In medical school and residency training, we learn about how poverty can directly and indirectly negatively affect someone’s health. This is especially true for children due to their developing minds and bodies. For example, for kids, childhood poverty can increase infant mortality, cause low birth weight and birth complications (1). Poverty can exacerbate chronic conditions (asthma, obesity, diabetes, etc) due to poor access to clean living environments or healthy food options (1). Additionally, it can increase the chances of language and developmental delays, and mental and behavioral health conditions due to exposure to chronic stress (1). While these examples are not comprehensive, they expose the wide variety of negative outcomes that can affect children for the rest of their lives. As pediatric residents working in the hospital and clinic settings, we see how these manifest in our patients daily, often disproportionately.

The most updated data we have on national poverty rates comes from 2022 census data. This information tells us that the national poverty rate was 11.2%, with the child poverty rate slightly higher at 12.5% (7). Notably, the child poverty rate had steadily increased from a post-pandemic low of 5.2% in 2021 (7). Locally, the DC child poverty rate is higher than the national average at 21.4% in 2022 (5). It is well known that in DC, there are large disparities in rates based on the ward, with Ward 3 having the lowest childhood poverty rate of 1.3% versus Ward 8 having the highest at 35.8% (5). Because Children’s National Hospital serves the whole DC and DMV area, we often see these disparities firsthand in our patients.

As medical trainees, we often experience these issues and ask ourselves, how can I contribute to solving this problem? There are opportunities in every patient encounter we have to address family’s needs and set kids up for success by discussing social determinants of health and poverty measures with our families and working with our social workers and other ancillary support staff. There are also larger policy and community-based efforts that can extend our impact as advocates for children. When thinking about ways to address childhood poverty, there exists a lot of overlap between other important child advocacy areas, such as food insecurity, housing instability, employment, and health insurance coverage. This allows there to be a wide variety of areas in which childhood poverty can be addressed.

Our local and national governments play a significant role in creating policies that influence child poverty. On the national scale, one proposed cause of the child poverty rate increase from pandemic lows in 2021 to the most recent reported rate in 2022 is the expiration of the COVID-19 child tax expansion (4, 6,7). This increased credit was estimated to have lifted 2.9 million children out of poverty over the pandemic (7). Notably, the 2024 senate failed to pass a slightly more limited but permanent expansion packet. This issue, and similar issues like Medicaid, WIC, SNAP, and school meals, will certainly come up this fall in the election and in upcoming years.

While one unique aspect of attending residency in the nation’s capital is being so close to national action like these, another benefit is being so close to the local DC city government. DC residents have the opportunity to advocate for issues by talking with their elected officials, testifying publicly in support of or against DC legislation, or being involved with other local advocacy groups and efforts. These are all methods that pediatric residents have participated in in recent years.  And similarly to the national scale, there are a lot of issues that affect childhood poverty on the DC city council radar.

The 2025 DC budget is currently under congressional review, but some major anti-childhood poverty legislation is included. Similar to the national child tax credit, DC has its own credit which is being proposed. Under this budget plan and bill, DC families with children under 6 would receive a tax break of $420 per child (up to three children) with phase out at higher incomes (3). Other topics currently on the table include affordable housing programs, family leave, universal school meals, and affordable daycare programs (2). These policies have the potential to make a significant impact on those 21.4% of kids in DC living in poverty.

With all these topics being discussed, stakes are high in the local DC elections this fall. Half of the ward council members and two at-large members are up for re-election this year. This puts the DC community, including Children’s National residents, in a good position to research and vote for candidates who support the kids that we treat every day.

Pediatric residents have been involved with policy pushes in DC at multiple levels for a long time. For example, this past spring, a group of second-year residents advocated to the DC Health Care Finance office to expand coverage of generic fluticasone under DC Medicaid. Their direct advocacy led to coverage for all patients under 12 starting in June 2024. Another group advocated at various council member’s offices to support B25-0035, the Universal Free School Meal Amendment Act, which is currently under council review. Other residents have worked with the local DC AAP chapter to testify on various other bills at the DC city council.

These are just a few examples of how residents can be involved with advocacy and policy issues that directly affect our patients who are experiencing poverty in our community. There is always a lot at stake for the children we serve. We, as pediatricians, must use our voices and influence to speak for our patients, who often can not advocate or fight for themselves.