The APA Task Force on Childhood Poverty

The APA Task Force on Childhood Poverty

Benard P. Dreyer, MD
Past President, Academic Pediatric Association

Paul J. Chung, MD, MS
Chair, APA Public Policy and Advocacy Committee

Presidential Address


  • To raise our voices as pediatricians and pediatric health care professionals regarding the high rate of childhood poverty and its effect on the health and well-being of children
  • To make the issue of childhood poverty a major focus of our policy, advocacy, and educational activities
  • To take a leadership role among our fellow pediatric organizations in creating an agenda to lift children out of poverty and ameliorate the impact of poverty on poor children.


  • To end or greatly reduce childhood poverty in the US
  • To ensure that all children reach school-age with the cognitive and social-emotional skills that will allow them to learn, to succeed in their education, and to become productive and successful adult members of society.

Facts of Childhood Poverty in the US

  • Children are the poorest group in US society. Approximately 1 in 5 children live in families whose income is below the federal poverty line. This has been true since the 1970s and little has been effectively done to change that rate. Even more young children 5 years of age or younger live in poverty, 1 in 4. Furthermore, half of poor children live in extreme poverty, less than 50% of the federal poverty level.
  • Children living in poverty have poorer health outcomes, including increased infant mortality, low birthweight and subsequent problems, increased frequency and severity of chronic diseases such as asthma, poorer access to quality health care, increased accidental injury and mortality, and increased obesity and its complications.
  • Perhaps even more importantly, there are severe consequences to poor children's well-being and chances for a productive and successful adult life. These negative consequences include poorer educational outcomes (with poor academic achievement and higher rates of HS dropout), less positive social and emotional development resulting in more problem behaviors that lead to life trajectory altering events (such as early unprotected sex with increased teen pregnancy, drug and alcohol abuse, and increased criminal behavior as adolescents and adults), greater likelihood of being poor adults with low productivity, low earnings, and intergenerational poverty. Considering the importance of early brain development, the increased incidence of poverty in very young children is an urgent problem for our country.
  • Almost 1 in 2 children live in poverty or near poverty. Research shows that children living in families with income between 100% and 200% (and perhaps as much as 350% in some areas of the country) of the federal poverty level, are living in "near poverty", and suffer significant material hardships that lead to many of the same outcomes listed above.
  • Poverty is also an issue of inequities of health and well-being based on race and ethnicity. Racial/ethnic minority children are much more likely to be poor, much more likely to be extremely poor and persistently poor throughout their childhood, and to lack assets that might cushion the experience of poverty. And these inequities are magnified for the youngest minority children, who are going through rapid brain and skill development.
  • Government does work and can make a difference in decreasing poverty. Our government is capable of addressing poverty, as evidenced by the reduction of the poverty of senior citizens (previously the poorest segment of our society) from 35% in 1959 to 9% in 2010 through the institution and expansion of government programs. We need to do the same for children.
  • The private sector can and must help. In a country that emphasizes the social benefits of a strong private sector, corporations should be engaged on a national level to help reduce childhood poverty and its effects, through community partnerships, employment programs directed at impoverished communities and young parents, and advocacy at the local, state and national level.
  • Compared to other developed nations, the US is in a disgraceful position concerning childhood poverty. The average childhood poverty rate of OECD nations is 12% with many European nations having childhood poverty rates well under 10%. And most European countries have policies that protect children, so childhood poverty rates are lower than overall poverty rates (which is the opposite of the situation in the US, where childhood poverty rates exceed overall poverty rates).
  • Most European countries, including the UK, have active plans to reduce childhood poverty as well as alleviate the impact of existing poverty on children. The UK's War on Childhood Poverty has reduced absolute childhood poverty from 26% in 1998 to 10% in 2010. During the same period absolute childhood poverty in the US increased from 19% to 22%. No plans to address childhood poverty exist in the US. There is not even a national discussion of the subject of childhood poverty.
  • We know what can be done to reduce childhood poverty and alleviate its consequences for poor children. There are existing government programs of benefits, subsidies, and tax credits to poor families that could further reduce childhood poverty. And there are proven programs in early childhood that can greatly alleviate the consequences of poverty on early brain development. We need to expand and widely implement these programs.

