Rx for children’s health: Renew the expanded Child Tax Credit 

A powerful, life-saving medicine was brutally yanked away from millions of kids this year with the expiration of the expanded Child Tax Credit, which temporarily lifted nearly 3 million children out of poverty, a record drop. Since then, millions of children have fallen back. In the last weeks of the 117th session, Congress should prescribe the return of the expanded Child Tax Credit.  

The health care implications are drastic. Pediatricians do everything in their power to make kids healthy, but the most potent medicine can’t be ordered on the electronic medical record or picked up at the local pharmacy. We spend $4.1 trillion on health care every year – 20 percent of our entire Gross Domestic Product – but a main driver of ill health, the malignancy of childhood poverty, is left untreated. This doesn’t just erode the health of kids, but the lives of the grown-ups they will someday become.  

The more we learn about the developing brain, the more we understand how poverty — especially early, deep, and persistent poverty — injures the brain and dramatically hinders a child’s entire life trajectory. Poverty is one of the strongest risk factors for bad health — increasing the rates of asthma, obesity, developmental delay, infant mortality and injuries. 

We both work in Michigan, where more than one in two children in the city of Flint are officially poor, among the highest rates of child poverty in America. Many more families living just above the poverty line still struggle to make ends meet. Once touted as the birthplace of the middle class, Flint has formerly prosperous neighborhoods where more than an astounding 80 percent of young children have fallen below the official poverty level in recent years. Thousands of kids in Flint — and millions across the nation — grow up without their basic needs met, including food, shelter, clothing, security, safe transportation, adequate education, and consistent child care, in addition to health care. Even in the tightest labor market in a generation, good living-wage jobs are scarce. 

Poverty, especially when experienced in early childhood, and other forms of exposure to prolonged, significant adversity are recognized by the medical establishment as toxic stress that alters biological function at the molecular, cellular, and behavioral levels. It messes with many body systems in complicated, life-altering ways, including genomic function, brain structure and activity, metabolism, neuroendocrine-immune function, the inflammatory cascade, and the microbiome.  

The fall-out can impact development to such a deleterious degree that it’s seen in academic achievement, economic productivity, lifelong chronic illness, and even life expectancy. A child born in Flint can expect to live 20 fewer years than a child born in a more affluent part of the same county, a striking place-based disparity that is echoed throughout our nation. Before these kids are even born, their potential is poisoned.  

So what’s the treatment? In Flint, we are tired of band-aiding health inequities. A broad coalition of community partners — residents, nonprofits, academics, the government, and others — is working on a universal cash allowance pilot program for every child from birth to age 5. We still have millions of dollars to raise, but we are determined to build a foundation for health that endures and takes our children into adulthood, rather than continue to patch preventable ailments.  

Renewing the expanded Child Tax Credit has a similar game-changing potential for the entire nation. Providing supplemental income support to families with children — similar to “family allowances” that many other countries provide — is the easiest, boldest, and most effective strategy to prevent and reduce child poverty. Research done by UNICEF shows that every country that adopts a family allowance policy, including Canada, Germany and the UK, sees child poverty fall dramatically.  

And that’s exactly what happened in the United States when an expanded Child Tax Credit took the form of a modest cash transfer to poor and middle-class families in the second half of 2021 — $250 every month for every 6- to 17-year-old child and then $300 every month for kids under 6 years old. The evidence is rolling in. Our rate of child poverty plummeted to its lowest ever. Food insecurity among families with children, known to be closely linked to many long-term health conditions, also fell to the lowest rate ever recorded, with evidence indicating that the greatest impact was felt among families of color. The data show that families had more give in their bank accounts in 2021 and 2022 and were better able to sustain a financial crisis than before the pandemic. It wasn’t just families in poverty who saw these health-supporting benefits. Working class families had less trouble putting food on the table during the months of the expanded Child Tax Credit and more of a financial cushion.  

Raising kids is expensive. Even families well above the poverty line struggle to pay for child care, diapers, and all the other things kids need. Providing cash support for families helps all our children succeed. And although there has been concern that cash benefits during COVID-19 contributed to inflation, more than 400 economists recently signed a statement arguing that the Child Tax Credit was “too small to meaningfully increase inflation across the whole economy.” 

Fighting poverty with this kind of approach has already had enormous success in the U.S. Senior poverty was dramatically reduced with the creation of Social Security and Medicare in the 1960s. Today 16 million seniors are lifted out of poverty and shielded from hardship with an immensely successful cash benefit. For children, the long-term impact, according to a National Academies of Sciences report, pays a multiplicity of societal dividends. Economists recently found that adding $1,300 in family income during a baby’s first year in life led to higher earnings in adulthood. In addition to being pro-health, the expanded Child Tax Credit is pro-economy with a profound return on investment. 

No amount of health care can compensate for our lack of investment in prevention. As Frederick Douglass said, “It’s easier to build strong children than repair broken men.” Sometimes building strong kids comes as an infection-fighting jab in their arms and sometimes it’s the passage of a potent policy that helps poor and middle-class families alike. 

The lame duck session could be the last time in many years that we as a nation can return to this profoundly effective poverty prevention tool. It is past time our policies caught up with the science of early development and the lifelong impacts of significant adversity.  

It is time for a national prescription. Rx: Renew the expanded Child Tax Credit and refill until the age of 18. 

A pediatrician, Mona Hanna-Attisha is a C.S. Mott Endowed Professor of Public Health and director of the Pediatric Public Health Initiative at Michigan State University College of Human Medicine in Flint. She is the author of “What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City.” H. Luke Shaefer is the Hermann and Amalie Kohn Professor of Social Justice and Social Policy at the Ford School of Public Policy and director of Poverty Solutions at the University of Michigan. He is the co-author of “$2.00 a Day: Living on Almost Nothing in America.”