Children’s Health Rx: Renew the Extended Child Tax Credit

A powerful, life-saving drug was brutally ripped away from millions of children this year with the expiration of the Expanded Child Tax Credit, which temporarily lifted nearly 3 million children out of poverty, a record low. Since then, millions of children have given up. In the final weeks of the 117th session, Congress must enact the return of the expanded child tax credit.

The health implications are drastic. Pediatricians do everything in their power to keep children healthy, but the most powerful medicine cannot be ordered in the electronic medical record or picked up at the local pharmacy. We spend $4.1 trillion on health care each year – 20 percent of our entire gross domestic product – but the main driver of ill health, the malignancy of child poverty, remains untreated. This undermines not only the children’s health, but also the lives of the adults they will one day become.

The more we learn about the developing brain, the more we understand how poverty—especially early, deep, and persistent poverty—damages the brain and dramatically impedes a child’s entire life trajectory. Poverty is one of the strongest risk factors for poor health – increasing rates of asthma, obesity, stunting, child mortality and injury.

We both work in Michigan, where more than one in two children in the city of Flint is officially poor, among the highest rates of child poverty in America. Many more families living just above the poverty line are still struggling to make ends meet. Once touted as the birthplace of the middle class, Flint has formerly prosperous neighborhoods where more than a staggering 80 percent of young children have fallen below the official poverty level in recent years. Thousands of children in Flint — and millions across the country — are growing up without their basic needs met, including food, shelter, clothing, security, safe transportation, adequate education and ongoing child care, in addition to health care. Even in the tightest job market in a generation, jobs with good living wages are few and far between.

Poverty, especially when experienced in early childhood, and other forms of exposure to prolonged, significant adversity are recognized by the medical establishment as toxic stresses that alter biological function at the molecular, cellular, and behavioral levels. It tangles with many body systems in complex, life-changing ways, including genomic function, brain structure and activity, metabolism, neuroendocrine immune function, the inflammatory cascade, and the microbiome.

Falling out can affect development to such a detrimental degree that it can be seen in academic achievement, economic productivity, lifelong chronic disease and even life expectancy. A child born in Flint can expect to live 20 years less than a child born in a more affluent part of the same county, a staggering disparity based on place that reverberates across our nation. Before these children are even born, their potential is poisoned.

So what is the treatment? In Flint, we are tired of patching up health care inequity. A broad coalition of community partners—residents, nonprofits, academia, government, and others—is working on a pilot program for universal cash assistance for every child from birth to age 5. We still have millions of dollars to raise, but we are determined to build a foundation of health that will last and see our children into adulthood, rather than continuing to patch up preventable diseases.

Renewing the Expanded Child Tax Credit has similar game-changing potential for the entire nation. Providing additional income support to families with children — similar to the “family benefits” that many other countries provide — is the easiest, boldest and most effective strategy to prevent and reduce child poverty. A study done by UNICEF shows that in every country that adopts a family allowance policy, including Canada, Germany and the United Kingdom, child poverty drops dramatically.

And that’s exactly what happened in the United States when the expanded child tax credit took the form of a modest cash transfer to poor and middle-class families in the second half of 2021 — $250 each month for each child ages 6 to 17 child and then $300 each month for children under 6. The evidence is rolling in. Our child poverty rate has fallen to its lowest level ever. Food insecurity among families with children, which is known to be strongly linked to many long-term health problems, also fell to the lowest rate ever recorded, with evidence showing that the greatest impact was felt among families of color. The data shows that families had more donations in their bank accounts in 2021 and 2022 and were better able to weather a financial crisis than before the pandemic. It’s not just families in poverty who have seen these health benefits. Working-class families had less trouble putting food on the table during the extended child tax credit months and more of a financial cushion.

Raising children is expensive. Even families well above the poverty line struggle to pay for childcare, diapers and all the other things children need. Providing financial support to families helps all our children succeed. And while there have been concerns that cash benefits during COVID-19 have contributed to inflation, more than 400 economists recently signed a statement arguing that the child tax credit is “too small to significantly increase inflation across the economy’.

Fighting poverty with this kind of approach has already been a huge success in the US. Adult poverty was dramatically reduced with the creation of Social Security and Medicare in the 1960s. Today, 16 million seniors are lifted out of poverty and protected from hardship with highly successful cash benefits. For children, the long-term impact, according to a report by the National Academy of Sciences, has numerous social dividends. Economists recently found that adding $1,300 to family income during a baby’s first year of life leads to higher incomes in adulthood. In addition to benefiting health, the expanded child tax credit benefits the economy with a large return on investment.

No amount of health care can make up for a lack of investment in prevention. As Frederick Douglass said, “It is easier to make strong children than to mend broken men.” Sometimes building strong children comes as a shot in the arm to fight infections, and sometimes it is the adoption of powerful policies that help both of poor as well as middle-class families.

The lame duck session may be the last time for many years that we as a nation can return to this highly effective poverty prevention tool. It is high time that our policies catch up with the science of early development and the effects of significant adversity across the lifespan.

It’s time for a national recipe. Rx: Renew the Extended Child Tax Credit and complete it by age 18.

A pediatrician, Mona Hanna-Attisha is the CS Mott Endowed Professor of Public Health and director of the Pediatric Public Health Initiative at Michigan State University College of Human Medicine in Flint. She is the author of What the Eyes Can’t See: A Story of Crisis, Resistance, and Hope in an American City. H. Luke Schaefer is the Herman and Amalie Kohn Professor of Social Justice and Social Policy at the Ford School of Public Policy and director of the Solutions to poverty at the University of Michigan. He is the co-author of “$2.00 a Day: Living on Almost Nothing in America.”

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