Alt-Health: The Faces We Are Shown

I remember a class discussion in fifth grade. The teacher at our suburban middle school was talking about “poor people” and the challenges they faced. A kid from an affluent family raised his hand and interrupted. “My dad says poor people have what they deserve. If they worked harder, they wouldn’t be poor.” Most of the other kids, myself included at the time, agreed.

Looking back, I am embarrassed. But we were only reciting the values we’d been taught, accepting them naively as truth. We didn’t know any better. I know better now.
There is a great divide between the lower and upper classes. It’s not just a matter of finances, but a matter of opportunity. The financial position of your family is going to determine, on a primary level, what you can and cannot do in life. This applies not only to education and job opportunities, but to physical and mental health. In the game of life, the socioeconomic class that you land in is a random crap shoot. Babies don’t get a choice. And sometimes, no matter how hard they work, they can’t get ahead.

Even before birth, poverty begins to take a toll. The Affordable Care Act has made prenatal services more accessible for those living at or below poverty level, but the effect has not yet been seen in the general population. For anyone old enough to read this article, those changes came too late.

Here are the statistical facts: Mothers who receive late, or no, prenatal care are more likely to have babies with health problems. These mothers are three times more likely to give birth to a low-weight baby, and their baby is five times more likely to die.

Low income pregnant women are the least likely to seek prenatal care. Many of them live in poor housing conditions and lack social support and transportation. They can be aware of the benefits of prenatal care, but an overwhelming number of barriers prevent them from getting it. And if a woman lives in an abusive or stressful situation, those conditions tend to increase with pregnancy. It’s a difficult time to bring substance and alcohol use, smoking or obesity under control. These habits contribute to complications for unborn children.

The often chaotic environment of home can cause problems in a newborn that will extend long past childhood. Chronic exposure to stress can release toxic chemicals that cause damage to the brain tissue — neurons begin to die off. The structure of the brain is slow to develop and I.Q. potential is lowered. If a child’s initial brain wiring is poorly done, it’s very difficult to come back and build a solid structure on that shaky foundation. Such children seldom get the special attention and care they need. As a result, they face a life full of challenges that they are ill equipped to handle.

Impoverished families are far more likely to live in substandard housing or in areas where lead pollution from industrial waste and highways is greatest. Lead exposure has devastating consequences. At high levels, it attacks the brain and central nervous system, causing coma or even death. Children who survive are usually left with brain damage and behavioral problems. Lower level of exposure can produce loss of cognition, dyslexia, and attention deficit disorder. In most cases, these effects are forever.

Today, more  than 16 million children in the United States – 22% of all children – live below the federal poverty level. The government establishes that level at $23,550 a year for a family of four, but the facts is that a family of four needs an income twice that in order to cover basic expenses. Using this standard, 45% of children live in low-income families. If you come from such a background, unless you are exceptional, or lucky, you will probably receive inadequate nutrition and have few resources for education and employment. The prevalence of serious mental illness is highest among those with the lowest family income level.

The link between income and longevity is a matter of record. The life expectancy of upper income men has increased by six years since the late 1970s. Men in the lower range have gained a mere 1.3 years.  People living in poverty are likelier to smoke. They have less access to good health care. They tend to weigh more. And their bodies suffer the debilitating effects of intense and more constant stress. Everywhere, and across history, the poor tend to live shorter lives than the rich, no matter which culture you examine.

To my fifth grade self, and others like me, a reminder: There are always reasons behind the faces we are shown. It’s easy to assume, but only those who live it know.

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