Robert C. Bowman, M.D.
The loss of 1500 medical students admitted in 2004 compared to 1997 from parents made less than $40,000 should be a concern. The loss of 1500 middle income types in the same time period should also be a concern. They have been replaced by 3000 more top income matriculants. The progressive declines have not raised much attention so far. The reasons are complex. Rather than starting with higher education or science in math at high school, perhaps a much earlier approach might help
In past postings I have discussed various aspects of leveling the playing field with better distribution of education and child development to improve education and health outcomes and state budgets. Other considerations are a broader applicant panel for college or for professional school.
As medical educators we see the upper status students. As a family physician I see the middle and lower income patients and populations. At the upper end of status, we often consider areas such as college or medical school admission. At the lower end, we know all too well the challenges that many face from birth to grave, and an early grave for too many.
There are patterns to observe and begin to understand. Those that leave children behind, are doing a great disservice to the children, their children, and the nation. One has to do with age. The major winners in the last 40 years have been the elderly with rates of 28.5% in poverty in 1966 to 15% by 1976 and now the lowest rates of any age group in America in 2007 at less than 10%. The major losers have been children. Of course some of the elderly are losing as well. One of the fastest growing new modes of families is grandparents caring for their grandkids. What is our nation doing?
Child poverty can be addressed. Our own nation has improved poverty rates in the past. In recent years the UK has adopted many of the US efforts and has done well. These are not one way government to poor donations or no donations at all, but an effort to gain work from those who can and support those who cannot work. Facing rapidly growing problems, the United Kingdom adopted policies aimed at child poverty and has seen dramatic decreases in poverty levels (hills and Waldfogel 2004) falling to 30 percent in 1991–1992, 24 percent in 1997–1998, and 12 percent in 2002–2003. The policies involved arose from recognition of growing problems relating to increases in child poverty, anticipation of worsening problems, and evidence from economic and other studies regarding the benefits of reducing child poverty http://www.clasp.org/audio/061606/AThirdWayinWelfareReformEvidencefromtheUK.pdf
American leaders make the same speeches, but do not address the specifics. America has made other choices and suffers from the consequences. In recent comparative studies, one group stands out as facing the worst increases in child poverty - working white families with less than college education
It is not a surprise that this is also the group disappearing from medical school admissions in US allopathic medical schools.
THE NEW POOR Regional Trends in Child Poverty Since 2000 http://www.nccp.org/media/npr06_text.pdf
The states that divide more clearly into highest and lowest income quintile states with the widest ratios and inequities have had the greatest increases in child poverty rates. Each region of the nation has different reasons for poverty changes
South - immigrant increases, increases in white poverty
Northeast - increases in poverty for white children
West - no changes
Midwest - greatest increases in child poverty, linked to changes in regional economies, increased for all groups, worst increase for working parents without college education The midwest has been an area with relatively high school graduation rates but average or lower college graduation rates - a balanced distribution of education resources. Midwest child poverty has increased from 27% to 35% for families with high school graduation or less and from 7 to 9% for college educated families. Child poverty rates increased in the midwest for working parents, but not for children in families where parents were not working.
"What is clear from the Midwest story is that low-wage, service sector employment is not sufficient to prevent hard working families from falling into poverty. The majority of poor parents work. What’s more, they often work full-time in jobs that pay low wages and offer no benefits."
Other areas are likely to be impacted, such as access to college for these children and access to professional school. Community colleges are another venue. Each of these choices moves children away from professional school admission or delays admission to those older, if their medical school considers older admissions.
The midwest states with the greatest changes include Michigan, Illinois, Wisconsin, Indiana, and South Dakota Iowa and Missouri had no change Nebraska, North Dakota, and Minnesota had decreases in child poverty - these are states with top high school graduation rates even in rural areas, few inner city areas and in MN a different system of addressing education, child development, and other areas The midwest also involves older populations and support from agriculture, Medicare, and Medicaid - factors to consider particularly in some states.
Increased concentrations of people and resources (and decreased distribution to lower income types) and changes in types of employment from manufacturing are likely the major causes of child poverty increase in Michigan, Illinois, Wisconsin, and Indiana. In South Dakota poverty includes the status of reservations and 5 of the poorest counties in the nation.
The south still has the highest child poverty with increase from 19% at 20% from 2000 to 2004 , but the midwest is catching up fast from 14% to 17% in 4 years.
Blacks and whites had the greatest increases with Asian and Hispanic the least increase or actual decrease. Blacks lead in child poverty, but Black child poverty rates declined in the West (32% to 29%), remained stable in the south 31% to 32%, and the northest 33 to 34%. in whites child poverty increases are reported as significant in the midwest (% data not in report) and increased 1 percentage point in all other regions
Asian poverty rates have declined to a level equal or better than others in each region of the country. Asian poverty rates declined from 15% to 10% in the northeast and from 12% to 9% to equal the lowest levels of child poverty in the nation, along with whites in the northeast at 9%
The midwest child poverty rates for those with high school graduation (or less) at 35% now exceed child poverty rates for Black and Latino populations in the West, South, and Northeast
Data and quotes from THE NEW POOR Ayana Douglas-Hall is a Research Associate at NCCP. She currently analyzes demographic data for NCCP reports and fact sheets. Heather Koball, Ph.D., is Senior Research Associate at NCCP where she conducts demographic research on poverty trends and studies the impact of social policies on family structure. Her most recent research has focused on low-income parents. ACKNOWLEDGMENTS This publication was made possible by the generous support of the Annie E. Casey Foundation. The authors alone are responsible for the final content. National Center for Children in Poverty
We can pay now and early or pay more and in wasteful ways later.
Email: rbowman@unmc.edu
Restoring America by restoring Young Professionals to Underserved Areas