The pressing problem of child poverty and poor health
September 10, 2024—Throughout the fall, Harvard Chan faculty will share evidence-based recommendations on urgent public health issues facing the next U.S. administration. Rita Hamad, associate professor of social and behavioral sciences and director of the Social Policies for Health Equity Research (SPHERE) Center, offered her thoughts on how child poverty drives poor health, recent policies that have showed significant promise in alleviating the challenge, and opportunities to lift more children out of poverty.
Q: Why is child poverty such a pressing public health issue?
A: We have decades of research, both in public health and economics, that show how poverty is associated with poor health throughout children’s lives. The strength of the evidence is just overwhelming.
For example, pregnant women living in poverty have less access to health care, healthy food, and other key health influences. Research tells us that when their children are born, those kids end up less healthy.
After birth, kids who are living in poverty are more likely to endure less safe, less clean neighborhoods, and lack access to high quality health care and nutrition. These deficits make it harder to do well in school, to get good jobs, and on it goes. The hardships suffered by these children are due in part to the intergenerational transmission of poverty—and as a result the cycle is likely to continue for their own kids.
Q: What are the biggest challenges facing the next administration on child poverty?
A: The biggest problem is how disturbingly common child poverty is. One in eight U.S. children live in poverty, roughly 12% of all kids. The next administration will have to tackle that, because it’s a real outlier when compared to our peers, other high-income countries. These child poverty figures aren’t just a challenge for today, but they also create future challenges for society as a whole. Children growing up in poverty are less likely to participate in the workforce, more likely to need governmental assistance, more likely to be involved in the criminal justice system. So reducing child poverty is not only the fair thing to do to support these children, but also essential to having a well-educated and informed public to contribute to society.
Importantly, in 2021 the child poverty rate went down to 5%, the lowest ever, in large part due to pandemic-era safety net programs. But then these programs expired, and that rate more than doubled from 2021 to 2022. The silver lining is that we have tools at our disposal that can make a real difference on child poverty if we can muster the political will.
Q: What are your top policy recommendations to address child poverty?
A: One of the single best tools in our toolbox to fight child poverty is the Child Tax Credit (CTC). This tax credit has been around for more than twenty years as a benefit for primarily middle- and high-income families, but during the pandemic it was expanded significantly and offered benefits to poorer families, even those making zero income. That meant unemployed parents got benefits, and the benefit size was largest specifically for the lowest-income families. The CTC’s delivery mechanism also changed—rather than one lump sum disbursed after filing taxes, the IRS actually distributed the payments monthly to people who had recently filed taxes.
These were significant policy innovations, and they really worked! As I mentioned above, child poverty rates were nearly halved in 2021. Unfortunately, Congress only authorized short-term funding, and the expansion expired at the end of that year. When the benefits ended, we saw a reversal of the significant progress.
Another tool at our disposal is the Earned Income Tax Credit (EITC), which is the largest U.S. poverty alleviation program for families with kids. The EITC lifts millions of families out of poverty every year, but like the original CTC offers no benefit to people who have zero income. This means that families who are struggling the most and the children who are potentially most in need are left behind.
Beyond expanding these tax credits, we also should increase the minimum wage. America’s minimum wage is $7.25, and it has remained flat since 2009 despite increased costs of living and inflation. That means that some Americans are trying to get by and raise kids on $7.25 an hour, which comes out to about $15,000 a year. Try to imagine a household, particularly a single-parent household, raising children on that amount of money. It’s simply not feasible.
Finally, it’s important to acknowledge one fundamental challenge with our safety net system, which is that it consists of many different programs each with slightly different complex eligibility requirements and confusing applications. Asking families who are already struggling with poverty to navigate this fractured system is too much. Millions of families miss out on critical benefits—and their children remain in poverty—simply because they can’t figure out these complicated bureaucratic hurdles. The new administration needs to take on a major overhaul to simplify the system for these families.
Q: What’s the evidence supporting those recommendations?
A: In terms of the CTC, the first piece of evidence was the sharp drop in child poverty during the credit’s expansion. Given the extensive studies that show how exposure to poverty in childhood can drive long-term health problems and even hinder brain development, reducing poverty will improve health. For example, a study by my team found that the CTC expansion reduced anxiety and depression among low-income parents, which can create mental health benefits for children as well.
My team has also found evidence that the EITC is linked with positive health benefits, including in birth outcomes, child development, and closing racial health disparities. These are benefits that last across the lifespan and are well worth pursuing.
In terms of the minimum wage, health economist George Wehby and his team at the University of Iowa have compared states that have instituted a higher minimum wage to those that have stuck with the lower federal standard. Their studies and others have found that increasing the minimum wage is beneficial for children’s health.
My team has also shown how the most marginalized families—like those with the lowest incomes or non-English speakers—are the least likely to receive the poverty relief for which they are eligible. New policy approaches are needed to remedy this unfair and inefficient policy failure.
Q: What do you hope could be accomplished to address child poverty in the next four years?
A: In the middle of a global pandemic, we were able to pass legislation that significantly alleviated child poverty across our country. We did it then and we can do it again. If the next administration could get some of these policies passed, it would lead to drastic improvements in child poverty.
That would set up all children with the opportunity to live healthy lives and be productive members of society. Beyond that, supporting children who didn’t choose what households they’d be born into is the right thing morally. In four years, I’d love to say that our country has finally tackled child poverty in ways that other countries figured out decades ago.
