Ag and Rural Caucus Call To Meeting, September 2022
Astrid Newell, Thriving Children and Youth Thursday 1830 September 15, 2022
Thriving Children and Youth
Department of Health
Child Trends and the New York Times reported Monday that child poverty has decreased 59 percent from 1993 to 2019. “This is an astounding decline in child poverty. Its magnitude is unequaled in the history of poverty measurement.”
The dial can move. Policy can make a difference. The refundable earned income tax credit is major. Republicans, on the other hand, say it is the work requirement for cash relief: “The system sent a message: You can’t live on welfare any more.”
Either way: “A childhood free of poverty predicts better adult outcomes in just about every area you can imagine, including education, earnings and health.”
Less happy is Melissa Santos report this morning in Axios: “Washington children were diagnosed with anxiety or depression at a higher rate than the national average at the onset of the pandemic, per a recent report by the Annie E. Casey Foundation.”
Join Astrid Thursday evening for an upbeat conversation on public health and Thriving Children.
13 September 2022
Determinism, Causation and Probability
Social determination of health is descriptive. Poor people suffer more disease, receive inferior treatment, and die younger. Carla Prock, Benton-Franklin Health District, in 2017 advised us for good health: “Don’t be poor. If you can, stop. If you can’t, try not to be poor for too long.”
There is such a strong correlation of adverse social conditions and poor health that it is fair to call socio-economy “determinant” of health and live chances, and begin to unpack the causalities, weighing the different contributors.
Social justice demands that we take seriously social determinants of health. ACES is a little different. Adverse Childhood Experiences can translate the everyday stressors of growing up in tough conditions into adult mental, physical and social dysfunctions but there are other pathways. The seminal study on ACES was 17,000 clients of Kaiser-Permanente, a decidedly middle-class group.
The listing of stressors counted into an ACES score are not exclusively those afflicting marginal communities. The index stressors are independent of economic standing. “Good” homes can induce chronic stress with negative outcomes, the same as homes dealing with acute economic and social stress.
Recognizing that ACES analysis works also for mainstream families broadens its policy ambition. ACES becomes not special pleading for helping “undeserving” families on the margins of society and the economy. It becomes a commitment to improve the health of all of us. It defuses victimization by throwing a random element into who may be affected.
Determinism and causality are tough words, even fighting words. Probability helps us leaven their binary choices. Socio-economic factors have a high probability of inducing morbidity and mortality. Adverse childhood experiences increase the probability of poor adult outcomes. Not every child subjected to sustained, acute stress ends up cutting their education short, spending time in prison, and unable to hold a job. And poor families can also be strong families. That’s where probability comes in. It is just that the probability that poverty induces stress tipping over into adverse childhood experience is unacceptably high.
8 September 2022
Carla Prock’s presentation. See p. 25 for a mapping of ACES for Washington; p. 23 for social determinants of health.
American Academy of Pediatrics. Adverse Childhood Experiences and the Lifelong Consequences of Trauma
The Deserving Poor
“Why, I support helping out the less fortunate, at least those who work for a living, those who deserve our help.” How often have you heard these words while doorbelling a pleasant older voter?
Language matters and this language conveys a social philosophy. It is the dominant social philosophy of this country that builds on the myth that America assures equal opportunity for everyone. If you have had this equal opportunity and you fail to succeed, this is your personal shortcoming. And failures seem to be predictable. Skin color, language accent, sexual orientation, low educational achievement, gender and marital status seem to correlate nicely with low probability of living the American dream.
What if our life chances are not merely individual choices from a Happy Choices smorgåsbord? What if how we get on in this life is constrained by structures of race and class? Or, conditioned by random events like losing a friend to a school shooting? What if our life trajectories are bent downward by bad things happening to us? Do we give up our “deserving” label? And if we happen to a be winner at the lottery of life, do we build a healthy and prosperous community by making sure the undeserving remain on the margins?
Our program this month is about investing in our youngest and most vulnerable citizens. Astrid Newell heads up the Thriving Children and Youth Section in the Department of Health.
Astrid spoke to us some years ago (2016?) when we met in person in Ferndale on the sidelines of a noisy state committee meeting. She spoke to us then about Adverse Childhood Experiences Syndrome (ACES) and how childhood stress factors account for success in education and adulthood.
I have asked Astrid to return to our Ag and Rural forum. A basic ARC commitment is investment in rural human resources. I had expected that wider familiarity with ACES would push more resources to intervene with children at risk as well as to alleviate those risks at the source. I have been disappointed that ACES does not seem to have changed our broader understanding of how society works. Astrid, in the front lines of addressing childhood health and investing in our future, can better help us evaluate our progress.
3 September 2022
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