Journals > Journal: School Readiness: Closing Racial and Ethnic Gaps > Article: Health Disparities and Gaps in School Readiness
Journal Issue: School Readiness: Closing Racial and Ethnic Gaps Volume 15 Number 1 Spring 2005
Introduction
Every parent knows that a small child sick with an earache may not sit still to listen to a story, indeed may not listen at all, until she recovers. For some chronically ill children, the struggle to achieve academically may go on throughout childhood. This article explores some of the health conditions most common to American children, notes racial disparities in the health of children, and asks how much disparities in children's health might contribute to the racial gap in school readiness. Given the growing recognition that school readiness encompasses behavior as well as cognitive abilities, I highlight the effects of health on both domains.
Health problems can affect a child's school readiness both directly and indirectly. Lead poisoning, for example, directly impairs a child's cognition and causes behavior problems. Poor health can also affect readiness indirectly by crowding out beneficial activities and changing the way the family treats a child. For example, parents who perceive a child as frail or vulnerable may be overly protective. They may coddle or inadequately discipline the child or may discourage him or her from engaging in activities that could hone both academic and social skills. Maternal health conditions and health-related behaviors may also have consequences for a child's school readiness.
Clearly, health conditions can impair school readiness in individual children. Whether racial health differences are responsible for a large fraction of the black-white gap in school readiness is a more complex question. For health problems to affect the gap, three conditions must hold. First, the health problem must affect many children. Severe illnesses like childhood cancer are mercifully rare and thus cannot explain the overall readiness gap between black and white children. Second, there must be a link between the health condition in question and academic performance or behavior problems. Health disparities that do not affect children's academic achievement or behavior cannot contribute to gaps in achievement or behavior. Third, there must be a racial gap either in the prevalence of the health problem or in its effects.
These same considerations have guided my choice of which health problems to address. Because space constraints make it impossible to discuss the possible contribution of every health condition, let alone every type of health behavior, I focus on health conditions and behaviors that affect many children or that affect children in some racial groups much more than in others. I also focus on health conditions whose connection with school readiness has been documented by research. Racial disparities in childhood injuries, for example, are large, but little research links these gaps to school readiness. Finally, I focus on five broad health domains: mental health conditions, chronic conditions, environmental threats, nutrition, and maternal health and behaviors. Within those domains, the specific topics are attention deficit hyperactivity disorder (ADHD), asthma, lead poisoning, anemia and iron deficiency, breastfeeding, and maternal depression. I consider maternal health and behaviors because they may have larger effects on racial disparities in school readiness than do most of the children's health conditions.
Within each area, I highlight studies based on large samples and good research designs. I focus on black-white and poor-nonpoor gaps in health status because most studies of disparities in health discuss these contrasts. Poor-nonpoor gaps are relevant because black children tend to be poorer than non-black children. In 2002, for example, 37.5 percent of black children under the age of five were poor, compared with 15.5 percent of white children.1
Although some of the specific health conditions considered here have large effects on children's cognitive skills and behavior, most explain little of the overall racial gap in school readiness. Still, the total cumulative effect of health differentials summed over all conditions is significant. “Back-of-the-envelope” calculations indicate that racial differences in health conditions and in maternal health and behaviors together may account for as much as a quarter of the racial gap in school readiness.
