I ask all the families of my young patients if they are working, staying at home, or in school.
I have learned that this inclusive, nonjudgmental question helps me understand family dynamics and gives me insight into family income. To make ends meet, many of the parents I meet work overnight shifts, in low-income jobs, and sleep during the day, only when their infant does. Others face long commutes to poorly paid retail work.
The most life-saving accomplishments in medicine over the last century include advances in sanitation, vaccines, and the discovery that a simple mold can be made into an antibiotic to cure once-fatal infections. Until the discovery of penicillin in 1928, the average life expectancy in the United States was 47 years. Because of penicillin, the leading cause of death is no longer infection, it is chronic diseases such as diabetes, heart disease, and cancer.
A friend asked me the other day what would do the most to improve the health of the children I see in my pediatric clinic.
“Raising the minimum wage,” I said without hesitation.
She looked perplexed. She was expecting something like gene-splicing or advances in cancer treatment. But, as I explained my answer, she quickly saw why this controversial intervention could do the most good, for the most vulnerable people.
In Philadelphia, the childhood poverty rate hovers at about 35%. Even more troubling, 65% of infants and toddlers in Philadelphia, whose brains and bodies are developing more rapidly than at any other age, live in areas of concentrated poverty. This makes them much more susceptible to the effects of poverty-related stress, which can harm health and development long after they are grown up.
Scientific evidence is irrefutable: infants and children who grow up in areas of poverty and in households that subsist on poverty-level wages, are more likely to:
Unbuffered poverty has long-lasting effects on areas of the brain responsible for learning and decision-making. It causes inflammation of the coronary arteries and lungs, leading to heart attacks and COPD. It even affects DNA.
Philadelphia has the distinction of having one of the worst discrepancies in life expectancy by zip code of any big American city. By the lottery of birth, a child who grows up in zip code 19132, called Allegheny West, has a life expectancy of 68 years. The average annual household income for a family of four there is $24,000. In 19106, the Old City part of town, where the median income is four times that of Allegheny West, the average life expectancy is 88 years. Just a few miles means 20 years.
Obviously, wealth equals health in Philadelphia.
For more than 10 years, Pennsylvania’s minimum wage has been $7.25 an hour, the lowest wage allowed by federal law. A majority of Philadelphians voted to raise the minimum wage to $15 in May. Doing so would benefit underpaid workers, especially women who often head their households. These women are breadwinners for a majority of the 65% of infants and toddlers living in concentrated poverty. They are the defenders and the decision-makers for our city’s future. Some worry that a wage increase will hurt small businesses and teens trying to get their first jobs. This fear doesn’t pan out in the research.
In 2004, the U.S. Department of Labor reviewed 64 studies on the effects of minimum wage increases and unemployment and found no correlation between the two. A groundbreaking study just released in July by the Institute for Research on Labor and Employment demonstrated that a $15 minimum wage would not create job loss in low-wage states such as Pennsylvania, but would lift more people out of poverty. Their research did not identify any adverse effects on employment, including weekly hours among workers with a high school diploma or less. To recap: no adverse effects on workers, more money for families, more protective health effects, decreased inequities.
I think back to a tired-eyed single mother I saw recently with her 10-month-old baby boy in her lap. She had just finished her overnight shift in a factory, where she makes $10 an hour. I thought back to my friend’s question.
Daniel R. Taylor is an associate professor at Drexel University College of Medicine and director of community pediatrics and child advocacy at St. Christopher’s Hospital for Children.