Whether you're able to take your kid to a dentist or get good care during childbirth may depend on your skin color or income, according to new studies that document the health of U.S. children. Economic status affects children's health, and with one in five American children in living in poverty, children are particularly vulnerable. Health disparities appear in health measures including rates of HIV/AIDS infection, lead poisoning, tooth decay and maternal death in childbirth.

Lead's Continuing Threat
A 1999 report published in the Journal of the American Medical Association shows a relationship between elevated levels of lead in the blood and tooth decay, both of which appear disproportionately among minority and low-income children. According to the report, environmental lead exposure is associated with an increased prevalence of dental caries (the disease that causes cavities) in the U.S. population.

A related report said that both lead exposure and low dietary calcium continue to pose significant health risks to urban minority children. The U.S. Centers for Disease Control and Prevention confirms that low-income children of color living in distressed communities are at highest risk for lead poisoning—not a thing of the past, but a continuing problem in the U.S. According to Robert J. Bogdon, a professor at New Jersey Medical School and an author of the report published in Environmental health Perspectives, "It's clearly recognized that underprivileged kids from low-income families have exposures or other health problems related to their economic status."

Bogdon worries about public perception that lead poisoning was eradicated when the country stopped using leaded gasoline and house paint with dangerous levels of lead. "You hear in the media that we've made great progress in reducing blood lead concentrations nation-wide," Bogdon says, "but it's not uniform." Lead poisoning is a continuing problem, particularly in large eastern cities with older homes, and can affect everything from children's hearing to their mental development.

The Alliance to End Childhood Lead Poisoning reports that almost one million U.S children continue to suffer from elevated blood lead levels, resulting in reductions in IQ, learning disabilities, behavior problems, and eventually lost productivity and reduced quality of life. "There's no biological reason why lead poisoning should affect lower-income children more than upper-income children, or black or Mexican American children rather than white children," says Ralph Scott of the Alliance. "We believe it traces back to the housing these children live in, and different housing opportunities for different income and racial groups."

Scott says that perhaps the most important piece of legislation pending on the matter is the Children's Lead Screening Accountability for Early-Intervention Act of 1999 (S. 1120), sponsored by Robert Torricelli (D-R.I.) and Jack Reed (D-N.J.). The bill is designed to improve the identification and treatment of lead-poisoned children in Medicaid and other federal health programs. It responds to a GAO study released in January 1999 which found that children in poverty are not being screened for lead poisoning, despite the fact that they are at high risk.

Disparities in Oral Health
The report on the association between lead poisoning and dental caries may help bring attention to an emerging concern about our nation's children: oral health. Amy Seif, senior project associate of the National Center for Education in Maternal and Child Health Bureau, says that oral health is an important issue because kids who suffer from tooth decay may also suffer from chronic pain, a lack of self-esteem because of disfigured smiles, poor speech development and other problems. "The important thing to know is that it's preventable," Seif says.

But the U.S. may not be doing a great job at preventing oral disease. The National Center for Education in Maternal and Child Health Bureau reports that oral disease remains pervasive among millions of children, especially those from families with low incomes and from minority groups. Although all children enrolled in Medicaid are entitled to comprehensive dental services, the U.S. Department of Health and Human Services Office of the Inspector General reports that only 18 percent of Medicaid-eligible children received even a single preventive dental service. In addition, 25 percent of children account for 80 percent of all tooth decay observed in the population.

That's part of the reason the U.S. Surgeon General is getting serious about children and their oral health. The Surgeon General has commissioned a report on oral health that will feature children's issues. He has also scheduled a workshop to develop an implementation plan to identify action steps to improve children's oral health and a conference to promote attention and action on oral health disparities' impact on children's overall health and wellbeing.

The oral health of U.S children is coming to the attention of policy-makers. Senator Jeff Bingaman (D-N.M.) sponsored the Children's Dental Health Improvement Act of 1999 (S-901), to provide disadvantaged children with access to dental services. The bill addresses the fact that only one in five New Mexico children on Medicaid receives any preventive dental care.

Other Disparities in Children's Health
Maternal mortality, or mothers dying in childbirth, is another issue that affects children disproportionately among racial and ethnic groups. The Centers for Disease Control reports that the maternal mortality ratio ([MMR], i.e., the number of maternal deaths per 100,000 live-born infants) for black women is higher than for white women in every state where a ratio could be calculated. According to the CDC's Mortality and Morbidity Weekly Report (MMRW), the increase nationally in risk for maternal death among black women compared with white women is one of the largest racial disparities among major public health indicators.

According to the MMRW, "Race and ethnicity are not risk factors for maternal mortality but instead may be markers of social, economic, cultural, health-care access and quality, and other interrelated factors that may increase the risk for death among pregnant women."

Risk of HIV infection is also high for adolescent black women, according to a 1998 CDC study. The study showed that young black women had the highest HIV infection rate of any group of 16- to 21-year-olds tested. CDC experts recommended prevention programs to reach young women early so that they have healthy self-esteem to delay sexual intercourse and negotiate condom use.

Proactive behavior on the part of adults is an important component to dealing with the many health problems that threaten U.S. children—whether it's increasing calcium in children's diets, testing for lead in paint and dust in community homes, or asking legislators to address children's oral health or AIDS education. Preventive measures may be able to eradicate these problems and narrow the health gap between children in racial, ethnic and economic groups.