Inside the numbers: Tennessee children are healthier, but possibly because of poverty

When the Kids Count National Data Book was revealed on July 25, Tennessee had a mixed bag of results. The state came in at 16th in the country in children’s health, an achievement lauded by the Tennessee Commission on Children and Youth.

But low rankings in economic well-being (38th), family and community well-being (39th) and education (42nd), dampened the call for celebration.

A surface reading of Tennessee’s ratings provides an anomalous picture: Kids are getting poorer, but healthier. Among the specific data used to come up with the ratings:

• The percentage of children living in poverty increased from 20 percent in 2000 to 26 percent in 2010.
• More than 550,000 children lived in a household where no parents had full-time year-round employment.
• The number of children without health insurance decreased by 27,000 from 2008 to 2010.
• The child and teen death rate and teen drug and alcohol abuse numbers have decreased over the past three years.

However, the economic and health factors aren’t mutually exclusive, according to the commission’s executive director, Linda O’Neill. In fact, the economic downturn has had a positive impact on children’s health.

“One of our better areas is on children without health insurance. Tennessee has consistently been fairly aggressive in Medicaid coverage and then in CoverKids, the public health programs. Those are really important in terms of having fewer children who don’t have health insurance,” O’Neill said. 
“And actually, when children are poor they are more likely to be eligible for those programs.”

Enrollment numbers from TennCare reflect statistics from the Kids Count report. From 2006 to 2012, TennCare’s child enrollment increased from 629,278 to 703,506 in the state. That figure doesn’t include 52,703 children covered by the state’s CoverKids program in 2012. Only 16,378 kids were enrolled in the first year of CoverKids in 2006.

TennCare’s most recent numbers suggest the overall percentage of children without health insurance is even lower than the statistic reported by Kids Count. The University of Tennessee conducted a study of TennCare recipients that showed only 2.4 percent of the state’s children were uninsured — which is lower than the Kids Count figure of 5 percent in 2010.

And according to O’Neill, the number of uninsured children may continue to decline. The Affordable Care Act will provide even more opportunities for children to receive health care coverage, O’Neill said. 
“One of the important things about expansion of health coverage under the Affordable Care Act is that it will apply to all children and it also will apply to more families,” O’Neill said.

“Right now, children are more likely to be eligible than families, but there’s a fair amount of research that suggests when parents are also covered, they are more likely to apply for and use health care insurance ... for [their] children.”

That’s what leads to the commission’s “two generation” strategy for curbing the economic numbers and retaining good health ratings.

“[We need] to focus on not only improving outcomes for children through investing in their health and development and educational services, but also to focus on parents and especially young parents to be sure they have job skills and employment,” O’Neill said.

“Again, the recession has been devastating — children who live in high-poverty areas whose parents lack secure employment ... we really need to be strengthening the workforce and the availability of jobs in Tennessee.”

Another key point for the commission is pushing for more pre-kindergarten programs for kids in Tennessee. Gov. Bill Haslam mentioned in May that he would consider expanding pre-K programs with the state’s improving economic status. 
According to O’Neill, a good pre-K program could help improve educational and social factors that affect the well-being of children. 
“A good-quality early childhood education program provides the kinds of activities that help with healthy brain development and learning basic social skills,” O’Neill said. “It not only helps children’s cognitive development, but almost as important, it helps with their social and emotional development.”

Voluntary state-funded pre-K programs for at-risk children will be available in every county in Tennessee this school year.

In all, O’Neill hopes the state will continue to fund initiatives to help kids and families. 
“Good public policy and strategic investments make a difference in improving outcomes for children,” O’Neill said.

By the numbers
In addition to the statewide data provided by the Kids Count report, there were also several data sets for Nashville-Davidson County numbers. Here are some highlights:

• 25.7 — The percentage of children in poverty in Nashville in 2008 and 2009. The number is a slight increase from 24.2 percent in 2007.
• 54,698 — The number of children receiving food stamps through the federal Supplemental Nutrition Assistance Program in 2008. 39,628 kids received stamps in 2005.
• 239 — The number of teen births recorded in Nashville in 2009, which is 100 fewer teen births than in 2006.
• 73,075 — The amount of Nashville children on TennCare. In 2002, only 63,356 children were enrolled in TennCare.