The Health Divide: Pediatric care is worse for kids of color; federal nutrition program faces worrying shortfall

Children of color receive subpar health care

Children of color receive worse medical care than white kids, according to a sweeping new review in The Lancet Child & Adolescent Health. 

“No matter where you look, there are disparities in care for Black Americans, Hispanic, Latinx, Asian Americans — pretty much every racial and ethnic group that’s not white,” Dr. Nia Heard-Garris, study author and pediatrician at Lurie Children’s Hospital of Chicago, recently told NPR’s Maria Godoy.

Heard-Garris’ team reviewed studies of care quality, across several pediatric specialties, that had been published between 2017 and mid-2022. 

Children of color were more likely to languish in the emergency department waiting room and more likely to have complications during and after surgery.

They were less likely to receive diagnostic imaging or diagnosis and treatment for developmental disabilities.

Most glaringly, kids of color where less likely than white children to receive pain management for conditions such as broken bones, migraine or appendicitis. 

The researchers say the problem is rooted in structural racism, which leads to issues such as biased attitudes among physicians.

In an accompanying Lancet article, the authors argue that sweeping policy changes that explicitly combat structural racism are the solution. For example, improvements to housing, employment and health coverage programs also have the potential to improve health equity.

But such changes are not easy to implement, NPR’s Godoy notes. 

A simpler change, Heard-Garris suggested, is for health care providers to check and address their own unconscious biases. 

Nutrition program for infants and parents in danger of funding shortfall

A federal program that pays for food for babies and parents is in danger of coming up $1 billion short for the first time in its 5-decade history, reports Amanda Becker at The 19th. 

The problem, if not solved by Congress, could mean some families end up waitlisted, or even lose their benefits. The burden wouldn’t be shared evenly, since more than half of participants are people of color.

The Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, helped almost 40% of the nation’s infants during the 2023 fiscal year. All told, it supported more than 6 million children, breastfeeding parents and pregnant people. 

WIC benefits are linked to lower risk of preterm birth, low birthweight, and infant mortality.

The U.S. Department of Agriculture oversees the program, and a rise in both food costs and WIC enrollment caused the department to revise its 2024 estimated costs from $6.3 billion to $7.3 billion. 

The program has been funded in the short term by Congress’ multiple stopgap spending resolutions since October, but the government has not acted to provide the requested $1 billion boost.

The Senate and Democrats in the House of Representatives consider WIC funding essential, reports Becker, but House Republicans are calling for cuts.

The states, territories and tribes that administer WIC are already spending money as if they’ll be fully funded, so a final budget that doesn’t meet the program’s needs would be catastrophic, said Nell Menefee-Libey, senior manager of public policy for the National WIC Association.

If the shortfall persists, some of the 810,000 eligible people who apply for services each month would be waitlisted, and some participants might even lose their benefits, the USDA said in a press release in December.

According to the nonpartisan Center on Budget and Policy Priorities, some 2 million people could lose WIC services, “with harm falling disproportionately on Black and Hispanic families.”

Babies don’t receive needed hearing aids in many states 

Disabled children aren’t getting their needs met in eighteen states that don’t require health insurance to cover their hearing aids, reports Colleen DeGuzman at KFF Health News.

That impacts a huge number of children: For every 1,000 babies born in the U.S., two or three have some detectable hearing loss.

The aids cost thousands of dollars, and they must be replaced every few years as children age. Paying out of pocket is more likely to be out of reach for impoverished, Black and Hispanic families with lower wages, according to the Heuser Hearing Institute. 

Not getting hearing aids affects those children’s development and speech, said Los Angeles audiologist Brooke Phillips, co-chair of the volunteer coalition Let California Kids Hear.

“You have to learn to hear before you can learn to speak, and we all speak how we hear,” Phillips said.

California Gov. Gavin Newsom, who has supported supplemental hearing aid coverage in the past, surprised advocates in October when he vetoed a bill that would have required private health plans to pay for hearing aids. Newsom cited the state’s projected $68 billion deficit, expressing concern that the requirement would force the state to offset the costs.

Grassroots efforts in many other states have secured the needed coverage.

“We do a great job of diagnosing these kids,” said Daniela Carvalho, an audiologist at Rady Children’s Hospital-San Diego. “About more than 99% of kids that are born here are screened. But how can that be a good thing if we’re not following up at six months and giving them what they need to be able to hear?”

Black people face health risks due to ongoing sleep loss

African Americans have high rates of a variety of sleep disorders, which in turn contribute to other health issues, but the scope of the problem has gone understudied, reports Aswad Walker at the Houston Defender Network. 

“Racism robs Blacks of one of nature’s most powerful healing agents — sleep,” writes Walker.

Poor sleep quality is linked to lower socioeconomic status jobs that include shift work and long hours, and to living in neighborhoods with noise, pollution, and other disturbances, said Karen Lincoln, a professor of environmental and occupational health at UC Irvine.

Sleep disorders including sleep apnea, shorter sleep times and insomnia plague Black people at higher rates than any other ethnic group, according to Lincoln.

But because Black people have been underrepresented in clinical trials, it’s difficult to know exactly how much those sleep deficiencies affect other health concerns.

For example, poor sleep quality has been linked to risk for Alzheimer’s disease, but that’s based on studies done mainly in white people.

Lack of sleep is even robbing Black people of joy, Walker writes, citing a new analysis in the journal Psychological Bulletin that linked sleep loss to anxiety and poor mood.

“Even when sleep is only mildly deficient, there are measurable negative changes in how we react to everyday events,” said study author and psychologist Candice Alfano of the University of Houston.

But, Walker notes, Alfano’s study did not break out the effects of race on sleep and emotion.

“Major studies on sleep continue to sleep on the specific impacts on Black people,” he writes.

From the Center for Health Journalism

1/31 Webinar, 11 a.m. PT: ‘Dangerous Deliveries’: The Spread of America’s Maternity Care Deserts. We’ll hear from two reporters who have extensively covered America’s maternity care crisis and the unequal harms suffered by pregnant women of color and their children. Reporters will gain essential context, resources and data points, and story ideas for covering this worsening maternal health crisis in their area. Sign-up here!

National Fellowship

Application Deadline: April 10. The program, held June 24–28, prepares fellows to report a major enterprise health or social well-being reporting project. More info here!

Domestic Violence Symposium and Impact Reporting Fund

Application Deadline: April 11. This program, for journalists covering domestic violence in California, will begin in May. More info here!

What we’re reading

• “Rising suicide rate among Hispanics worries community leaders,” by Andy Miller and Molly Castle Work, KFF Health News
• “First Opinion: It’s time to remove skin color from the Apgar score for newborns,” by Amos Grünebaum, Monique De Four Jones, Dawnette Lewis, and Frank A. Chervenak, STAT
• “Inequality is a health risk — and it’s getting worse,” by Arline Geronimus, Wired
• “Afrofuturism: A journey to health equity,” by Anissa Durham, Word in Black
• “With menthol cigarette ban still uncertain, American Lung Association calls for White House to act ‘swiftly’ to save lives,” by Jacqueline Howard, CNN