The Impact of Disparities on Children’s Health

[Read more: The Impact of Racism on Children’s Health]

Dr. Elsie Taveras, a professor of nutrition in the department of pediatrics at Harvard Medical School, said, “While there has been some progress in leveling off the exponential increase in childhood obesity over the last 20 years, there still remains disproportionate obesity among African-American and Hispanic children.” The disparities are present by the age of 2, she said. “It points to the first thousand days, behaviors and risk factors that begin in utero.”

As with infant mortality, some of this is tied to risk factors during pregnancy. Dr. Taveras pointed to higher rates of excess gestational weight gain in black and Hispanic women, and higher rates of gestational diabetes, both associated with excess weight in infants. During infancy, she said, these infants are less likely to be breastfed exclusively, more likely to have solid foods introduced too early, more likely to get sweetened beverages, and less likely to get the recommended amount of sleep — again, all risk factors associated with childhood obesity.

Dr. Ruchi Gupta, a professor of pediatrics who is the director of the Center for Food Allergy and Asthma Research at Northwestern and Lurie Children Hospital, studies these conditions which, like eczema, represent forms of atopy, hypersensitivity in which the body’s defenses overreact, potentially causing harm.

She said that while it is well known that black and Hispanic children are more likely to be hospitalized and even to die of asthma, it has been less fully appreciated that there are also disparities around food allergies, which had initially been thought of as having more of an impact on white children. In fact, in a 2018 study by her team, the prevalence was higher among African-American children.

But research has shown, Dr. Gupta said, that while food allergies affect about 8 percent of all children, black children were diagnosed less frequently, and were not getting access to medical care. In one study by Dr. Gupta and her team, published in March, children on Medicaid were less likely to be diagnosed with food allergies. When a child seems to react badly to a food, “A lot of people just avoid the food and don’t talk to the pediatrician, a lot of the time, they never get to an allergist,” she said. “You avoid the food and sort of hope for the best.”

Research shows there is less spending on specialty care, less spending on special foods, and more spent on emergency department visits — the visits that could perhaps be avoided with specialized foods and with specialized medical care.

So disparities can manifest as conditions that occur more frequently in socially marginalized or disadvantaged groups — like premature birth, or like severe asthma, which may be related to exposure to pollution and other factors related to neighborhood and housing — but also as differential access to medical care and treatment.

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