The Future of Children, Princeton - Brookings: Providing research and analysis to promote effective policies and programs for children.

About 1 child in 5 and 1 very young child in 4 live in families with incomes below the federal poverty level, and many more live in families marginally above the poverty level. Because health problems in childhood compromise future health, the health problems of low-income children should be of considerable concern in a country dedicated to equality of opportunity. Low income is responsible for much if not most of the disadvantages found among children in other high-risk groups such as racial minorities.¹⁵

The summary in Table 5 indicates that poor children are more likely to become ill and have more serious illnesses. Among the reasons for this are increased environmental exposures resulting from poor housing and hazardous neighborhoods, poor nutrition, and inadequate preventive care.¹⁶ However, the higher rates of the more serious problems and the increased death rates from diseases at all childhood ages also reflect poor access to medical care.¹⁷

The 15 million children who live in rural areas of the country are another group at high risk. These children comprise one third of all children in the nation, and almost one half of them reside in the South. Rural and urban children do not differ much in their overall death rates, and the frequency of the major chronic conditions and limitation of activity associated with them are very similar. Rural children have slightly lower rates of acute conditions, however.¹⁸ The major disadvantage of rural children is a result of their greater likelihood of death from injuries, particularly those caused by exposure to farm machinery, firearms, and falling objects; and drowning and injuries to occupants of motor vehicles (especially pick-up trucks).^19,20 (See the articles by Perrin, Guyer, and Lawrence, and by Klerman, in this journal issue.)