Social Issues Affecting America's Children - Children's Health

Health Insurance

While medical science has made great advancements in health care in recent years, the cost of treatment and the price of health insurance escalated. "The cost of family health insurance is rapidly approaching the gross earnings of a full-time minimum wage worker," said Drew Altman, President and CEO of the Kaiser Family Foundation at the September 2004 release of the organization's Annual Employer Health Benefits Survey. "If these trends continue, workers and employers will find it increasingly difficult to pay for family health coverage and every year the share of Americans who have employer-sponsored health coverage will fall."

Children with health insurance could receive preventive health care, treatment for recurring illnesses such as ear infections and asthma, and treatment when they were sick. The social and economic changes that affected children during the last decades of the twentieth century made access to health care even more essential. Changes in family composition and economic conditions put many children in situations that often required health services—hunger, poor housing conditions, violence, and neglect. Children living with two married parents were more likely to have health insurance (91.3%) compared to children living with their mother only (85.8%) or father only (82.2%), Census data revealed. Only 59.3% of children living with neither parent had health insurance. (See Table 4.1.)

From 1987 to 1996 the number of American children without health insurance climbed from 8.2 million to 10.6 million, the highest levels ever recorded by the U.S. Census Bureau. That trend began to reverse in 1999, when the number of uninsured children dropped to 9.1 million. By 2000 8.5 million children were uninsured and that number remained the same through 2002. While 11.6% of all children were without health insurance in 2002, 20.1% of children in poverty had no insurance. A much higher proportion of Hispanic children (22.7%) lacked insurance than children of other racial or ethnic groups. (See Figure 4.4.)

CHILDREN IN LOW-INCOME WORKING FAMILIES. Census Bureau records revealed that, of children with insurance, nearly one in four was covered by Medicaid. Most uninsured children came from low-income working families that were not eligible for public assistance because the family earned too much to qualify for Medicaid. In most cases the parents worked for small companies that did not offer health insurance. When these companies

FIGURE 4.2

FIGURE 4.3

did offer insurance plans, the cost to employees was often too much for low-income workers. According to the National Academy of Sciences and its Institute of Medicine, even with insurance, low-income families had a number of additional barriers to overcome, such as difficulty in scheduling appointments, cultural differences with medical providers, or a lack of services easily accessible from where they lived.

TABLE 4.1

STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP). In an effort to improve access to health-care coverage for uninsured children from low-income families who were ineligible for Medicaid, Congress initiated the State Children's Health Insurance Program (SCHIP) as part of the Balanced Budget Act of 1997 (PL 105–33). Each state developed its own eligibility rules for federally assisted insurance programs designed to support working

families and low-income families alike by providing health insurance to their children. By 2004 in most states, uninsured children eighteen years old and younger whose families earned up to $34,100 a year (for a family of four) were eligible. The programs covered doctor visits, prescription medicines, hospitalizations, and much more. Most states also covered the cost of dental care, eye care, and medical equipment. To encourage parents of uninsured children to enroll in the state programs, the U.S. Department of Health and Human Services (HHS) began a national campaign to link families with the free or low-cost programs. Diverse business and organizational partners were enlisted to support a promotional effort called Insure Kids Now!

Overweight and Inactive Children

In 2002 a report issued by the office of the U.S. Surgeon General noted a number of risk factors for over-weight children. These included high cholesterol and high blood pressure, both of which were linked to heart disease; type 2 diabetes; and poor self-esteem and depression. In addition, statistics showed that overweight children would almost inevitably carry that weight into adulthood. The Centers for Disease Control and Prevention (CDC) reported in 2003 that approximately 15% of all U.S. children and adolescents were overweight in 1999–2000. This was roughly triple the level of those overweight among children and adolescents in the late 1970s.

Sandy Proctor, coordinator of the Kansas State University Expanded Food and Nutrition Education Program, cited a variety of causes for the increase in overweight children, including reduced physical activity and poor eating habits. She noted that fewer children walked to school while television, video games, and computers offered popular but sedentary after-school entertainment. Children often had less freedom to play outside without supervision due to parents' fears of child abduction. Compounding these issues were funding constraints that forced many schools to reduce or eliminate physical education programs.

ROLE OF SCHOOLS IN CHILDREN'S WEIGHT PROBLEMS. Changes in eating habits also contributed to weight gains. Many working parents and busy families abandoned home-cooked family meals and relied more on prepared and fast foods, which typically had high fat and salt content. Food choices available in schools followed the taste patterns of students. In an October 2003 article for Education Week on the Web, Darcia Harris Bowman reported the lucrative practice of school districts signing exclusive vending contracts with soft drink companies. Such contracts generated an estimated $54 million annually for Texas public schools, according to one survey. Subsequently, Texas became one of the first states to limit children's access to "foods of minimum nutritional value" in elementary and middle schools.

In its Youth Risk Behavior Surveillance—United States, 2003 the Centers for Disease Control and Prevention (CDC) found that 15% of all high school students were at risk of becoming overweight in 2003, while another 14% were actually overweight. Nearly twice as many male students as female students were in the overweight

FIGURE 4.4

category. More than one-third of African-American female students and two-fifths of Hispanic male students were at risk or actually overweight, while white, non-His-panic female students had the lowest proportion of being at risk or overweight. (See Table 4.2.)

According to the same 2003 report, less than one-third of high school students participated in daily physical education at school. (See Table 4.3.) By comparison, 38% of all high school students watched three or more hours of television per school day. The number of African-American students watching three or more hours of television was more than double that of white students. (See Table 4.4.)

UNHEALTHY ATTITUDES TOWARD WEIGHT AMONG FEMALE STUDENTS. In a paradoxical turn, as overweight rates for Americans climbed, many "waiflike," extremely thin women were featured in television, video, and fashion media aimed at youth. In their quest for acceptance and popularity, many adolescent and teenage females measured themselves by pop culture icons and felt fat, even if they were of normal weight for their height and build. The 2003 CDC report revealed that 36.1% of female high school students described themselves as over-weight, and 59.3% of female students reported that they were trying to lose weight. By contrast, 23.5% of male students saw themselves as overweight and 29.6% were trying to slim down. (See Table 4.5.)

Female teens were also more likely than males to engage in unhealthy behaviors in an attempt to lose weight. Twice as many female as male students had gone without eating for twenty-four hours or more, the CDC report found. Use of diet pills, powders, or liquids, without the advice of a doctor, increased with age among female students. About 9% of ninth-grade females tried these weight loss or weight prevention products compared to about 13% of eleventh- and twelfth-grade females. Among female students at all grade levels, more than 8% reported vomiting or taking laxatives to lose weight or prevent weight gain. (See Table 4.6.) In some cases females developed distorted self-images that led to a serious eating disorder called anorexia nervosa, defined as a refusal to maintain a minimally normal body weight. The American Psychiatric Association estimated that from .5% to 1% of women between ages fifteen and thirty suffered from anorexia.