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Many aspects of a child's life can influence his or her health beyond what takes place in the clinic during conversations with health care providers. Factors like affordable food, safe housing, high quality schools, and financial security can all influence child health through their influence on the experiences, behaviors, and opportunities children are afforded as they grow. These factors, termed the social determinants of health, have been shown to strongly influence health lifelong and have a tremendous impact on life expectancy (i.e. number of years of life). Many pediatricians, including those in my field of general pediatrics, are now beginning to focus not only on the traditional medical care that we're all trained to provide but also on how we can influence these social determinants of health through changes in our practice. Networks of health services researchers are working to understand the ways in which social determinants of health influence our patients' lives so that we can reshape the health care system to support optimal health and protect patients beyond our clinic walls.
This new direction in health care research has already produced tremendous innovations, including programs that directly link patients with financial services, housing, healthy food, and vibrant communities to support all around health. In Los Angeles, we are developing programs that may one day improve family health by focusing on financial as well as their physical health. Innovations like these are appearing all across the country and only seem to be gaining momentum. Hospitals and health plans have caught on too, and screening for so called "social needs" and social determinants is becoming more and more common. The question that remains, of course, is how clinicians, hospitals, and health systems can best help patients once they identify a social need that threatens health. Answers to that question and others will likely be clearer in the coming years, but in the meantime don't be surprised if your doctor or nurse asks you if you ever have trouble making ends meet or need help affording healthy foods. The goal of these questions isn't to be nosy or rude — clinicians just want to help you and all patients stay as healthy as possible by attending to your social determinants of health.
One particular social determinant of health has been identified as a priority for action by the American Academy of Pediatrics: Child poverty. Based on many years of research and experience, the American Academy of Pediatrics has articulated what many of us already know intuitively: Poverty is bad for your health. Not only does the stress of poverty predispose children to greater cardiovascular health risks and obesity, it also directly interferes with optimal cognitive function and development. Children in poverty are at higher risk of a host of chronic health problems than their more well-to-do peers, and the number of children in poverty in America means that poverty itself is a significant health risk for tens of millions of children nationally.
What can be done about this?
Well, as a start, pediatricians have begun to offer help to families that are struggling economically by connecting them with services in their communities that are designed to alleviate the stress of poverty and avoid the worst harms of growing up poor. The WIC, SNAP, and other public benefits programs are designed to help families avoid having to decide between paying the bills or putting food on the table. Other programs, like medical-legal partnerships and medical-financial partnerships can help families connect to legal and financial services that can help them get out from under social circumstances that would otherwise keep them down economically. Other programs like Reach Out and Read are designed to ensure that families have access to affordable books and that they learn how to read to their children in ways that will maximize their language development and put them in the best position possible to continue their literacy development in school. All of these programs are becoming more and more common tools in the pediatrician's toolkit, and finding the right tool for each family begins with a conversation about economic struggles in the clinic with pediatric providers.
Beyond clinical encounters between families and pediatricians, there are lots of ways pediatricians are trying to help low-income families raise healthy kids by breaking the cycle of intergenerational poverty. One of the most powerful tools to reduce poverty is the Earned Income Tax Credit, which returns more financial resources to the pockets of working families than any other in the nation. Pediatricians have joined the call for expansion of the Earned Income Tax Credit, along with many prominent economists and child advocates. Some pediatricians have even proposed helping families find free tax preparation services, which are sponsored by the Internal Revenue Service all over the country during tax season, through their clinical encounters so that they can receive this underutilized resource. Because the Earned Income Tax Credit is just about the largest economic stimulus low-income families have the opportunity to receive and pediatricians know that keeping families above water financially helps them raise healthy kids, it just makes sense for pediatricians to align their practices with these tools from the world of financial services. In the future, it may not be unusual for families to get their taxes done in the doctor's office or to create a budget while they are waiting to receive their vaccines. These cross-sector innovations have a name: Medical-Financial Partnerships. Given how interconnected child poverty is with health, these and other tools are likely to become more and more widespread in health care.
So, the next time you go to the doctor's office, ask yourself this: What would it help my doctor to know about my finances that would inform my care and help my medical team take care of both my physical and financial health? Given that health care is becoming more and more expensive and consuming a larger proportion of many family budgets, these conversations could be a natural evolution of the doctor-patient relationship. Indeed, the health of millions of children may depend on it.