Child poverty in America

How can the United States-still the richest nation on earth-tolerate one of the highest child poverty rates in the industrialized world? This is not inevitability but failure: we have the wealth to end it, yet lack the will. The same is true of widening inequality since the 1980s-it is a political choice, not an economic inevitability.

Child poverty is not a natural phenomenon, like an earthquake or a hurricane. It is a social condition for which we are collectively responsible, brought into existence and maintained for decades due to the economic policies we have pursued and supported. "That our society tolerates this violent indifference to the life experience of millions of impoverished children remains a profound failure and abdication of our most fundamental responsibility to future generations. It does not have to be this way," Academic Pediatrics, the journal of the American Pediatric Association, notes.

Startling statistics

Eleven million children, out of the 74 million children residing in the United States, live in poverty. One in six children under the age of five (which is to say, three million children) are poor – that is the highest rate of any age group. In short, children constitute the poorest age group in the United States. The Children's Defense Fund has shown that the burden of poverty falls disproportionately on children of color, as well as those under five years of age, those belonging to single mothers, and those living in the South, which is home to roughly 47 percent of the children in this country who live beneath the poverty threshold.

In 2023, Black, Hispanic, and American Indian and Alaska Native children were about three times as likely as white children to fall below the poverty line. Child poverty fell to a record low of 5.2 percent in 2021 – an achievement which was largely attributable to the expanded Child Tax Credit (CTC), which lifted over 700,000 Black children and 1.2 million Hispanic children out of poverty. However, lawmakers opted not to extend the expansion of the CTC, and essentially all the gains in poverty reduction vanished the following year, pushing millions of Americans into poverty in 2022. Since 2021, the child poverty rate has more than doubled, standing at 13.4 percent in 2024.

The impact of economic policy

As the Economic Policy Institute (EPI) pointedly notes: "The results of the policy response to the pandemic proved that we purposely choose to tolerate a disproportionately high level of poverty for children of color in the United States." Children are especially susceptible to the deleterious consequences of poverty – in terms of health, mental and physical development, and education – with ramifications that can easily extend into adulthood.

Moreover, children living in impoverished neighborhoods are faced with significant challenges, regardless of their family's income; this includes schools that are insufficiently funded and inadequate access to healthcare. The fact is that child poverty and life in disadvantaged neighborhoods present an obstacle to medical care, which can carry "these health harms into adulthood and across generations."

The health implications for poor children

Child poverty means lower health outcomes for children – it means greater illness, chronic disease, sickness, and mortality. Reducing child poverty means having healthier children in America, and a sound healthcare policy can, in turn, help to reduce child poverty. To see that requires acknowledging "the role of the US health care system in fostering economic hardship in the first place."

To begin with, health care policy can address child poverty by lowering the likelihood that medical bills will deplete a family's financial resources. Unexpected medical bills remain the number one cause of bankruptcy among American families.

Moreover, if we want a healthcare system that reduces child poverty, we need to remove the perverse financial incentives that remain characteristic of a healthcare system that Drs. Joshua M. Sharfstein and Rachel L.J. Thornton observe: