Children (0-17 years) generally have the best health status of any age group of the population.  However, at mid-decade, increasing numbers of children are afflicted with asthma, weight issues, and other health problems.  

In recognition of the 11th annual National Public Health Week, April 3-9, 2006, the following CHDB data article will focus on the health status of children in the region.  

This year’s theme is “Designing Healthy Communities: Raising Healthy Kids” and highlights many public health challenges, such as access to fresh and healthy food and opportunities for physical activity, that affect children.   The Healthy People 2010 Initiative has set forth a myriad of objectives addressing children, including objectives focusing on health insurance, fruit and vegetable intake, weight, and physical activity. 

The following article presents those objectives and examines information about children residing in SEPA from PHMC’s 2004 SEPA Household Health Survey.

Health Status

Being in excellent or good health can send children on a trajectory of good health in adulthood. Currently in SEPA, 7.2%, or approximately 68,000 children are in fair or poor health, which has increased by 64% since 1994, when only 4.4% of children were in fair or poor health.

Demographic Characteristics

·  Boys and girls (7.3% and 7.0%, respectively) are equally likely to be in fair or poor health.

·  One-in-six Latino children (16.2%) and one-in-eight Black children (12.1%) are in fair or poor health, compared to Asian (8.0%), and White (3.1%) children.

·  Poor children (14.4%) are three times more likely to be in fair or poor health than non-poor children (4.6%).

County Differences

·  Philadelphia County has the highest percentage of children (11.1%) in fair or poor health in the region, while Chester County (4.1%) has the lowest percentage.

Asthma

Asthma is the leading cause of chronic illness among children and adolescents, and is rising more rapidly among preschool-aged children than any other age group. When not properly treated, asthma may result in emergency department and inpatient admissions, absences from school, learning difficulties, functional limitation and disability, and stunted growth.  Nationally, 12.2% of children suffer from asthma (NHIS, 2002).

At mid-decade, more than 170,000 children in Southeastern Pennsylvania suffer from asthma7—representing 18.1% of all children in the five-county SEPA region. The percentage of children diagnosed with asthma has steadily increased over the past ten.
 
While there are many triggers to an asthmatic episode, one trigger that may be difficult for children to avoid is cigarette smoke in the home. One-fifth (20.5%) of children in the SEPA area with asthma live with a smoker who smokes inside the home. In addition, 17.5% of children live with a smoker who smokes inside the car.

Asthma-Related Healthy People 2010 Objective

·  Reduce the percentage of children who are regularly exposed to tobacco smoke at home to 10%.

Demographic Characteristics

·  Boys are slightly more likely to have asthma than girls (19.4% vs. 16.7%, respectively).

·  Nearly one-quarter of Black (24.9%) and Latino (24.7%) children have asthma compared to White (14.5%), and Asian (10.3%) children.

·  More than one-quarter of poor children (27.2%, representing over 41,000 children) have asthma compared to 16.3% of non-poor children.

County Differences

·  More than one-fifth of children residing in Philadelphia County (22.4%) has asthma, followed by children living in Delaware (16.7%), Montgomery (15.2%), Chester (14.7%), and Bucks (14.4%) Counties.

Health Insurance Status

Currently in the SEPA region, approximately one-in-twenty children (4.8%) does not have any health insurance coverage—representing over 45,000 children in the area. While the percentage of children in the region without health insurance coverage has fluctuated overtime, there has been an increase since 2000 (Figure 1).  In addition, among children who are insured, currently 3.9% of children in SEPA are insured through CHIP—representing over 35,000 children.   The percentage of uninsured children in the region does not meet the HP 2010 objective of increasing the percentage of children with health insurance coverage to 100%.

Healthy People 2010 Objectives

·  Increase the percentage of children with health insurance coverage to 100%.

Demographic Characteristics

·  Latino children (13.4%) are approximately three times more likely than Black (5.1%), Asian (4.7%), and White (3.4%) children to not have health insurance coverage.

·  Poor children (9.1%) are more than twice as likely to not have health insurance coverage than non-poor children (4.0%).

County Differences
 
·  Philadelphia County has the largest percentage of uninsured children in the region (7.0%), followed by Bucks (5.9%), Montgomery (3.9%), Chester (1.7%), and Delaware (1.1%) Counties.   These counties are close to reaching the Healthy People 2010 objective to have 100% of children covered by health insurance. 

At-risk for Overweight and Overweight

Being overweight in younger life, children and adolescents become more prone to becoming obese adults, placing them at-risk for developing chronic conditions, including high blood pressure, Type 2 Diabetes, coronary heart disease, and stroke.  The Healthy People 2010 initiative addresses overweight among children and adolescents by seeking to reduce the percentage who are overweight to 5%.  Nationally, 16% of children ages 6 years and older are at or above the 95th percentile for Body Mass Index and are, therefore, considered overweight (NHANES, 2002). Locally in SEPA, more than one-fifth of children of comparable age groups (22.4%) are overweight. An additional 14.3% of children ages 6 years and older are considered at-risk for overweight in the SEPA area.8 Combined, approximately 214,000 children in Southeastern Pennsylvania, or 36.7%, are either at-risk for overweight or overweight.  In addition, nearly one-quarter of children (2-17 years of age) do not eat two or more servings of fruit or vegetables daily (Figure 2). 

Healthy People 2010 Objectives

·  Reduce the percentage of children ages 6-19 years who are overweight as defined by being at or above the age- and gender-specific 95th percentile of Body Mass Index to 5%.

·  Increase the proportion of persons ages 2 years and older who consume at least two daily servings of fruits.

Demographic Characteristics

·  The percentage of boys (38.8%) and girls (34.4%) who are either at-risk for overweight or overweight is roughly comparable.

·  Greater than one-half of Latino children (52.6%) are at-risk for overweight or overweight, compared to nearly two-fifths of Black (43.6%), one-third of White (32.5%) and one-quarter of Asian (26.0%) children.

County Differences

·  Philadelphia County has the largest percentage of children in the SEPA region that are at-risk for overweight or overweight (44.7%)—followed by Chester (34.2%), Montgomery (32.9%), Bucks (30.8%), and Delaware (29.2%) Counties.

Physical Activity and Sports Participation

Ongoing physical inactivity has been associated with a host of health-related problems—most notably weight gain. Some of the benefits of regular physical activity include both physical and mental development—such as building and maintaining healthy bone structure as well as allaying feelings of anxiety and building self-esteem. Participating in school or community sports is one such way for children to engaging in physical activity.  One-third of children ages 6 years and older in the SEPA region (33.4%) have not participated in any organized sports or activities in the past year9.  While it is recommended that all children age 6 and above participate in some form of daily physical activity regardless of weight status, over two-fifths of overweight children ages 6 years and older in SEPA (43.4%) have not participated in any organized sports or activities in the past year.  In addition, almost one out of five adolescents (12-17 years of age) exercise less than three times per week for 30 minutes.   

Healthy People 2010 Objectives

·  Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardio-respiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Demographic Characteristics

·  Girls are more likely than boys to not play sports (37.0% vs. 30.0%, respectively).

·  Latino (53.5%), Asian (46.4%), and Black (44.8%) children are more likely to not play sports than White children (24.7%).

·  Children with a fair or poor health status (62.2%) are twice as likely to not play sports than children with an excellent or good health status (31.0%).

·  Approximately one-half of poor children (48.8%) do not play sports, compared to nearly one-third of non-poor children (30.5%).

County Differences

·  Nearly one-half of children in Philadelphia County (46.6%) do not play sports, compared to the other counties in the SEPA region: Delaware (29.5%), Bucks (25.9%), Montgomery (23.1%), and Chester (21.2%) Counties.

Conclusion

At mid-decade in Southeastern Pennsylvania, many children continue to experience obstacles to receiving healthcare. One out of twenty children (4.8%) do not have any private or public health insurance.  One out of fourteen children (7.2%) is in fair or poor health and nearly two-fifths of children (36.7%) are either overweight (22.4%) or at-risk for overweight (14.3%).   With Healthy People 2010’s deadline approaching, many health indicators have yet to be met in Southeastern Pennsylvania.  For example, overweight among children continues to increase overtime, placing the Healthy People 2010 target of 5% for children at a greater distance. It is imperative that the prevalence of these behaviors decrease in the remaining time to ensure the attainment of the overarching goals developed by the Healthy People 2010 initiative: increasing quality and years of healthy life among the population.  For more information about the health status of children in SEPA, please contact Francine Axler at Francine@phmc.org or  215-985-2521.