PEDIATRICS Vol. 89 No. 4 April 1992, pp. 710-713
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Perpetual Poverty: Child Health and the Underclass

Robert M. Kliegman MD1

1 From the Case Western Reserve University, Cleveland, Ohio

Poverty is a predominant social precursor to poor health.1-9 The disadvantaged health status among the poor is associated with reduced life expectancy and a high risk of death from preventable illnesses.2,10-12 Child health is affected particularly, as exemplified by excessive rates of low birth weight, prematurity, and neonatal, infant, and postneonatal mortalities. Specifically postneonatal deaths among poor children are often due to preventable or treatable illnesses such as diarrhea, pneumonia, influenza, and accidents. (New York Times. July 17, 1990: A10; New York Times. August 6, 1990:A1).2,3,11,16-18 In addition rates of teenage pregnancy, drug dependence, and death due to intentional and unintentional injuries are excessively high among poor, urban adolescents (New York Times. July 17, 1990:A10; New York Times. August 6, 1990:A1).7,17-18

UNDERCLASS STATUS AS A RISK FACTOR

Related risk factors that adversely affect pregnancy or neonatal outcome include, single parent status, adolescent age, minority status, limited education, unemployment, and alcohol and illicit drug use. However, between 80% to 90% of poor women with these factors have healthy infants. It has become apparent that all poor women are not equally at risk or even equally financially disadvantaged despite having in common the traditional poverty-associated risk factors (Newsweek. May 28, 1990:78).7,15,19 The subpopulation of poor people which has the highest risk for infant mortality and other health complications, includes the most disadvantaged people, known collectively as the underclass. Although use of this term has been considered controversial and may have negative implications, the idea that there is a group of the most disadvantaged citizens has been accepted for some time (Newsweek.

Submitted on March 4, 1991
Accepted on October 23, 1991




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