Children raised in poverty have—on average—higher rates of a multitude of problems, including school failure, antisocial behavior and delinquency, early pregnancy, drug addiction, and depression (Compton, Thomas, Stinson, & Grant, 2007; Kalichman et al., 2006; Valdez, Kaplan, & Curtis Jr., 2007). Recent evidence further shows that a child raised in poverty has a 30 to 60% higher likelihood of heart disease as an adult, as well as asthma and autoimmune disorders—even when they transcend poverty by adulthood (Chen et al., 2006; Dube et al., 2009; Kittleson et al., 2006). The enormity of the economic burden on society for such problems including the cost of the most common problems for all youth, such as violence, drug abuse, high-risk sexual behavior, poor academic achievement, high school dropouts and suicide attempts, totals nearly $500 billion annually (estimated in 2014). And these estimates do not include the compounding costs of later problems in adulthood, from unemployment and incarceration to serious physical health problems and mental illness.
The Potential of Prevention Science
Efforts to combat poverty have primarily focused on increasing family income. However, programs and policies that improve family income will not necessarily ameliorate established patterns of conflict that may have resulted from the stresses of living in poverty. Interventions are needed that support the ability of families and schools to effectively nurture our children and build the social and academic skills of young people.
Prevention science has reached a point at which all U.S. communities can ensure that young people reach adulthood with the skills, values, and health habits needed to lead productive lives in caring relationships with others. The 2009 Institute of Medicine (IOM) report identified numerous tested and effective programs, policies, and practices that can prevent the most common and costly problems of youth. Some interventions can directly affect the economic well- being of those in poverty or who are vulnerable to falling into poverty. Others do not directly or immediately affect economic standing, but ameliorate the negative effects of poverty, such as academic failure, delinquency, depression, and unwanted pregnancy. Of course, alleviating some of these effects can very well improve later economic well-being; e.g., decreasing school drop-out rates and improving academic performance. Many of these interventions can also help to prevent inter-generational poverty. If a national initiative ensues that widely implements these effective interventions, virtually every citizen and entire communities will benefit.
The value of an evidence-based prevention science approach is that it invests only in proven programs; precious resources are not wasted and problems are prevented before they develop rather than after they have become entrenched. Along these lines, Rep. Ryan and Senator Murray have introduced bipartisan legislation for the Commission on Evidence-Based Policy Making. This body recognizes the need to infuse scientific evidence into the decisions of policy-makers as the first step to effectively designing policies that improve our lives while not wasting tax-payer money on unproven strategies. The Commissioners have been charged with three general tasks: (1) to improve the federal data infrastructure while respecting privacy and security concerns; (2) to incorporate outcomes measurement, cost-benefit data, evaluation, randomized controlled trials (RCTs), and rigorous impact analysis into federal program design; and (3) to consider the value and nature of a clearinghouse that would facilitate access to data by various constituencies and enable the research community to judge what works and what does not. The Commission will focus on ways to incentivize the rigorous evaluation of programs and policies that aim to reduce the problems associated with detrimental prevailing conditions and promote more healthful and productive outcomes. Until now, many programs we invest in do not possess stringent indicators of their effectiveness and, thus, there is no justification for their continuation.
Relevant to poverty reduction, such a bipartisan, evidence-based approach avoids more controversial economic measures and, thus, is more likely to bring legislative success. Over time, proven interventions save government money; e.g., there is no longer a need to institute programs to counteract problems that no longer exist. In addition, those no longer in poverty are more productive and able to actively contribute to society leading to more money in government coffers. This scenario is certainly preferable for all involved, from those directly impacted by poverty to those affected by the exorbitant costs of poverty, such as threats to public safety and the need for more specialized educational, mental health and juvenile justice services.
Building a Comprehensive National Prevention System
The U.S. can exert a measurable impact on poverty and improve the chances for success among our youth by implementing tested and effective programs, policies, and practices. It is a significant undertaking that requires several years of concerted effort, but if we unite everyone around a common understanding of what is needed, we can build a system to support child and adolescent development and prevent problems to a degree never before seen.
A comprehensive and effective prevention system would have four facets: (a) implementation of a large-scale and sustainable system of family supports; (b) infrastructure for positive behavioral reinforcements and social competency skills for children in schools; (c) ongoing public education about the importance of building environments conducive to healthy child and adolescent development; and (d) a data-driven system for monitoring the wellbeing of children and adolescents. A realistic plan for this system can be created if all the agencies and organizations designated to address health and wellbeing (e.g., education, juvenile justice, health care, etc.) coordinate their efforts.
There is a solid body of evidence showing that community, family and school-based interventions can prevent the development of most of the problems cited above and thereby minimize the harm of poverty and assist many children in eventually escaping from it. From the prenatal period through adolescence, there are programs that can help families nurture their children’s cognitive, social, and physical development. They teach parents how to reduce conflict in the home and how to help their children develop key skills for social and academic success. Such programs can prevent impoverished children from failing in school and from developing aggressive behavior that leads to delinquency, substance abuse, early pregnancy, and continued poverty.