The health and well-being of children
Pat Gleich

The health issues facing today’s children cannot be painted with a single brushstroke. Economic security, physical safety of neighborhoods, access to health care, parental presence and a host of factors influence the health status of young people in the United States. However, the unfortunate reality for most children today is that they are not quite as safe, not quite as protected and not quite as often encircled by concern and care as generations before them. The particular risks to childhood differ according to one’s surroundings and accoutrements, but to develop an accurate picture of the lives of many young people, it is important to look closely at factors that influence the well-being of children and adolescents, and to explore various aspects of their lives, including the health risks and hazards that inhabit their individual lives and world.  

Health risks

If we have been listening, we already know that children’s health issues are causing consternation, with increasing obesity rates and the early signs of diseases like hypertension and diabetes, exacerbated by weight gain, at record levels for young people. Sedentary lifestyles eating habits and nutrition are likely key to much of this change.  We also know that autism is being diagnosed at increasing rates — one child in every 150 — potentially reflecting better diagnostic tools compounding a real increase in numbers of cases, a rise that some suggest maybe be attributable to mercury that has been used as a preservative in vaccines. 

These mentioned are but the beginning of a litany of health concerns impacting the lives of children. After having declined for decades, the percentage of low birth-weight babies (affecting both infant mortality and ability to thrive) is again rising and the rate among African-American mothers is double that of Caucasian and Latina women. The infant death rate in the United States is double that of Hong Kong, Sweden and Japan with the United States rate ranking 26th among developed countries. Most alarming, the infant mortality rate for African-American babies is 2½ times that of the rate in the combined general population. (1)

A recent study published in the Journal of the American Medical Association reports that of the 80 million children in the United States today, almost 8 percent, 6.5 million young people, have chronic health issues that interfere with their daily activities. According to James M. Perrin, M.D., lead author of the study and professor of pediatrics at Harvard Medical School and Massachusetts General Hospital, Boston, even a larger number of children could be affected. “If children with chronic conditions not severe enough to be disabling are counted, chronic conditions affect about 18 percent of American teens and children in all.” This number has risen steadily for the past four decades. According to Perrin, in 1960, only 2 percent of children had chronic health conditions [now-eradicated polio accounted for many of these]. Again, according to Perrin, the top three causes of chronic disease are 1) obesity, affecting at least 18 percent of children and teens, 2) asthma and 3) Attention Deficit Hyperactivity Disorder (ADHD). (2)

HIV/AIDS

Stereotypes have frequently clouded the reality of who is at risk for HIV/AIDS. According to a report from the CDC on heterosexual transmission, young women, especially those who are African-American or Latina, are increasingly at risk for HIV infection through heterosexual contact.  The report indicates that the HIV prevalence rate among disadvantaged youth is 50 percent higher among young women aged 16–21 than the rate among young men in that age group. (2) African-American women in this study were seven times as likely as white women and eight times as likely as Hispanic women to be HIV-positive. Young women are at risk for sexually transmitted HIV for several reasons, including biologic vulnerability, lack of recognition of their partners’ risk factors, inequality in relationships and having sex with older men who are more likely to be infected with HIV. (3)

HIV infection rates among young men who have sex with men are also rising. Medications that allow some to better manage HIV/AIDS seem to have created the illusion that practicing safe sex is not as necessary as it once was.

Poverty and access to care

Economic security is clearly tied to well-being and poverty affects living conditions and access to health care and nutrition, all of which contribute to health status. In 2004 one out three African-American and Latino children lived in poverty while one in 10 Caucasian children did. One in five children under age six lives in poverty. (4) 

We also know that one in five children is classified as requiring “special needs services.” These services range from medication, emotional/behavioral special education to specialized therapies. The 2001 National Survey of Children with Special Health Care Needs found that one in three parents reported either cutting back on work or stopping work completely due to their children’s needs, with a resultant impact on family income. Parents in lower-income families, having fewer resources to support appropriate childcare, were most likely to have stopped working. (5)

Another important measure of well-being is access to health care. Currently an estimated 9 million children in the United States do not have consistent access to health care, and that access varies according to race, ethnicity and income level. Caucasian children are the most likely to obtain health care, Latino children are the least likely with African-American and Native-American falling in between. Not calculated in that number are children who do not have dental or mental health care access. (6)

Environmental factors

Yet another important indicator of well-being relates to environmental health and hazards in the homes and lives of children. Lead-laden paint on interior walls and floors provides a continuing risk. A 2004 EPA study tested levels of cotinine (the residual chemical component of nicotine ingested as second-hand smoke) and found that 81 percent of African-American children, 61 percent of Caucasian children and 41 percent of Latino children had measurable levels of cotine in their blood. (4)  Additionally, almost half of all children live in communities where toxic air pollutants rise above allowable levels.  These combined factors have resulted in a four-fold increase in asthma and other respiratory diseases among children. African-American and Latino children are at greater risk because lower health care access and because they are more likely to be living in areas of higher exposure to pollutants. Notably, among Native-American and Mexican children, asthma, unseen only three decades ago, is climbing steadily. (7)

The main culprits are ground-level ozone, particulate matter, carbon monoxide, nitrogen dioxide, sulfur dioxide and lead. Some researchers suspect that children residing in heavy transportation thruways are experiencing the highest rates of respiratory illness.

