Carol Duh-Leong, MD, MPP and Laura Marcus, MD
This past summer in our primary care clinic in the South Bronx, the most important anticipatory guidance we gave was not to take a vitamin or to eat a new vegetable, but rather to read a new book. Studies show that achievement gaps in high school between students of high socioeconomic status and students of low socioeconomic status can be traced back to differential summer learning over the elementary school years.1 While this knowledge is discouraging, it also creates a potential point of intervention for pediatricians. Summer plans for our patients are often fraught with anxiety, due to the prohibitively expensive nature of camps, travel, or additional structured activities. However, reading year round, with the help of a library card and the encouragement of your pediatrician, has always been free. Books are the cheapest form of international travel, the easiest way to meet presidents and heroes, and the greatest innovation we have engineered for time travel. If Yeats is correct and learning is not the filling of a pail, but the lighting of a fire, books are the kindling. The value of reading and independent learning cannot be underestimated in a school system fraught with overcrowding and lack of resources.
The impact of literacy and education on health outcomes cannot be understated, nor can the effects of health on education. Asthma is the leading cause of absenteeism among elementary school children, and accounts for more than 14.7 million days of school missed in 2002 nationally.2 Additionally, a study undertaken in our state’s schools revealed that 51% of school nurses feel that asthma is more disruptive to school routines than any other chronic condition.2 However, in a family in which more basic needs, like food and security, are at stake, remembering to give your child a controller medication for asthma is often a much lower priority, and lower health literacy often compounds this problem. As doctors we see every day that insufficient education and poor health are intimately and inextricably linked, and that both are a symptom, as well as exacerbating factor, of poverty.
In the Bronx only 54.7% of students who started high school in the year 2010 graduated within 4 years, as compared to 64% in Brooklyn and 67% in Queens and Manhattan.3 In our clinic, there exists a harsh discrepancy between the answers to, “What do you want to be when you grow up?” and the actual outcomes we see. Every day we hear our patients say that they want to be doctors, nurses, social workers, teachers, criminologists, police officers, and business people. Many adolescents express interest in going to college. As pediatricians, we push our adolescents to dream. However, in order to land among the stars, rockets require the forethought, training, and focus, often extinguished by the crushing weight of scarcity. It is our job to utilize what resources we do have, one of which being public libraries filled with books, to help put our children on the path to success.
Alexander, Karl L., Doris R. Entwisle, and Linda Steffel Olson. 2007. “Lasting Consequences of the Summer Learning Gap.” American Sociological Review 72 (2): 167–80. doi:10.1177/000312240707200202.
“Asthma and the School Environment in New York State.” 2008. Center for Environmental Health at the New York State Department of Health. http://www.health.ny.gov/diseases/asthma/docs/asthma_in_schools.pdf.
"Graduation Results: Cohorts of 2001 through 2011 (Classes of 2005 through 2015) Graduation Outcomes." NYC Department of Education. NYC Department of Education, n.d. http://schools.nyc.gov/accountability/data/graduationdropoutreports/default.htm
This piece also appeared in the AAP FACE Poverty newsletter.