Children in the South face higher health risks
Regional disparities profoundly impact health of children, UF researchers say
Children living in the South are up to three times more likely to battle poor health and its consequences - including obesity, teen pregnancy and death - than those in all other regions of the United States, even if they receive the same medical care, a new University of Florida study reveals.
"Hurricane Katrina gave the world a glimpse of the disparities in the South," says Jeffrey Goldhagen, M.D., M.P.H., the study's lead author and an associate professor of community pediatrics at the UF College of Medicine - Jacksonville. "Our research documents just how profoundly these disparities impact the health of children in the region."
The study, published recently in the journal Pediatrics, is the first to statistically relate region of residence to measures of child health, Goldhagen says.
"In fact, we now believe that where a child lives may be one of the most powerful predictors of child health outcomes and disparities," he says.
The poor health outcomes researchers documented included low birthweight, teen pregnancy, death and other problems such as mental illness, asthma, obesity, tooth decay and school performance.
The eight-member research team set out to determine whether living in the South has a negative effect on children's health and whether a scientific approach could identify which states in the South have poorer health outcomes for children. UF researchers also sought to look at what is it about living in the South that results in poor health outcomes.
To find out, researchers computed a Child Health Index that ranked each state in the nation according to five routine indicators of physical health in children - percentage of low-birthweight infants, infant mortality rate, child death rate, teen death rate and teen birth rates. The scores revealed that eight of the 10 states with the poorest child health outcomes in the nation - that is, Mississippi, Louisiana, Arkansas, Tennessee, Alabama, Georgia, North Carolina and South Carolina - are in what the researchers defined as the Deep South. The remaining Deep South states, Kentucky and Florida, are in the lowest quarter.
Living in the Deep South proved to be the best predictor of poor child health outcomes, moreso than any other factor commonly used to describe health differences among groups of children, including poverty, parents' employment status or single-parent households.
"We weren't really surprised by the results because I think most people thought this might be the case," says co-author William Livingood, Ph.D., a UF associate professor of pediatrics and director of the Duval County Health Department's Institute for Health, Policy and Evaluation Research. "But we were able to apply epidemiological principles to assess, clarify and map the problem and then document this intuitive feeling by making it scientific and evidence-based - much like the first epidemiologists in London who recognized, mapped and then defined the cholera problem."
Researchers warn that the study evaluated children as a group, so the findings don't apply to any single child's risk. And overall, most American kids are quite healthy.
"Generally, children in the world's developed countries are healthy," says Goldhagen. "But children who live in some of the states in the Deep South are two to three times more likely to die or have other health problems as compared to children living in some states in other regions of the country."
The reasons for these risks are complex and are related to social, economic and other public policies in the South, he says. "These policies, which consign 50 percent of children to poverty, neglect quality early education, generate huge income disparities, result in homelessness and limit access to quality nutrition and critical health services, may differentiate children in the South from those in other regions," says Goldhagen.
"For the first time, disparities in race, gender, education, income and poverty are not the critical issues here," he adds. "In this study, region is the disparity issue, and previous studies have not taken us in that direction."
Other researchers say the findings are valuable and demand additional research.
"This paper presents important disturbing information, and adds unique information to our vast literature demonstrating shameful disparities in our children's health," says Michael Weitzman, M.D., chairman of pediatrics at New York University's School of Medicine. "Why there are disparities and what to do about them are our society's responsibility to our children."
The study raises vital questions about the link between public policies and children's heath, says Peter Gorski, M.D., M.P.H., a University of South Florida professor of public health, pediatrics and psychiatry, who hopes the team will next study regional differences among groups of individuals categorized by family income, education and other characteristics.
"We need new tools and hypothetical models to study the ecology of disease, and we need interdisciplinary professionals from medicine, public health, economics and the social sciences to collaborate," says Goldhagen. "This can't be shoved under the desk or put on hold because the maps show in color the disparities that children in the Deep South face every day."
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