Accidents and violence

Violence and exposure to violence also play a part in the safety and well-being of children.  Injuries account for 43 percent of all deaths of children aged one to four. Cleanly separating the deaths of those children into intended and unintended injuries is futile, because the line separating intent and neglect blurs. For older children unintentional deaths due to injury are the highest cause of death. Deaths from vehicle crashes, firearms, drowning, fires and falls account for four out of five deaths. Additionally, injuries, some resulting in life-long disability, continue to rise though many are preventable by wearing seatbelts and helmets, driving only when not drinking and refusing to ride in a vehicle with a driver who is drinking. (8)

To more fully understand violence and related factors in adolescence, it is important to look further.  Homicides — primarily gun-related — account for 60 percent of youth deaths and, in the 15-19 age group, 36 percent of the deaths were the result of suicide. (9)  Still, this age grouping cannot be viewed monolithically.  The rate of death from unintentional injuries among Native-American and Alaskan-Native youth is higher than for any other group — three times the rate of Caucasian teens and four times the rate of African American and Latino teens. (10)

Research suggests approximately 20 percent of all high school students experience serious suicidal thoughts in a given year, and that about 4-8 percent make actual attempts. While adolescent females attempt suicide at a higher rate than males, adolescent males complete suicide at a rate of nearly five times as great as females. Rates of suicidal behavior increase as children get older, hitting their peak near age 20. Another group at higher risk for suicide are those youth who identify as gay, lesbian, transgender or bi-sexual and those who are questioning their sexual orientation or gender identity. (11) According to the National Association of School Psychologists, “Rates of suicidal ideation, attempts, and suicide by sexual minority youth are estimated to be two to three times higher than for heterosexual youth.” (12) 

There is much to learn about the reasons for these high suicide rates. Attempting to identify causes, one survey in 2003 found that “28.6 percent of high school students reported feeling so sad or hopeless almost every day for two weeks or more that they stopped doing some usual activities in the 12 months preceding the survey.” (13)

A new report published in the June 2007 issue of Archives of Pediatrics and Adolescent Medicine has established a relationship between dating violence and suicide attempts in young women and sexual assault and suicide attempts in young men.

Domestic violence is a pervasive problem. Households in which there is violence between intimate partners are more likely to have violence against children. One study found that in addition to a high degree of overlap, abuse in the home setting is related. “That is, the more severely a woman is battered the more severely her child is likely to be abused.” These same researchers also found that “the more dominant a husband is in a family’s decision making, the more likely a child is to be abused.” (14)

Violence in school settings is sensationalized through the media, and although the number of high school students who report taking weapons to school has decreased, nearly 9 percent of students reported being threatened or injured with a weapon on school property in 2001 and an additional 7 percent of students reported that they had stayed away from school because they feared bullying or felt unsafe at or near school.  (15)

Violence toward young women must also be mentioned. Two Canadian studies have specifically explored violence against young women. The first found that “over 49 percent of female students in high school had been emotionally abused, 14.5 percent reported being physically forced into sex and 9.1 percent had been physically assaulted. (16)

The National Council of Women of Canada reported (1999) “the chance that a young woman or girl will be a victim of some form of violence before she reaches 16 is 50 percent. Furthermore, girls from marginalized groups tend to experience violence at heightened levels; these are girls and young women of the First Nations, refugees and immigrants, lesbians, bisexual and trans-gendered youth.” (17)

Findings from an additional study do not mince words and underline the permissive societal connection to violence against women, particularly young women.

Strong societal influences condone sexist attitudes and disempower young women. Despite the frequency of incidents of violence and harassment against young women, many still think that "it might happen to one of my friends, but it can’t happen to me."

For young women from marginalized groups, this situation is compounded: the marginalization increases their vulnerability to many forms of violence. Sexual abuse and addictions among girls from specific marginalized groups increase their sense of isolation, vulnerability, lack of social identity and low self-esteem. (18)

Going forward

Perhaps one thing that has not changed so much from the times of past generations is the need to have adults paying attention to what is happening in the world of young people and speaking up appropriately on their behalf. Educating both young people and adults, bringing forward the issues in ways that do not sensationalize or trivialize the needs of young people, is a small but important first step.

Building active youth programs in congregations — including not only the children who are members, but reaching out those others who may not have the support or parental presence — is also an important avenue for improving the lives of children.

Through our churches we can educate, we can advocate for systemic change and we can reach into our communities to address issues that negatively impact children and find ways to help rebuild that cocoon of protection each child warrants.

For more ways to advocate for children, visit the PC(USA) Child Advocacy Web site.

References:

1. Education Commission of the States
2. Perrin, J. Journal of the American Medical Association, June 27, 2007; vol 297: pp 2755-2759
3. Child Health USA 2003
4.  Valleroy LA, MacKellar DA, Karon JM, Janssen RS, Hayman DR. (1998) "HIV infection in disadvantaged out-of-school youth: prevalence for United States Job Corps entrants, 1990 through 1996." Journal of Acquired Immune Deficiency Syndromes. 19:67–73.
5. Centers for Disease Control and Prevention
6. America’s Children in Brief: Key National Indicators of Well-Being, 2006
7. Child Health USA 2003
8. The North American Commission for Environmental Cooperation
9. HealthyPeople 2010, Injury and Violence Prevention
10. Centers for Disease Control and Prevention
11. National Association of School Psychologists
12. National Association of School Psychologists
13. Bowker, L. H., Arbitell, M., & McFerron, J. R. (1988). On the relationship between wife beating and child abuse. In. K. Yllo, & M. Bogard (Eds.), Feminist Perspectives on wife abuse (pp. 158-174). Newbury Park, Calif.: Sage.
14. Education Commission of the States
15. Child Health USA 2003
16. (DeKeseredy, WS, and Schwartz, MD, February 1998, Measuring the Extent of Woman Abuse in Intimate Heterosexual Relationships: A Critique of the Conflict Tactics Scales, National Resource Center on Domestic Violence)
17. Education Wife Assault
18. Jiwani, Y, et al (1999) "Violence Prevention and the Girl Child: Final Report," London, Ontario: The Alliance of Five Research Centres on Violence.