STRENGTH IN DIVERSITY – Young Children and Colorado’s Future: Demographics, Equity, and Family Support Charles Bruner BUILD Ini1a1ve and Child and Family Policy Center September 15, 2014
The Opportunity A mother brings her six month-old in for a check-up and it’s clear that the mom is stressed, uncomfortable and feeling out- of-place, and not picking up on the child’s cues for a:en;on. While there isn’t a medical condi;on that requires a:en;on today, the prac;;oner fears that in two years there will be significant indicators of developmental delay and likely social and emo;onal problems. The primary health prac;;oner does not want to wait two years to take ac;on and the mom seems recep;ve to receiving help. At the same ;me, what can the child health prac;;oner do to respond to what are clearly more than and different from medical needs?
Health and Health Equity Defined Child health is a state of physical, mental, intellectual, social and emo4onal well-being and not merely the absence of disease or infirmity. Healthy children live in families, environments, and communi4es that provide them with the opportunity to reach their fullest developmental poten4al. – World Health Organiza4on Health equity is achieving the highest level of health for all people. Health equity entails focused societal efforts to address avoidable inequali4es by equalizing the condi4ons for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injus4ces. – Healthy People 2020
THE IMPERATIVE: Equity in Diversity Of all the forms of inequality, injus4ce in health care is the most shocking and inhumane. -- Mar4n Luther King We cannot allow a child’s zip code or color of skin determine the child’s health. -- Maxine Hayes
What We Know and Can Do About Health Equity & Young Children Colorado’s youngest are its most diverse and 1. most in need The first years are the most cri7cal to equitable 2. growth (but where we invest the least) Inequi7es currently exist but are preventable 3. Family strengthening is key 4. Community building is also key 5. We know enough to act 6.
1a. Colorado’s Youngest Are Its Most Diverse COLORADO Racial/Ethnic Informa6on By Age United States: Percent of Popula4on Combined Non-white and Hispanic 0 to 5 years: 49.0%; 6 to 17years: 45.2%; 18 to 64 years: 35.7%; 65 + years: 20% Source: United States Census, 2012 American Community Survey
1b. Colorado’s Youngest Are Its Most in Need COLORADO Poverty/Income Level by Age Group United States: Percentage of Popula5on Below Poverty, By Age: 0-5 years: 24.8%; 6-17 years: 20.0%; 18-64 years: 14.2%; 65 + years: 9.0% Source: United States Census, 2012 American Community Survey
1c. Colorado’s Most Diverse Youngest Are Its Most in Need Poverty/Income Level by Race/Ethnicity: 0-5 Year Olds Source: United States Census Bureau, 2009-2011 Public Use Microdata Sample
2a. Science Shows the First Years of Life Most Critical Protec've Factors (Strengthening Families) • Adverse Childhood Experiences (CDC) • Resiliency (AAP) • Epigene'cs (Gene'cs) • Neurobiology (Brain Research) • Toxic Stress (Center on the Developing Child) • Social Determinants of Health • (World Health Organiza'on) Harry T. Chugani, MD, PET Center Director, Chief of Pediatric Neurology and Developmental Pediatrics, Children’s Hospital of Michigan
2b. AND Science Spells Out the Solution • P rotec&ve Factors (Strengthening Families) • A dverse Childhood Experiences (CDC) • R esiliency (AAP) • E pigene&cs (Gene&cs) • N eurobiology (Brain Research) • T oxic Stress (Center on the Developing Child) • S ocial Determinants of Health (World Health Organiza&on)
2c. Protective Factors and Social Determinants Points to Same Set of Needs The Social Gradient . Life expectancy is shorter and most diseases are more common further down the social ladder. [ Concrete services and supports in 5mes of need ] Early Life . A good start in life means suppor;ng mothers and young children; the health impact of early development and educa;on lasts a life;me. [ Knowledge of healthy child development ] Stress . Stressful circumstances, making people feel worried, anxious and unable to cope, are damaging to health. [ Resiliency ] Social Exclusion . By causing hardship and resentment, poverty, social exclusion and discrimina;on cost lives. [ Posi5ve and suppor5ve ac5vi5es with children ] Social Support . Friendship, good social rela;ons and strong suppor;ve networks improve health at home, at work and in the community. [ Social 5es ]
2d. … But Where We Invest the Least Per Child Expenditure by Age Group as % Per Child (6-18) US CO Expenditure Per child (0-2) Exp as % Per 7% 5% Child (6-18) Per Child (3-5) Exp as % Per 25% 13% Child (6-18) Per Child (0-5) Exp as % Per 16% 9% Child (6-18) BUILD Initiative. Early Learning Left Out (2013).
