Infant malnutrition at staggering levels in Massachusetts

By John Marion
3 August 2011

The Boston Globe reported last week on staggering levels of infant malnourishment in the Boston area. Basing itself on research by the Children’s HealthWatch organization, the Globe compared malnourishment among poor Boston children to that seen in the “developing world.”

While statistically Massachusetts has not been hit as hard as some other states by the economic crisis—the jobless rate stands at 7.6 percent and the state economy grew 4.8 percent in the quarter ending June 30—the Boston Medical Center (BMC) has seen “more hungry and dangerously thin young children ... than at any time in more than a decade,” according to the Globe.

The Globe reported a 5 percent increase between 2005 and 2010 in the number of severely underweight infants (less than a year old) referred to BMC by family physicians. According to surveys conducted by Children’s HealthWatch, the percentage of “significantly underweight” children under the age of three increased from 12 percent in 2007 to 18 percent in 2010.

Between 2007 and May 2011, the number of Massachusetts residents on food stamps (known as EBT cards, or Electronic Benefit Transfer) increased from 452,000 to 815,000. Boston Medical Center doctors told the Globe that “many families are unable to afford enough healthy food to feed their children,” demonstrating that neither food stamps nor Women, Infants, and Children (WIC) food supplements are adequate to meet the needs of unemployed workers and their families in the current economy. Even these limited social benefits stand to be drastically cut back as the effects of federal budget cuts are passed along to the states.

The Boston-area increases in infant malnutrition have been larger than in Baltimore, Little Rock, Minneapolis, and Philadelphia, where Children’s HealthWatch also conducted surveys. While the Globe attributes Boston’s crisis to food and housing prices higher than the national average, income inequality also plays a significant role.

Along with food insecurity, housing insecurity can seriously damage children’s health, and the two are often tied in together. An article published in the August 2011 issue of the American Journal of Public Health sums up the results of a survey conducted by Children’s HealthWatch between 1998 and 2007, before the onset of the recession.

The total study population was slightly more than 22,000 (slightly less than 5,800 in the Boston area) and the study was conducted at acute care clinics, primary care clinics, and hospital emergency rooms in seven cities, among families who had brought their children in for emergency care. Housing insecurity was defined in the study as crowding (two or more people per bedroom) and/or multiple moves (two or more in the year before the interview). Food insecurity was defined as affecting those who “could not afford enough nutritious food for active, healthy lives,” “skipping or reducing the size of child meals,” and poor diet quality.

Only Minneapolis had a higher rate of study participants in the overcrowding category than Boston, when taken as a percentage of the total survey. Boston accounted for nearly 25 percent of the total in the multiple moves category.

The survey found that “multiple moves were significantly associated with caregivers reporting their child’s health as fair or poor.” It also found a statistical correlation between food and housing insecurity in the total population: “child food insecurity (CFI) was found in 7 percent of families with secure housing, 17 percent of families with crowding, and 19 percent of families with multiple moves” and that children in the multiple-moves group had significantly lower weight-for-age.

The introduction to the survey notes that crowded housing is “associated with mental health status, ability to cope with stress, child and parent interaction ... sleep ... [increased] childhood injuries, elevated blood pressure ... and exposure to infectious disease,” the effects of which can last into adulthood.

Families who move frequently are more likely to use emergency rooms because they are unable to find a “medical home.” While the 2006 Massachusetts health insurance law was designed in part to reduce the use of emergency rooms, it has proven ill equipped to address this issue.

In addition to the effects of housing insecurity, food insecurity in infants can cause learning, social, and psychological problems and lead to obesity later in life, according to the Globe.

Multiple moves and crowding are not the only economic pressures on poor and unemployed workers. While the federal government’s standard has long been that housing costs should equal no more than 30 percent of a household’s income, an American Journal of Public Health article noted that in 2008 nearly 25 percent of US renter households spent more than 50 percent of their income on rent.

Despite this evidence, the fiscal year 2012 Massachusetts budget reduces funding for transitional programs by $29 million—close to 9 percent—compared to 2011.

The cost of living in Boston is higher than in many parts of the country, with the fair market value for a two-bedroom rental at about $1,400. According to the June 2011 Consumer Price Index numbers from the US Bureau of Labor Statistics, the price of electricity in the Boston area is about 7.5 percent higher than the average of the 14 metropolitan areas surveyed. The price of natural gas per 40 therms is about 8 percent higher than the average. The CPI for “food at home” in the Boston area increased by 2.9 percent for the year ending June 30.

Other factors are at play, however. The web site MassBenchmarks reports that between the second quarter of 2007 and the fourth quarter of 2009, the ratio of unemployed Massachusetts residents per job opening shot up from 1.79 to 4.94. Construction was particularly hard hit, with the ratio at 44.2, followed by manufacturing at 19.0. Although the statistics for the fishing industry are not specifically called out, many local fisherman have seen their livelihoods devastated because of overfishing.

MassBenchmarks, which characterizes the state’s recent economic growth as a “white collar recovery,” calculates the ratios as 2.9 unemployed per job opening in the information technology industry, and 3.1 in professional and scientific services.

Hundreds of thousands in Massachusetts are unable to find jobs, or jobs paying adequate wages to support housing and other basic needs. As the Children’s HealthWatch research shows, this translates into high levels of low birth weight and poor nutrition for many of the state’s youngest residents.

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