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Children who live in poor families face pervasive challenges
to their health and development. These challenges result in increased
rates of illness, developmental delay, behavioral problems, school
failure, and social dysfunction. Poverty, adverse exposures, and
unmet basic needs amplify the impact of biological vulnerabilities
on the child. However, as with other threats to health and development,
poverty’s effects can be offset by individual, family, community, and
professional buffering factors that offer both protection and support.
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The official poverty level is based on the estimated cost of
food multiplied by 3; this is based on the assumption that food
accounts for one third of a family’s income after taxes,
which for a family of four is $20,650 or less. The level
is adjusted for size of household but not for regional variations
in cost of living or actual expenditures and income.1 Estimates
from the National Center for Children in Poverty at Columbia estimate that
13 million children lived in poverty in 2006, an increase of 1.2
million children just since 2000. Contrary to stereotypes, almost
two thirds of poor children have parents who work, and over one
half of poor children live in the suburbs or in rural areas. There
are enormous racial disparities in poverty: a greater proportion
of African American and Latino children live in poverty (ie, 33% of
all African American children and 27% of all Hispanic children
live in poverty, versus 10% of white children), but in absolute
real numbers there are more poor white than poor African American
or Latino children. However, families whose incomes are even twice
the federal poverty level have trouble making ends meet. Twenty-eight
million children live in such “low-income” families.2
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The concept of “poverty” encompasses insufficient
income and the range of conditions that poor families endure.3,4 Poverty’s
impact varies, depending on whether it is normative within a given
society; urban or rural; brief, intermittent, or chronic; relative;
or at a level that compromises physical survival. Income inequality
is now thought to be a more sensitive indicator of health problems
than mean income. This may be mediated through social marginalization,
the end product of the experience of social inequalities such as
poor schools, poor health services, and poor homes. Some US families
may have members who are disabled by mental illness, alcoholism,
or other chronic conditions, and local economic stagnation or racism
may limit their access to educational opportunities, quality health
care, and better jobs, leading to multigenerational poverty.
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Families in such variable settings experience different social
environments and have different expectations for themselves and
their children. For example, families who fall under the poverty
level for shorter periods because of transient unemployment may
have more economic and psychological reserves with which to endure
its effects than families who have been in poverty for several generations. Families
living in urban poverty have increased exposure to lead, violence,
household allergens, and airborne pollutants, while rural families ...