August 5, 2019
As children, we are often able to delegate the onus of responsibility for our health to an older and more knowledgeable caretaker, a person we trust to act in our best interest and to care for us when we are ill. Unfortunately, however, this privilege does not extend to all young people. There are currently over 400,000 children in the American foster care system, many of whom experience severe chronic health conditions. It is estimated that anywhere from 30 to 80% of foster youth have at least one chronic medical condition, and roughly 25% have three or more chronic illnesses.
For many children, chronic conditions are life-changing but often manageable diagnoses given one’s access to resources and familial support; however, foster children seldom possess these advantages and, as a result, consistently experience far worse outcomes when dealing with such conditions.
Chronic illness is defined as any condition which requires ongoing medical attention or greatly compromises one’s quality of life. This can include a wide breadth of diagnoses such as type 1 diabetes, eating disorders, asthma, and cerebral palsy. For children in foster care, chronic conditions are not only more pervasive than in the general population but also more likely to cause serious and long-lasting health consequences.
For example, asthma affects 8.4% of the general youth population but boasts a prevalence rate of 32.8% within the foster care system. Compared to children in stable home settings, foster youth with asthma are less likely to attend recommended or scheduled outpatient visits and four times more likely to experience asthma-related hospitalizations.
Furthermore, triggers such as emotional stress and wrongfully prescribed medications, both of which foster children are routinely subjected to, are known to increase the likelihood and severity of asthma attacks. These undesirable realities place foster youth at a heightened risk of experiencing both asthma emergencies and other serious health complications.
Another example of this undue burden comes in the form of eating disorders. Histories of abuse, maltreatment, and other traumatic events are commonly viewed as risk factors in developing such illnesses. Given the trauma often associated with entering and navigating the child welfare system, it is perhaps unsurprising that bulimia occurs at a rate seven times greater in foster children than in the general population.
Additional data indicate that 77% of foster children display eating abnormalities either sometimes or frequently. Coupled with elevated rates of comorbidity, the volatility and impersonal nature of the child welfare system render foster youth with eating disorders an especially vulnerable population. This can ultimately lead to a vicious cycle of recoveries and relapses for such children, one which requires more intervention and individual consideration than the foster system can reasonably provide.
It is not enough to express pity or concern for these children; rather, we need to take deliberate steps to ensure that foster youth receive the physiological and psychological help they need. Mandating comprehensive and timely health evaluations for all children entering the foster system and improving data management and collection strategies represent two changes essential to solving this problem. Expanding chronic illness education and support services for caretakers, developing partnerships between foster care providers and advocacy organizations, and promoting individual advocacy efforts are also paramount in systemically improving the quality of life for youth in care.
Much is at stake in the quest to alleviate the burdens carried by foster youth with chronic health conditions. The test of our collective humanity demands that we ensure our children are not deprived of the support, intervention, and care they need to live healthy and fulfilling lives. It is up to us to do right by children who must face both a broken child welfare system as well as the trials and tribulations that accompany chronic illness. With our action or inaction, we wager their health and their futures.