Structuring Poverty: How Racism Shapes Child Poverty and Child and Adolescent Health

Introduction

This article brings together studies across disciplines to understand the relationship between structural racism, poverty, and child health. Structural racism is defined as “differential access to societal goods, services, and opportunities by race.” The authors argue that a focus on poverty without appropriate consideration of racism has failed to address the negative health outcomes of child poverty. They contend that structural racism helps produce and sustain poverty among  racially minoritized groups through historical and ongoing patterns of inequity embedded in the United States’ capitalist economic system.

The authors review literature on historical and current racism, underscoring disparate homeownership rates, experiences of incarceration, unequal access to quality schools and recreation, and the consequent effects  of these inequities on children’s health. They critique federal policies that have sought to reduce poverty without addressing structural racism and advocate for an explicitly antiracist policy agenda. Finally, the authors offer antipoverty

strategies through policy recommendations.

This review is important because it synthesizes scholarship from multiple disciplines and highlights the institutional and historical determinants of child health that are often overlooked in the pediatric field. The authors, Nia Heard-Garris, MD, MSc; Rhea Boyd, MD, MPH; Kristin Kan, MD, MPH, MSc; Leishla Perez-Cardona, MPH; Nevin J. Heard, PhD, NCC; and Tiffani J. Johnson, MD, MSc, are affiliated with medical institutions in Chicago, Illinois and California and bring significant expertise in medicine, public health, and counseling.

Methods and Findings

The authors structure an overview of studies linking institutional and historical racism to child health outcomes through housing, education, and recreation.

1. Where children live: homeownership and mass incarceration

Homeownership is a source of wealth and stability for families. However, a history of racial exclusion, discrimination, and marginalization has led to dramatically disparate homeownership rates. Redlining, the Great Recession, and gentrification illustrate how these inequities developed. 

Redlining was a practice of the Home Owners Loan Corporation (HOLC) in the mid-20th century which advised against lending in predominantly non-white areas, making it almost impossible for racially minoritized families to receive a mortgage. This concentrated advantages for white families and led to neighborhood disinvestment, particularly in areas that were majority Black. Formerly redlined areas see higher rates of low birthweights, stillbirths, and premature births. The most severe outcomes are seen in the worst Home Owners Loan Corporation graded neighborhoods. 

Before the Great Recession, racially minoritized households were targeted with predatory home loans and were disproportionately affected by housing and job loss when the market crashed. During the recession, rates of low birthweight and childhood obesity rose, and  racially minoritized children who were most affected by the recession experienced more premature aging, negative effects of long-term stress, and worse overall health.

Gentrification, defined in this paper as “an influx of individuals from a favorable social position into lower-income neighborhoods,” may  negatively impact by contributing to the displacement of low-income households through  inequitable investment in these communities may result in the displacement of low-income households. Yet, one study finds that gentrification is correlated with poor mental health, although physical health is statistically unchanged. 

Beginning in the 1980s, mass incarceration disproportionately affected racially minoritized groups, especially Black men, and increased poverty rates for Black households. Parental incarceration is associated with children’s justice system involvement and mental health challenges, including post-traumatic stress disorder. Children with incarcerated parents are more likely to skip medical care, abuse drugs, and have more sexual partners by young adulthood.  

2. Where children learn: quality education

Lower incomes and property values in many racially minoritized communities,   shaped by a history of redlining and other mechanisms of segregation, contribute to disparities in school funding. Academic outcomes are worse for Black kids regardless of their poverty level, which may reflect differences or inequities in school resources. Underfunded schools often face poorer physical conditions and greater environmental risks, which are associated with higher rates of respiratory illness, lower levels of physical activity, and weaker academic achievement for students. However, well-resourced schools may help mitigate these harms by providing  a positive social climate, smaller student population, and access to trained health professionals, all of which are associated with  improved wellbeing and reduced substance use.

3. Where children play: access to recreation

Racially minoritized children are less likely to have access to quality green space and may underutilize such spaces when available. “Cities with higher median incomes and fewer Black and Latinx residents have higher quality parks. Predominately Latinx cities experienced more park inequities than Black cities.” Structural barriers to park usage include: park quality (in its connection to park funding), socioeconomic resources, transportation, knowledge of outdoor activities, safety concerns, and a white workforce dressed similarly to law enforcement. Lack of access to neighborhood parks is associated with lower levels of physical activity, increased screen time, poor sleep, and higher rates of ADHD among children.

Conclusions

The authors conclude the article by recommending a policy focus on reparations, decarceration with support, and equitable educational and recreational funding. Reparations include financial compensation for slavery, public acknowledgment, and repair. These resources could finance homeownership, business formation, and education for Black and Indigenous groups. They advocate for expanding decarceration beyond nonviolent and drug offenses and championing re-entry services that would ease reintegration through education, employment, and housing. Additionally, they contend that school funding should be higher for districts with lower property tax bases, which would enable  hiring and retaining high-quality teachers and health professionals. Lastly, they advocate for recreational spaces to  be systematically and equitably funded.