October 2014 Newsletter Article

APA Task Force on Childhood Poverty Subcommittee on Immigrant Child Health

The APA Task Force on Childhood Poverty had long planned a third Subcommittee (in addition to Health Care Delivery and Medical Education), and formally started the Subcommittee on Immigrant Child Health in late spring 2014. Fernando Mendoza from Stanford and Benard Dreyer agreed to be the co-chairs.

Members, in addition to Benard Dreyer and Fernando Mendoza, include:
Alan Shapiro, Alex Foster, Alice Kuo, Arthur Fierman, Blanca Garcia, Christopher Raab, Claire McCarthy, Danielle Laraque, David Keller, Elena Fuentes-Afflick, Elizabeth Hanson, Fatima Gutierrez, Glenn Flores, Gloria Perez, Janine Young, Jose Manuel Delarosa, Judy Palfrey, Lisa Ayoub-Rodriguez, Lisa Matos, Maida Galvez, Marcia Griffin, Mark Schuster, Mary McCord, Mary Rimsza, Michelle Brane, Michelle Ratau, Moira Szilagyi, Nusheen Ameenuddin, Paul Chung, Rachel Gross, Rashmi Shetgiri, Ricky Choi, Ryan Van Ramshorst, Sandra Braganza, Sarah Polk, Shale Wong, Steve Federico, Woodie Kessel.

The purpose of the Task Force was to focus on immigrant children in two major areas as well as develop an action plan:

  • General Issues
  • Unaccompanied Immigrant Children Crossing Our Borders
  • Action Plan

  • General Issues

    One-fourth of all US children are immigrants or children of immigrants. In states like California, half or all children are immigrants, but immigrant children are living in many communities all over the country. They have specific issues that we as pediatricians need to help them with and we should advocate for the individual children we care for as well as for governmental changes.
    • Health insurance: Immigrant children and children in immigrant families are much more likely to be uninsured. For Mexican and Central American children, the rate is over 20%. There are many reasons for this increased rate of being uninsured, including undocumented status, fear on the part of undocumented parents to accept benefits for their citizen children, and the fact that many states are not taking the CHIPRA (the Children's Health Insurance Reauthorization Act) option to insure legal immigrant children in the first 5 years of living in the US. We as pediatricians can help individual families get health insurance benefits for their children. And we need to advocate to our state governments to insure legal immigrant children and pregnant women through CHIPRA. We in the APA Task Force support the AAP policy that advocates for health insurance coverage for every child living in the US, regardless of immigration status!
    • Poverty: Immigrant families are more likely to be poor than families with US-born parents. 30% of immigrant families are poor vs. 19% of families with US-born parents. For Mexican and Central American immigrant families, the poverty rate is almost 40%. And immigrant families qualify for fewer safety-net programs such as SNAP (food stamps), compounding the stress of their low-wages. When we see these families in our practices, we need to screen for food-insecurity, and help them get any safety-net benefits they qualify for.
    • Poorer Educational Outcomes: Immigrant children who are dual-language learners do much more poorly in school than English-language learners. We need to advocate for universal preschool and affordable high quality child care for all poor and low-income families, including immigrant families, as well as the adoption of effective educational practices for dual-language learners in school systems.
    • Support the DREAM Act: Children brought here by their families who are undocumented and who have spent their childhood here deserve our support. The DREAM Act (Development, Relief and Education for Alien Minors Act) would allow children who were brought here and have graduated from high school without criminal records to stay here for at least 2 years without deportation, apply for work permits, obtain drivers licenses, go to college, and on completion of college or military service have a pathway to citizenship. President Obama issued an executive order to help these children called Deferred Action on Childhood Arrivals, which we strongly support.
    • AAP Policy on Providing Care for Immigrant, Migrant, and Border Children: The Council on Community Pediatrics published a policy statement on the care of immigrant children in May 2013 which is an excellent source of information and recommendations regarding both health care and advocacy for immigrant children. Every pediatrician should read this excellent resource on the AAP website or in Pediatrics.

