Academic journal article The Future of Children

Health Disparities and Gaps in School Readiness

Academic journal article The Future of Children

Health Disparities and Gaps in School Readiness

Article excerpt


The author documents pervasive racial disparities in the health of American children and analyzes how and how much those disparities contribute to racial gaps in school readiness. She explores a broad sample of health problems common to U.S. children, such as attention deficit hyperactivity disorder, asthma, and lead poisoning, as well as maternal health problems and health-related behaviors that affect children's behavioral and cognitive readiness for school.

If a health problem is to affect the readiness gap, it must affect many children, it must be linked to academic performance or behavior problems, and it must show a racial disparity either in its prevalence or in its effects. The author focuses not only on the black-white gap in health status but also on the poor-nonpoor gap because black children tend to be poorer than white children.

The health conditions Currie considers seriously impair cognitive skills and behavior in individual children. But most explain little of the overall racial gap in school readiness. Still, the cumulative effect of health differentials summed over all conditions is significant. Currie's rough calculation is 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.

Currie scrutinizes several policy steps to lessen racial and socioeconomic disparities in children's health and to begin to close the readiness gap. Increasing poor children's eligibility for Medicaid and state child health insurance is unlikely to be effective because most poor children are already eligible for public insurance. The problem is that many are not enrolled. Even increasing enrollment may not work: socioeconomic disparities in health persist in Canada and the United Kingdom despite universal public health insurance. The author finds more promise in strengthening early childhood programs with a built-in health component, like Head Start; family-based services and home visiting programs; and WIC, the federal nutrition program for women, infants, and small children. In all three, trained staff can help parents get ongoing care for their children.


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. …

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