Lining them up (by income) and knocking them down.
I didn’t realize how strong the income gradient is for children’s emotional and behavioral problems. This new graph from the CDC combines data from 6 years of the National Health Interview Survey, and shows a steep relationship at all ages:
The question asked was, “Overall, do you think that [child] has any difficulties in one or more of the following areas: emotions, concentration, behavior, or being able to get along with other people?” Children are included here if the parent said “yes, definite difficulties” or, “yes, severe difficulties.”
As background: I’ve posted before on the income gradient for asthma, overall health, diagnosis timing, mammography, pregnancy, and women generally. That makes me curious, but not an expert. That is probably a good description for the authors of this recent review article, Janet Currie and Wanchuan Lin, who conclude:
Low-income children are in worse health than other children are. This paper explores the extent to which insults to health and activity limitations are responsible. In the most recent National Health Interview Survey (NHIS) data, low-income children are more likely than other children to have virtually every measured chronic or acute condition and are more likely to be limited by these conditions. Mental health conditions are particularly common and limiting. But the higher incidence of measured conditions and limits does not explain all of the relationships between income and overall health status, which suggests that unmeasured illnesses and injuries are also involved.
And finally, this reminds me of a good research tip. To get started on your subject, find a review article that’s a few years old or older, and then see which articles cite it — that should help bring you up to date. In this case, you could get these, which look highly relevant:
- Impact of Income and Income Inequality on Infant Health Outcomes in the United States. Pediatrics December 2010 126:61165-1173.
- Child Health and Young Adult Outcomes. J. Human Resources July 2010 45:3517-548.
- Policy Interventions to Address Child Health Disparities: Moving Beyond Health Insurance. Pediatrics November 2009 124:Supplement_3S246-S254. [Are we really ready to move “beyond health insurance”?]
- Early Childhood Poverty and Adult Body Mass Index. AJPH March 2009 99:3527-532.
- Access to and Use of Paid Sick Leave Among Low-Income Families With Children. Pediatrics August 2008 122:2e480-486.
Family Inequality 
What comes first? This leaves me with the question of what precedes the income inequality that results in poor health and emotional/behavioral difficulties? Can it just be described by income difference and what predisposes people to poverty that would also influence health outcomes and emotional/behavioral difficulties?
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I don’t know the state of research on this. I know that children with disabilities of all kinds are more likely to have parents with disabilities. But the pattern doesn’t have to be causal to be important — as a description of lived experience it’s important, too.
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Yeah, but…while I have no doubt that the great majority of health conditions correlate to income, mental health is a special case. Eyeballing the graph, I pretty strongly suspect what you’re seeing is essentially the tendency of educators, parents, and mental health professionals to pathologize childhood.
This tendency takes different very forms among the poor, middle class, and the wealthy. The wealthy are far better at covering up perceived problems — and thus not reporting them to the Survey — but the fact that they are covered up doesn’t mean they aren’t identified.
Remember that childhod mental health difficulties are *caused* in large part by the same people who are measuring them (parents). In fact, the process of identifying a child as a behavioral / mental health problem tends to cause such problems.
My personal conclusion (from working as a counselor) is that the middle class causes slightly less behavioral problems for its kids than the poor and owning classes: wealth and poverty both are closely connected to very different inherited patterns of mental illness and misbehavior.
The rich just don’t admit it.
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Thanks. That sounds plausible, and it is a flaw with measuring the outcome by a parental report. The big jump up around age 8 looks like a school-diagnosis effect. But some of what causes mental health or behavior problems is not just parent/child interaction — think of lead poisoning, nutrition, family instability, etc. On the other hand, some rich people goose up their kids’ learning disabilities to get them extra exam time…
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Yeah, obviously, there are serious problems with being a poor kid! My (rather casual) observation of the rich, though, is that they all crazy as bedbugs. I could say a bit more scientifically — and it is a problem others have remarked on — that wealth allows people to decompensate far more before the outside world makes them cope with their problems. Think the famous obsessive-compulsive behavior of J. Paul Getty.
I do agree that nutrition is a big difference, largely because the poor often choose to feed their kids such crap (meaning that it’s not that they can’t afford something better for them than coke and candy). On the other hand, the rich (and middle classes) feet their kids a lot more Ritalin, the nutritional value of which is very questionable.
But actually, a lot of mental health professionals would agree with me when I question the practice of measuring “child mental health problems” at all, since they primarily represent a symptom of family dysfunction. Which isn’t to say that they can’t be counted and statisticked…
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