3a. Child Health and Well-Being is in Jeopardy For the first *me in our country’s history, America’s children overall face the prospect of growing up less healthy, living less long lives, and being less equipped to compete and lead in a world economy – unless we address issues of inequity in health, educa*on, and social opportunity (through a family strengthening lens).
3b. This Means Family Strengthening For a Large Proportion of Children
3c.To Address a Range of Health, Social, and Educational Disparities… The Fi'y State Chart Book provides detailed informa0on on the indicators listed: Racial and Ethnic Popula0on of Children in the United States Young Child Poverty Levels by Race and Ethnicity Maternal Educa0on ABainment for Women with Children 0-5 Low Birthweight by Race and Ethnicity Infant Mortality by Race and Ethnicity Late or No Prenatal Care by Race and Ethnicity Health Insurance by Race and Ethnicity Access to Medical Home by Race and Ethnicity Immuniza0on Rates for Children 19-35 Months Percent of Children Having Well-Child Visits 10. Children 10 Months to 5 Years Screened for Developmental, 11. Behavioral and Social Delays Percent in Part C by Race and Ethnicity 12. Foster Care 0-5 by Race and Ethnicity 13. Children Under 6 Years Exposed to Risk Factors 14. Mothers’ Mental Health by Race and Ethnicity 15. Neighborhood Safety by Age and Race and Ethnicity 16. NAEP 4th Grade Reading Proficiency Scores 17. Race for Results composite indicator for children 18.
3d. Inequities are Reflected in Family Demographics Colorado Data: Family Demographics 25-34 year-olds with Associates Children in Child Degree or Single Parent Teen Birth Rate Race/Ethnicity Poverty1 Higher2 Families3 (per 1,000)4 31% 16% 32.5% 55 Hispanic 10% 51% 20.7% 18 White, non-Hispanic 41% 32% 51.4% 36 Black, non-Hispanic * = esSmates based on sample sizes too small to meet standards for reliability or precision S = esSmates suppressed when the confidence interval around the percentage is greater than or equal to 10% points 1. hZp://www.childrensdefense.org/child-research-data-publicaSons/state-of-americas-children/ hZp://dashboard.ed.gov/statecomparison.aspx?i=o&id=0&wt=40 2.
3e. … and in Family Concerns and Stressors Colorado Data: Family Concerns and Stressors Fair/Poor Parents are Live in an Maternal Usually or Unsuppor5ve Mental Always Stressed Race/Ethnicity Neighborhood Health about Paren5ng 28% 7%* 17% Hispanic 13% 3% 7% White, non-Hispanic 33%* 19%* 13%* Black, non-Hispanic * = es5mates based on sample sizes too small to meet standards for reliability or precision hOp://www.childhealthdata.org/browse/survey
3f… Resulting in Disparities in Child Outcomes Colorado Data: Child Outcomes Percent Proficient or above on 4th Concerns About Grade Reading Child’s Low – NAEP Race/Ethnicity Development1 Birthweight2 Assessment3 46% 9% 23% Hispanic 36% 8% 52% White, non- Hispanic 43%* 14% 19% Black, non- Hispanic *= esTmates based on sample sizes too small to meet standards for reliability or precision 1 hWp://www.childhealthdata.org/browse/survey 2 hWp://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf 3 hWp://nces.ed.gov/naTonsreportcard/naepdata/report.aspx
3g. …Which Involve BOTH Race/ Ethnicity & Socio-Economic Status Colorado NAEP 4th Grade Reading Composite Scores ALL Children 227 White Children 237 Not FRM Children 239 Hispanic Children 210 FRM Children 210 Black Children 203 FRM Not FRM White Children 223 242 Hispanic Children 205 228 Black Children 97 n.a. Note: AKendance Works indicates that a 12 point difference is equivalent to more than one grade level. The White/Hispanic/FRM/NotFRM shows differences for FRM/NotFRM of about 20 points within groups and the difference by White/Hispanic about 16 points within groups. This is to aKribute causality but suggest race/income are intertwined.
3h. Colorado is Not Alone Among States: But Colorado Has Work to Do ‘Race for Results’ Composite Scores Race forResults/Kids Count Colorado and U.S. Rankings Overall Kids Count 22nd White RaceforResults 8th Hispanic RaceforResults 27th AA RaceforResults 19th Hispanic/White Gap 41st AA/White Gap 35th
4a. Affecting the Health Trajectory Starts in the Earliest Years Source: BUILD Ini0a0ve and the Child and Family Policy Center (February 2013)
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