of Medicine sociologist and the study's lead author. "It may very well improve the health of children, but it's not going to solve the problem of social disparities. It's going to make it easier for families to get care, but there are other reasons why it's hard for people to get care.
"If you have a mom who's poor and a single mom, the difficulties she has in getting her kids to care and taking care of them is much worse than if you're just poor but also have two parents in a household," she said.
Greg Duncan, professor of education and social policy at Northwestern University, said the study suggests that relying on single-policy approaches to children's health, such as boosting health insurance, are not sufficient to solve the problem posed by social disadvantages.
"It tells us that nailing down health insurance and access to health care doesn't insulate disadvantaged kids from having poor health," he said. "That's a pretty discouraging kind of result. It's really saying that the sources of poor children's health run much deeper than just how much access they have to health care."