If the nation's institutions for health care and education are to deal successfully with the challenges identified in chapter 1, significant weaknesses in these services must be overcome. These problems impede optimal mental and physical development of the individual from the time of conception to initial stable employment or secure enrollment in post-secondary education/training.
There are five factors external to both the individual and the two sets of institutions. They can interpose substantial additional deterrents to physical and mental development. These are (1) economic status, especially poverty and parent unemployment or nonparticipation in the labor force; (2) neighborhood environments, particularly economically depressed and/or crime- or drug-ridden areas; (3) the plague of homelessness, wherein child and adult acquaintances are out of the economic and/or behavioral mainstream; (4) family structure that is disintegrating or fragmented, including parental death, separation, divorce, or desertion, and unmarried motherhood and consequent female-headed family and/ or household; and (5) parents and peers who are uncaring, abusive, or discouraged and who place a low value on, or disparage, educational achievement and good health practices.
For children, the incidence of poverty in a geographic or an employment context is often similar. The combination of economic disadvantage at home and growing up in a neighborhood where the cultural home-school-peer and surrounding environment discourages schooling, work, and societally legal or otherwise acceptable behavior can easily be disastrous. The noneconomic environmental factors are examined subsequently, but the following data include separate summations of poverty in general and its geographically concentrated incidence.