  • Unaccompanied Immigrant Children Crossing Our Borders

    Tens of thousands of unaccompanied immigrant children are crossing our southern borders, fleeing from violence in the Central American countries of El Salvador, Honduras, and Guatemala. You can read stories in the newspapers of the takeover of large parts of these countries by gang violence leading to increasing murder of children (murder rates of children have been going up each month) as well as children being forced into gangs or seeing their close friends or relatives gruesomely killed. The Trafficking Victims Protection Reauthorization Act of 2008 (TVPRA), which passed the Senate and House unanimously, protects them from immediate deportation and guarantees them a hearing in court. This is not true for children or families crossing coming from Mexico. These children are being processed by the US Customs and Border Protection agents and handed over to the Office of Refugee Resettlement (ORR). ORR is setting up shelters and contracting with agencies to run them across the entire US. There are 3,000 of these children in New York City alone and Drs. Dreyer, Shapiro, Fierman, and Galvez have been involved with pediatricians, lawyers, shelters, and agencies caring for them.

    The Task Force's position on this crisis and need for action includes:
    • This is a humanitarian crisis, not an immigration crisis: We should be advocating for their rights, their care and their safety. The majority of these children are fleeing violence and are afraid to return to their countries for fear of violence and death. Of course many of these children have family in the US and some are coming here primarily to try to reunite with parents. While many of these children are teenage boys 14/17 years of age, an increasing number of girls and young children are crossing our borders.
    • They need adequate legal representation: No child should have to go to court alone! While the TVPRA act guarantees them a day in court, it forbids government funds for legal representation. They need better access to lawyers and we need to advocate for training, support and coordination of pro bono legal services that is integrated into their ORR stay as well as follow-up once they are placed with family or foster care. Lawyers are often asked to prepare the case for court in a week or two. This is inadequate time to prepare a case and we should be advocating for at least a month before hearings are scheduled, with exceptions for continuances as needed.
    • These children should be granted refugee status: Refugee status is granted to immigrants fearing danger due to race, nationality, religion, political opinion or social group membership. Therefore the federal government frequently states that these children don't qualify for asylum because they don't fit into one of these categories. However "social group membership" is a term which certainly can describe these children regarding their position related to gangs. Children may also qualify for asylum based on abuse and abandonment by their family.
    • Mental health services are critical: Many of these children are suffering from PTSD, depression and other mental health problems. Access to mental health services, for some during their stay in ORR shelters, and many others after they are released to family, friends or foster care, is critically important.
    • Educational issues need our attention: Many of these children are entering school systems across the country this fall. They are all mono-lingual Spanish and some even primarily speak an indigenous language. Most of the older children have not gone to school after the age of 12. They all qualify for a free public education in this country. However, school districts may be stressed by the needs of this group of children. Some have tried, illegally, to turn them away. Pediatricians should be reaching out to school districts to open up discussions about how best to provide an appropriate educational experience for these children.
    • Organized follow-up is important: At present, there is little organized follow-up of these children once they leave the ORR shelters. Clearly the mental health and educational issues they face occur after they leave the shelters. And many of these children are being taken in by parents or extended family and friends whom they haven't seen for many years, (often since they were toddlers) or whom they have never known. Placements, therefore, don't always work out, and the teenagers, especially, may become homeless, prey to traffickers, or exploited as workers. Pediatricians should to work with social service agencies and other non-profits to provide a safety-net.

  • Action Plan
    The action plan of the Task Force Subcommittee on Immigrant Child Health has focused on the concerns of unaccompanied immigrant children and developed the following actions:
    • Submitted a workshop of the problems and care of unaccompanied immigrant children to PAS for the 2015 meeting.
    • Worked with AAP National office to develop a webinar to educate pediatricians about the problems of these children and resources to help them better care for these children.
    • Brought the voice of pediatricians on the border to the conversation at regional and national level
    • Worked locally in the New York City area to marshal health, legal, mental health, and educational resources for these children
    • Advocated for allocation of AAP endowment funds to help in this humanitarian crisis.
    • Reached out to advocates for immigrant families to collaborate on these efforts like Women's Refugee Commission, Children's Defense Fund, the NYC Immigration Coalition, Catholic Charities, and others.
    • Worked with the NYC Department of Health to develop an information sheet on the needs of unaccompanied immigrant children once they are placed with sponsors, which will be shared with all APA members
    • Advocating for local and state funding for the legal representation of these children when they have their deportation hearings.

Submitted by
Benard P. Dreyer

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Benard P. Dreyer, MD
Past President, Academic Pediatric Association




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