It is a well-documented fact that American children living below or just above the poverty line have much higher relative frequencies of health problems of all sorts. It goes without saying that access to health care is one of the key issues of child overall well-being. Basic medical care is absolutely necessary for survival and child development. Therefore, virtually all other industrialized countries see health care as a universal right for children. Not so in America. Poverty in this country influences child health directly by making it harder for families to afford health services. At any given moment in the United States around 12 million children are uninsured and have little or no access to adequate and appropriate health care. For instance, in 1992, a shocking 12.7 percent of America's children (8.4 million!) had no health insurance coverage for the entire year.

The point is that during the 1980s and 1990s growing numbers of families with children in this country simply fell through the medical safety net. One in three children in America has never seen a dentist! Very often poverty causes many parents to delay seeking medical care until a child is gravely ill... Poor American families are constantly forced to make impossible budget choices about which pressing needs to address and which to risk ignoring. Should they pay the rent if it means running out of food for their growing children before the end of the month? Should they buy winter clothes for the children if it means falling behind on the rent? Is it "worth" to having a child's medical checkup or immunization if it means missing another utility bill and having the heat or electricity cut off? The longer a family is forced to take these kinds of chances, the greater the likelihood the children's health will deteriorate to the point of irreversible damage...

The Medicaid system for poor Americans finances health care for only 40 percent of those below the official poverty line. It must be said that kids in working-poor families are without health insurance at a much higher rate than any other group of American children. More than a quarter of the children in these families live without any health insurance most of the time. That is about twice the rate for all Americans, and in most cases it is because the parents' employers do not provide health benefits. At the same time, these families are ineligible for Medicaid because they are not welfare assistance recipients. Besides, one major barrier to health care for poor families, even with Medicaid insurance, is the difficulty of finding a doctor who would accept Medicaid. Many doctors here simply refuse to accept it, in part because of very low Medicaid reimbursement rates from the government. As an example, in 1989 one in four pediatricians surveyed said that they would not accept Medicaid. In a survey by the U.S. General Accounting Office, 15 percent of uninsured and Medicaid-insured women who had received inadequate prenatal care or no care at all during their pregnancy said they could not find a doctor who would see them...

Thus, increasingly large numbers of poor children are simply left out of the American medical system, with predictable results. Many diseases of childhood are preventable with routine immunization, yet immunization rates for American children are very low. Only 67 percent of children under two years of age here get the full series of all necessary immunizations, as compared to a 90 percent rate announced by UNICEF in 1993 for twelve developing countries. The United States now ranks 70th worldwide in preschool immunization rates. Because of poverty, millions of American children are failing to receive vital immunizations that could protect them against such diseases as polio, measles, and mumps. The number of children immunized against polio declined sharply in the 1980s, and half of all small children in the U.S. are not now protected against this crippling disease. And measles is back, too. The last comprehensive immunization survey in the United States showed that 21 percent of one-to-four-year-olds were not immunized against measles. Consequently, 17,850 cases of measles with 41 deaths were reported in 1989, up from 1,500 cases in 1983. Further, in 1990 there were 27,672 reported cases of measles in the United States. The truth is that in the last decade of the XX century America is doing a poorer job of looking after the health needs of its children than Cuba does...