SAN FRANCISCO – If you visualize public health as a swatch of fabric, the tight weave would contain various threads. Yank just a single thread, however, and you would tug at a wide assortment of health woes, including chronic diseases such as asthma, obesity, mental health challenges, and developmental delays. According to Lanre Omojokun Falusi, MD, FAAP, a pediatrician at Children’s National Health System and Associate Medical Director for Municipal and Regional Affairs at Child Health Advocacy Institute (CHAI), one critical, unifying thread is poverty.
“Poverty really is a public health issue,” Dr. Falusi will tell attendees of the American Academy of Pediatrics 2016 National Conference. People living in poverty can simultaneously juggle concerns about food, housing, transportation, and neighborhood violence. “And your ZIP code matters. Your ZIP determines how many grocery stores are within driving distance, neighborhood safety, safe areas to play, school quality, academic achievement, and can even profoundly affect one’s lifetime earning potential,” she says.
For any child, and particularly children living in poverty, adverse experiences during childhood are linked to health conditions that can linger for much of their adult lives.
Take a city like Washington, DC. The metropolitan area is home to people who earn the nation’s highest incomes, and these residents’ income levels continue to inch higher. By contrast, the poorest DC residents – 39 percent of whom are children younger than 18 – live in poverty. And whether you look at the number of households or pregnant women who qualify for assistance with food expenses or people eligible for the income-based earned income tax credit, that percentage living in poverty has remained stubbornly unchanged.
While pediatricians are challenged by high case loads, Dr. Falusi believes that there is a place within the doctor visit for a discussion about such social determinants of health. Team-based care provides an opening for such conversations.
In some cases, pediatricians may feel out of their element. “It’s a very natural feeling: The best interventions to alleviate poverty are not the issues that doctors are used to working on,” she says. On the other side of the continuum are clinicians who try to take a lion’s share of the load. “Many pediatricians trained in hospitals that are very work-focused, and even I still fight the urge of saying ‘I myself need to fix this. It’s my job to make their health better.’ ” But social workers, who are trained in identifying such resources, and nurses are also integral members of the healthcare team. It would be equally natural for a referral to a food pantry or an application for the Supplemental Nutrition Assistance Program to come from these team members.
It’s a shift in mentality, refocusing on the patient’s broader needs that may impact health, rather than the narrow symptoms caused by those health concerns.
“It’s harder if you’re a community-based pediatrician with limited staff. It’s not always a seamless pathway to providing such information. They’re going to start with baby steps,” Dr. Falusi adds. There are tools, a handful of which have been validated, that help ease what might feel like an awkward conversation. “The pediatrician may say: ‘I’m just going to ask two questions about how food-secure they are.’ ”
Looking again at the Washington, DC region, among the resources for patients’ families include several efforts under the CHAI umbrella, such as a multi-pronged approach undertaken in Wards 7 and 8 that aims to improve residents’ access to proactive, preventive mental health services. Early childcare center staff are trained to identify issues as they first arise, and family support is embedded within the primary care centers to promote family resilience and address behavioral concerns early.
“Unfortunately, where you are born can determine health and wellness in negative way,” she says. “Within our programs, we can offer the tools parents need to make things better for children and to improve their health – even if they’re living in poverty.”
AAP 2016 presentation:
Saturday, October 22, 2016
- I1161- “Place Matters: Addressing the Needs of Children in Poverty in Rural and Urban Settings”
4 p.m. to 5:30 p.m.
Contact: Diedtra Henderson | Children’s National Health System | c: 443-610-9826/o: 202-476-4500 | firstname.lastname@example.org