原文: The Greatest Threat to Children's Well-Being

Snap quiz: What do you think is the greatest public health threat to children in the U.S.?

Hints:

• Approximately 13-40 million children in the U.S are exposed to this risk (depending on how you define it).
  
• The younger you are, the more likely you are to be exposed to it (43% under 3 years, 35% ages 15-17).
  
• Minority children are more likely to be exposed to it (35% of black children, 29% American Indian, 28% Latino, 11% Asian and 10% white)
  
• Because most kids in the U.S. are Caucasian, more white kids are exposed than any other group.

What could it be? Obesity? Drug resistant bacteria? Car accidents? TV? Sex, drugs and rock & roll? Jerry Springer?


The answer is poverty.

Poverty is - by far - the greatest public health menace facing American children. Its victims, however, are small, powerless, and seemingly far away. It is, in large part, a silent epidemic.



I'm sure it comes as no surprise that children born into impoverished circumstances are at higher risk for any bad health or developmental outcome you can name. In fact, they experience "double jeopardy":

1. They are more likely to be exposed to threats to their well-being (pick your poisons: inadequate nutrition, underfunded schools, overcrowded homes, lack of access to health care, family dysfunction, neighborhood and domestic violence, abuse and neglect, inadequate child care, lead poisoning...).
   
2. They experience worse long term outcomes when exposed to these threats than do advantaged children.

I have spent my professional career working in an urban, inner-city hospital and have witnessed poverty's devastating impact on children and families. But let me be clear: I'm neither a masochist nor a saint. More often than not I am inspired as I see children and families triumphing over their adverse circumstances, working with all their hearts to fashion meaningful and worthwhile lives out of the many challenges. I often wonder: would I be as courageous, as resourceful, as resilient, had I been born into such economic adversity?

Having said that, I don't want to romanticize the lives of poor families. Poverty sucks - no two ways about it. It can contaminate all aspects of a child's well-being and, subtly and tragically, prevent a child from reaching his full potential - for academic success, for rewarding work, for meaningful relationships, for good health, for happiness.

Given poverty's pervasiveness and its corrosive effect on our society, I'm distressed that the needs of poor families are pretty much off the political radar screen. That's why I hope you'll stick around my blog as I share some what I've learned about children and families living in poverty and why I think it's such an important issue to tackle.


Let's start with a simple question: what makes a family "poor"?

Since being poor is an intensely personal experience, I'd like you to think about what would be your definition of poverty for your own family. Let's assume you are living in a family of 4 - two adults and two kids. What is the minimum income you would need to not consider yourself poor? I realize, of course, that this is totally arbitrary (as all definitions of poverty are) but go ahead and be as arbitrary and as personal as you like. What is your poverty line for a family of 4?


Here's what Uncle Sam has to say on this matter. The established Federal poverty line for a family of 4 is $20,640.

Surprised? I suspect your personal poverty line was much higher than $20,000 (most come up with at least 2-4 x that amount). It seems so paltry. Where did this number come from?

The federal poverty line was created in the 60's to boost the War on Poverty (after all, how can you conduct a war if you can't identify the enemy?). They were looking to set an absolute income threshold below which families would "lack the resources to meet the basic needs for healthy living, having insufficient income to provide the food, shelter and clothing needed to preserve health." Fair enough.

Then they reasoned thusly: A family spends about 1/3 of their income on food, 1/3 on housing and 1/3 on other stuff. Let's estimate the minimum a family could pay for food and remain adequately nourished (called the "thrifty food plan"). Multiply that number by 3 and, presto, the federal poverty line is born.

Do the math and you'll see that in 2007 this amounts to spending about $15 a day on food for a family of four. You got a problem with that? And, as I'm sure you've realized, housing now grabs much more than 1/3 of most folk's income. And the cost of living is much higher in some areas. And non-cash benefits (like Medicaid, food stamps) are not added to the equation (as a result the "near poor" - who are not eligible for federal and state subsidies - are often in even worse shape than the poorer families who who are eligible).

The bottom line is an unrealistically low poverty threshold. If used alone as a measure of poverty, it vastly underestimates the number of poor families in the U.S. That's why many programs (like Medicaid, food stamps) allow an income 2-3 times the federal poverty line to gain eligibility. (The current debate over children's supplemental health insurance has to do with how much income a family must have to be eligible. Some states want 3-4 times the poverty line, but the president nixed that as too much income to qualify and a step to socialized medicine).

So, when you hear the about the numbers of kids in poverty ask yourself: how is "poverty" being defined and how many more kids and families could be considered poor if the criteria for poverty were changed (for example, if your personal poverty line were used)?

So much for Poverty 101. In the next post, I'd like to talk about why poor families are poor, why poverty has such a negative effect on some kids but not on others, and perhaps what we might try to do about it.

In the meantime, I'd be interested in your thoughts:

• What is your definition of family poverty and by what income threshold would you consider your own family "poor"?
  
• Whose fault is it - society's or the individual's - that the poor are poor in this rich nation, so full of opportunity?
  
• Why do some poor families and children do well, while others fall down the well?
  
• What do we as a society owe (if anything) to our poorest citizens - the children?

译文: 阻碍儿童健康成长的最大屏障

 

一份令人咋舌的调查：你认为公共卫生是影响美国儿童健康成长的最大威胁吗?

提示:

l         大约有1300万~4000万的美国儿童处在这种威胁之下(依据你如果定义威胁).

l         年纪越小越容易受到这种威胁的影响(三岁以下的儿童和15-17岁的青少年分别有43%和35%受其影响).

l         少数族裔的儿童更易受其伤害(包括35%的黑人儿童,29%的印地安人儿童,28%拉丁美洲儿童,11%的亚裔儿童和10%的白人儿童).

l         因为美国的大多数儿童都是白种人,所以相比其他种族的儿童，白人儿童更容易受到这种威胁影响.

