Stress and Other Adverse Childhood Events Have an Effect on Health into Adulthood

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Nearly 726,000 American children lost their health insurance in the three years before COVID-19 hit, reversing what had been a decade’s worth of improvement.

And since the pandemic began, the situation could deteriorate further, two child health experts told a National Press briefing. Losing health insurance will affect children’s health directly, as well as their ability to thrive and learn. It’s another way the coronavirus pandemic has exposed deep-seated inequalities in the United States, especially in how poverty harms the health of children.

Dr. Benard P. Dreyer, a professor at the NYU Grossman School of Medicine and a past president of the American Academy of Pediatrics, said it would cost $108.8 billion to reduce child poverty – but that the cost of ignoring it would be much higher.

“There are very good estimates that child poverty costs us about $800 billion to $1.1 trillion a year in extra costs in medical care, in education, in prisons and in loss of economic outcomes as adults,” he said. Dreyer is also a contributing author to “A Roadmap to Reducing Child Poverty,” a report from the National Academies of Sciences, Engineering and Medicine that outlines how the U.S. government could create programs to alleviate childhood poverty.

During the pandemic, Dreyer has witnessed a spike in family poverty. At the Bellevue Hospital Center, where he is director of pediatrics, Dreyer said doctors began raising money to give out $100 gift cards to help patients pay for food. His patients are disproportionately affected by the pandemic and don’t have any “cushion” to offset the economic crash and its widespread job losses, he said.

Dreyer said the nation’s most impoverished age group is children, with 14% living in poverty; among adults age 18-64 and those over 65, about 9% are poor. Broken down by race, the differences are apparent: Poverty among Black children is 32%, among Latinx children 26% and among white children 11%.

Poverty affects children later in life as well, due to the presence of toxic stress and trauma. Adverse childhood experiences, known as ACEs, include the divorce of a parent, domestic violence and poverty itself.

“When you can’t get food on the table, it’s hard to read ‘Goodnight Moon’ to your little child,” he said.

These experiences influence brain development, change emotional reactions and cause poor academic performance and economic failures. But government intervention can help alleviate these effects, he said.

Joan Alker, a professor and the executive director of the Center for Children and Families at Georgetown University, outlined how the lack of insurance and Medicaid funding affects children.

Alker said the most recent Census Bureau statistics showed that the child uninsured rate rose from 4.7% in 2016 to 5.7% in 2019. The children losing coverage are disproportionately Latinx; their uninsured numbers jumped from 8.2% to 9.2% over the last three years.

Among public health programs, Medicaid provides insurance to the most children in the United States and it has helped reduced the child poverty rate by more than 5%, said Alker. But the program is under pressure – states received a boost in the Medicaid budget in March, but that allocation was not enough, she said.

The Children’s Health Insurance Program has also been an important program in alleviating childhood poverty, but the program only insures 9.5 million while Medicaid insures 36.9 million. Medicaid is also necessary for communities of color, Alker said.

The rate of uninsured children is rising because of efforts to repeal the Affordable Care Act and cuts to the program’s funding, a fear in immigrant communities in asking for government assistance and more “red tape” in public policy, Alker said.

“The more red tape the state puts up, the fewer kids and families that will be able to access health insurance,” she said.

The red tape includes increased applications, fees and administrative tasks that deter families from applying.

Medicaid coverage helps children live healthier lives and attain greater academic achievement and economic success as adults, she said.

When covering Medicaid, Alker told reporters to look at state-specific data on proven benefits of the program, uninsured rates and how race and ethnicity affect those numbers and maternal and infant mortality statistics.


This program is funded by the David and Lucile Packard Foundation, W.K. Kellogg Foundation, and Heising-Simons Foundation. NPF is solely responsible for the content.


Q&A on How Poverty Affects Children’s Health
Dr. Benard Dreyer on Children’s Health
Joan Alker on Children’s Health
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