Pediatrician struggles to help patients through Philly's 'terrible lottery of birth'
Every day in our clinic at St. Christopher's Hospital for Children in North Philadelphia, I see upwards of 25 children, ranging from newborns to teens.
I spend as much time as I can talking with parents about their infants' feeding patterns, their toddlers' development and their adolescents' maturing bodies.
I try to provide helpful advice, appropriate medical care and positive assurances. But as I listen to the questions and concerns of the families I care for, I know that whatever we do, it may not be enough to get many of them past the extraordinary hurdles they face.
Several major reports have proven with reams of data that health and even life span are too often determined in this country by where a child is born. Even at a time when many Americans enjoy greater prosperity, many of my patients continue to bring these terrible statistics to life. Just two recent examples:
A little boy has been hospitalized three times in as many years for severe asthma, and nearly needed to have a breathing tube thrust down his trachea to save his life during his most recent crisis. His mother gives him his daily medications right on time, and administers her toddler's rescue inhaler exactly as she should. What she can't do, however, is afford the professional cleaning and maintenance needed to make the old row house she inherited from her grandmother safe for her son. Like so many of my patients' homes, hers is plagued by mold that escapes her best cleaning efforts. On top of the mold, there are the cockroaches. Even if you don't see roaches, their saliva and feces get kicked up into the air and are a potent asthma trigger for children like her son.
A 14-year-old girl came in late last year for a routine physical exam that, in a more affluent community, wouldn't have been at all routine. Like her mom, this girl has struggled for years with obesity. At each office visit, I've encouraged mom to help her daughter eat more fruits and vegetables and go outside to play. Common-sense health advice perhaps, but less than relevant to a mom who lives in a neighborhood where fresh food isn't sold, and where playing outside isn't safe. Now her daughter has Type 2 diabetes, a disease once thought to only afflict adults, but which is reaching epidemic rates among overweight teens in North Philadelphia.
Overall, things are looking up for American children. Poverty rates have dropped a bit, and obesity rates, though still high, have leveled off. Teen pregnancy rates have dropped to a historic low.
But in Philadelphia, the most impoverished large American city, the picture is different.
The City of Philadelphia's annual Community Health assessment was released last year and graphically reveals that it's zip code, not genetic code, that plays the greater role in determining health.
Look at the online map, and you see that the areas surrounding St. Christopher's Hospital are vivid red, the color chosen for highest rates of poor health, like an inferno blazing out of control. This area of 240,000 residents is the epicenter of late or no prenatal care, lowbreastfeeding initiation rates, and babies dying before they reach their first birthday. The teen birth rate is more thantriple the national average at nearly 79 per thousand births. Not surprisingly, almost 80 percent of households here are headed by single parents, one of the highest rates in the nation.
Children here are more likely to suffer accidental injuries, and that contributes to a high child mortality rate. But even surviving childhood is no guarantee of enjoying a normal lifespan, because so many adult diseases, from diabetes to cancer to mental health conditionshave their roots in the poverty, stress and other adverse experiences of childhood here.
In October, Public Citizens for Children and Youth issued "Left Out: The Status of Children in Philadelphia," comparing wellness measures from 2008 to 2014, the most recent statistics available. In economic well-being, health and education, almost all indicators worsened for Philadelphia's children. Citywide childhood poverty went up from 32 to 37 percent during this period. But in the red zone of North Philadelphia, poverty was twice as high.
"Philadelphia is on the rebound, so it is hard to believe that more children are growing up in poor families today than during the depths of the last recession," observed Mitchell Little, who leads the mayor's Office of Community Empowerment and Opportunity.
"We need to take decisive action now so that children, no matter what their race, ethnicity or zip code, have the resources they need to do well in school and in life."
But for me, there's no more clear — and outrageous — evidence of the crisis than the report from Virginia Commonwealth University last year that evaluated 21 cities and compared life expectancies by zip code. In Chicago, there's a 16-year difference in life expectancy between the richest and poorest zip codes. In Detroit, the widest disparity is 13 years; in New York, it's 9.
In Philadelphia, it's 20 years, the highest of all cities evaluated. A child born in the Swampoodle community near our hospital now faces an average life expectancy of 68 years -- but one born a cab ride away near Society Hill can expect to live 88 years on average.
As we care for children facing this terrible lottery of birth, we must, as families, neighbors, advocates, universities and corporations, find the will, the drive, the innovation, to close this intolerable, unjustifiable gap. We must be able to look into the eyes of a child bornin North Philadelphia and declare our belief that all children, in all zip codes, are created equal. The cost is too high to ignore.
Daniel R. Taylor, D.O., is an associate professor at Drexel University College of Medicine and director of community pediatrics and child advocacy at St. Christopher's Hospital for Children.