* * * *

这个问题的症结就是贫穷.

有一点可以确定，穷人的孩子免疫力更低，他们无法抵挡任何一种不良的公共卫生，任何一种我们所知的生产后遗症。事实上，他们正面临着“双重威胁“：

1.        他们的健康成长更容易受到威胁。他们受到多方面的侵害:营养不良，教学条件不足，兄弟姊妹过多，缺乏卫生医疗保健设施，家庭状况复杂，遭受邻居或家庭暴力、虐待、歧视，缺乏儿童保育，铅中毒等）。

2.        对于这种威胁的侵害，相对于生活条件较好的富人儿童，他们所受侵害时间更长，情况更严重。

* * * *

我一生都在一所失去医院任职，在那里，我亲眼目睹了贫困对穷人孩子及其家庭毁灭性的影响。但我必须声明，我并非一个受虐者也非一个圣人。每当我看到那些孩子和他们的家人克服困难，摆脱困境，全心全意地创造美好的生活时，我都备受鼓舞。我也经常问自己：如果我也生活在贫困的家庭，我能像他们那么勇敢，睿智，平静的接受挑战吗？

虽然对他们有如此的评价，但是我并不想美化贫穷家庭的生活。贫穷无非在两方面威胁了孩子们的健康成长。一方面，它破坏了一切孩子有利孩子健康成长的因素；另一方面，它潜移默化地扼杀了孩子的发展潜力，影响其取得学术成果，完成卓越的作品，赢得良好的社会关系网，拥有健康的身体，享受幸福生活。

我深入解了贫困以及其对整个社会的渗透作用后，却遗憾的发现，援助贫困家庭的方案远远未被选入政府政策。这就是我希望你们能点击我博客，阅读我的文章的原因，我希望你们能了解贫困儿童及他们家庭的情况。我觉得，这同时也是要尽快解决贫困问题的重要原因。

* * * *

我们先从一个简单的问题开始：是什么导致一个家庭走向“贫困”？

尽管贫穷纯粹是个人问题，但我希望你们给自己家庭下个贫穷的定义。设想你是一个四口之家，你们夫妇2个，还有两个孩子。最低收入是多少，才让你觉得并非处在贫穷状态？我承认，这确是太武断了（这完全取决于你如何定义贫穷）。但是，没关系，尽管以你得个人情况而定。对于一个四口之家，贫穷最低底线到底是多少呢？

* * * *

美国政府对这一底线做出了解释：根据联邦政府公布数据，一个四口之家的贫穷线是20640美元。

惊讶吗？我猜你个人的贫穷线应该远高于20000美元吧（而且大多数是这个数据的2~4倍）。这个数据看似那么脆弱无力。那它是从何而来的呢？

“贫穷线”是 60年代联邦政府鼓吹“反贫困之战”提出的（毕竟，如果无法确定敌人的身份，又怎么能发动战争呢？）。于是，他们试图设定一个收入决定阔值，生活在这个阔值之下的家庭“收入低，经济能力不足，无法承担维持基本生活的必需品。”这样做很合理。

因此，他们演算得出：一个家庭有1/3的收入用于食物，1/3用于供房，还有1/3用于其它物质支出。他们再估算出，一个家庭为维持健康而花费在食品上的最低金额（这就是所谓的“节约食物计划”）。最后，将最低金额乘以三。这样就可以迅速得出“贫困线”。

根据计算，可以得出，2007年一个四口之家每天花费在食物上的金额是15美元。难道你不会对以上的“贫困线”提出质疑吗？我敢肯定，你已经意识到了，普通人家花费在供房上的金额已经远超过了收入的1/3。在某些地方，供房花费甚至更高。另外，一些非现金福利（比如公共医疗补助和发给失业者或贫民的粮票）也不公平：那些处于“贫穷线”边缘的人，就无法得到联邦政府和州政府的补贴，导致他们比那些能够得到救济的真正“贫困者”更加贫困。

这个贫困的最低底线，也是不切实际的。如果单独以这个数据作为判定贫穷的标准，就大大减少了美国贫困家庭的数量。因此，许多政策（如公共医疗补助制度和发给失业者或贫民的粮票等）都支持给那些临近“贫困线”的家庭给与救济，他们的收入可能是联邦政府公布“贫困线”的2-3倍。现在引起争议的是，家庭的收入是多少，才能享受补充儿童健康保险？有些州提出，享受此保险的家庭收入应是贫困线的3-4倍，但是政府并不接受如此高的标准，他们为公费医疗制度设置了门槛。

因此，当你得知处于贫穷状态的儿童数量时，请问问你自己：你是如何定义“贫困”？当贫困标准改变时，又会有多少新增儿童和家庭被定义为“贫穷”？比如，如果你已习惯自己设定的贫穷线，标准改变了你又会怎样？

好了，关于贫困就说这些吧。接下来，我将谈谈为什么我家是贫穷的，为什么贫穷会对某些儿童但不会对所有儿童产生负面影响,或许我们还可以谈谈该如何应对贫穷。

同时，我也很想知道你的看法：

l         你是如何定义贫穷的？对于你自己的家庭，多少收入才是“贫穷线”？

l         在富裕的国家里，为什么有如此多的穷人，这到底是谁的责任？是社会？还是个人？

l         为什么有些穷人因为贫困而坚强，而有些却因为贫困而堕落呢？

l         作为一个社会成员，我们亏欠贫民什么？特别是那些贫民的孩子？