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Behind from the Start

Whitgob, Emily, MD, MEd

Journal of Developmental & Behavioral Pediatrics: January 2018 - Volume 39 - Issue 1 - p 54
doi: 10.1097/DBP.0000000000000532
Book Reviews

Developmental-Behavioral Pediatrics, Stanford University School of Medicine and Stanford's Children's Health, Stanford, CA

Disclosure: The author declares no conflict of interest.

Lenette Azzi-Lessing writes about the detrimental impacts of poverty on American children from birth through 5 years old. Initially a community social worker, Azzi-Lessing transitioned into an academic career and draws from the combined wisdom of the 2 experiences to expertly describe a fraught and nuanced topic. Readers benefit from both scholarly discipline and accessibility; educators, parents, policy makers, and mental health and medical providers will gain insight into the lives of children and their families.

Readers' attention is captured from the first pages of the book when the author sets out to explain the “stubborn rate of child poverty.” Pointing out that it should not be assumed that voters and policy makers will read the research literature, this book serves as an interpreter of current research. It draws from the varied fields of neuroscience, child development, and public policy, among others. Rates of poverty are persistently high, particularly for a country as wealthy as the United States. Throughout the account of the past 50 years of programs that have tried to improve the well-being of children in poverty, the intersection of race and poverty is illuminated, and the complex causes of the intergenerational cycle of poverty become clearer. The point is well made that poverty is structural and not cultural and that poor people are not to blame for being poor. This book explains how US responses to family poverty actually harm children by punishing families for being poor and by deferring to schools to rectify the damage experienced by children born into poor families. Even the programs designed to reduce poverty have not been effective or sustainable; an entire chapter is devoted to the child welfare system and its repeated tragedies. After depicting the disheartening reality faced by poor families and their young children, Azzi-Lessing moves on to outline specific program components to truly impact positive outcomes for this most vulnerable group.

The urgency of the problem of poverty is palpable. Although the book is situated in a relevant historical context, the role of the current administration figures prominently. This timely resource offers tools that are flexible enough to accommodate contemporary problems. Azzi-Lessing underscores that approaches to poverty that do not work are not simply ineffective when they are implemented, but they often make the problem even worse. One of her most compelling arguments is that to address something as complex as poverty within dynamic communities, simple solutions do not exist; comprehensive solutions are required. She challenges the commonly held beliefs about which social programs work and thoughtfully analyzes home visiting programs and universal preschool. Evaluating these programs must be rigorous and use quality evidence.

One could argue for more case examples, simply because Azzi-Lessing writes so vividly, and it is a luxury to read her illustrations of policies and programs. However, her explanations of the policies and their implications for children and their families are succinct as they stand. More examples may add unnecessary length to a direct and powerful volume.

In sum, anyone who is remotely connected to policy, health, or education or invested in the lives of children and marginalized groups will learn from this simultaneously deep and broad view of poor families with young children. Readers will finish this book with renewed energy to advocate for this group of vulnerable citizens.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.