Case Anne, Paxson Christina
Princeton University, Research Program in Development Studies, USA.
Future Child. 2006 Fall;16(2):151-73. doi: 10.1353/foc.2006.0014.
Children from low-income families are more likely than other children to have serious health problems. And, as Anne Case and Christina Paxson show, childhood health problems can prevent poor children from achieving economic success as adults. Income-related disparities in childhood health are evident at birth or even before, and the disparities grow more pronounced as children grow older. Not only do poor children have more severe health problems than wealthier children, but they fare less well than wealthier children who have the same problems. They also receive less and lower-quality medical care for their problems. And poor families may be less well equipped to manage their children's health problems, which could worsen their effects. The available U.S. data sets do not allow researchers to track individuals' health and economic well-being from birth into adulthood, but three British data sets are producing growing evidence that health in childhood is a determinant of educational attainment, which in turn affects adults' employment opportunities and wages. Children in poor health are also more likely to have poor health as adults, and their health as adults adversely affects their economic status. Case and Paxson note that eliminating income-related disparities in health problems in childhood would do little to reduce earnings disparities between richer and poorer adults. However, they emphasize that, for children in poor health, improvement in physical condition in childhood would lead to substantial improvement in economic circumstances. The authors cite several areas, including expanded prenatal care, maternal smoking cessation programs, and nutrition programs, as deserving particular attention. They contend that increased access to health care is not sufficient to improve children's health. The next wave of policies should focus on improving the quality of health care and strengthening the ability of parents to manage their children's health problems.
低收入家庭的孩子比其他孩子更有可能出现严重的健康问题。而且，正如安妮·凯斯和克里斯蒂娜·帕克森所表明的，童年时期的健康问题会阻碍贫困儿童成年后取得经济上的成功。与收入相关的儿童健康差距在出生时甚至更早便已显现，并且随着孩子年龄的增长，这种差距会变得更加明显。贫困儿童不仅比富裕儿童有更严重的健康问题，而且在患有相同问题时，他们的情况比富裕儿童更糟。他们因健康问题获得的医疗护理也更少且质量更低。此外，贫困家庭可能在应对孩子的健康问题方面能力更弱，这可能会使问题的影响恶化。美国现有的数据集不允许研究人员追踪个体从出生到成年的健康和经济状况，但英国的三个数据集正产生越来越多的证据表明，童年时期的健康状况是教育成就的一个决定因素，而教育成就反过来又会影响成年人的就业机会和工资。健康状况不佳的儿童成年后也更有可能健康状况不佳，而他们成年后的健康状况会对其经济状况产生不利影响。凯斯和帕克森指出，消除童年时期与收入相关的健康问题差距对减少富裕和贫困成年人之间的收入差距作用不大。然而，他们强调，对于健康状况不佳的儿童来说，童年时期身体状况的改善将导致经济状况的大幅改善。作者列举了几个值得特别关注的领域，包括扩大产前护理、孕妇戒烟项目和营养项目。他们认为，增加获得医疗保健的机会不足以改善儿童的健康。下一波政策应侧重于提高医疗保健质量，并增强父母应对孩子健康问题的能力。
