6 Public Heath Messes Caused by the #DiaperGap

My first job in governmental public health was a summer intern at the county health department. My mission: investigate the unique needs of babies in a public health emergency. It was a strange summer, to say the least. I imagined terrorist attacks, mass orphanages, and baby injuries. I experienced vast disparities in readiness between moms with no resources and moms clutching their pearls at the horror of the government being entrusted with the well-being of their child.

And I was proud of my final report. Its completion warranted a special trip to Walgreens to buy a fancy new blue binder, instead of the ragged used ones from the supply closet. Intern overachiever.

But much to my surprise, the report came back with a big red X on the cover. I had chosen a clip art image of a baby bottle to give my report some extra flair. My supervisor, a career public health nurse, informed me gently that public health has deep values that go beyond the obvious. We care about babies being fed, of course, but we also care that our messages (and report covers, apparently) encourage breastfeeding over bottle feeding. It was one of my first lessons in the complexity, but also the deep thoughtfulness, in public health’s comprehensive approach to shaping a healthy environment.

One of the issues addressed in my binder was diaper shortage. This was obviously an issue in my imaginary scenario where the local Walmart is targeted by terrorists — but for many families, a diaper shortage is a reality of the daily, chronic emergency of poverty.

Diapers can cost up to $100 a month for one baby. WTF. One in every three families report not having enough diapers. The poorest Americans can spend nearly 14% of after-tax income on them. Other families reuse, stretch their supply, or go without.

View live data: https://plot.ly/50/~cashmank

Diapers are often dismissed to taking the backseat to immediate concerns for low-income families, like for rent and food, but upon closer inspection they are an essential health asset. Poverty it usually discussed as an abstract concept, but diaper need offers a tangible manifestation of poverty that can be held in your hand and confronted.

The #DiaperGap is a public health issue — not just during emergencies — that causes or exacerbates health problems with lifelong consequences.

Here are six public health messes caused by inaction on the #DiaperGap:

1. Diaper Rash

Most obviously in the short term, babies left in soiled diapers develop diaper dermatitis (diaper rash) and urinary tract infections. In a recent study, approximately 8% of families reported stretching their diaper supply due to a shortage. This means more babies sitting in dirty diapers.

At any given time, over 2 million American babies (20–25%) have some type of diaper irritation — 10% (over 200K) being severe enough to blister, bleed, or peel. Not only does that sound painful, it can cause unnecessary visits to the pediatrician.

2. Maternal Depression

Mothers who lack an adequate supply of diapers report more symptoms of depression and anxiety than their peers.

Maternal depression is an incredibly common problem in need of preventive solutions. More than half (52%) of mothers reported during HeadStart Enrollment that they had enough depressive symptoms to be considered depressed when their children were under age 1.

Turns out, according to a recent peer-reviewed study, diaper need was actually a stronger predictor of a mother’s mental health need than food insecurity.

3. Low Academic Achievement

Though depression is obviously bad for mom, parental depression also has an impact on child health. Maternal stress and depression have been shown to be significant contributors to children’s well-being and their performance in school. This may actually mediate the relationship consistently observed between poverty and child outcomes.

“High levels of stress and depression in a parent can be associated with low achievement in school and mental health problems that can follow a child for a lifetime.” — Meghan Smith, Yale School of Medicine

Heightened stress in the home in early childhood can make children less ready for school, impact socialization, delay reading, and decrease utilization of preventative healthcare services.

Gaps in academic achievement then limit educational attainment, which perpetuates the cycle of poverty, unemployment, and poor health for a lifetime. If an adequate supply of diapers is a way to reduce parenting stress, this could be a smart early childhood investment.

4. Infectious Diseases

Sanitation is the cornerstone of modern public health. Toilets were designed to effectively separate human waste from human contact, in order to stop the spread of deadly bacteria, viruses and parasites found in human waste.

Until babies can mount a latrine, diapering and hand-washing are critical reduce the spread of fecal borne illness among children, families, and childcare providers. Noroviruses can be transmitted in the feces of children for at least 25 days after symptoms have stopped.

Public health workers have traced outbreaks in E.coli and Shigellosis to childcare diapering practices. Yikes, no thanks.

5. Child Abuse and Neglect

Diaper shortages have been directly linked to child abuse. Babies with diaper rash are cranky, cry more, and bond less. Crying adds to a parents stress and increases likelihood of abuse.

“What we see is a higher rate of child abuse. The child is unable to be consoled, and the parent already has such limited resources both financially and emotionally. If the baby keeps crying and crying, it really gets to most anyone, so the risk of injury to the child is certainly much higher.” — DiAnne Mueller, CEO of Crisis Nursery, a St. Louis-area child abuse prevention agency

Of course, child abuse and neglect set the trajectory for a lifetime of emotional consequences including anxiety and depression.

6. Health Disparities

Inequities in health and healthcare continue to ravage populations already most vulnerable for disease and lower life expectancy.

Diaper shortages disproportionately burden low-income children, particularly from Hispanic families. Because poor families can’t afford to buy in bulk, diaper prices can actually be twice as expensive for them. Yet another example of how much more expensive it can be to be poor. The wealth stratification of diaper affordability piles another struggle on families already at risk for poor health, and contributes to the inequity that segregates health in our country.

Action Needed

Diapers are just as important to low-income families as paying for rent and food. Yet government programs like food stamps do not currently cover paper products including diapers. In fact, the significant out-of-pocket expenses of diapers are depleting budgets many families need to pay for other critical expenses. Spending so much on diapers digs families deeper into poverty.

When viewed as a public health issue with lifelong consequences including poverty, mental illness, injustice, and risk of infectious disease — we all benefit when children are diapered. An adequate diaper supply can be a preventative health asset for both the individual child and the public— very much like vaccination.

This is why President Obama just announced a #DiaperGap campaign to confront the accessibility and affordability of diapers. His new Congressional budget request actually includes a $10 million investment to test ways to get diapers to low-income families. Until then, the White House is partnering with industry, start-ups, and non-profits to come up with innovate solutions.

But innovating affordability (via industry partnerships) is only one part of the public health puzzle.

By encouraging the use of disposable diapers, we accidentally cause more unintended public health impacts. Currently 16 billion diapers weighing 3 million tons create 2% of the entire US solid waste stream. Most users don’t follow instructions to dispose of feces into the toilet before throwing diapers away.

So huge numbers of diapers, full of potentially infectious bacteria, are being dumped into our waste stream and posing potential health risks to sanitation workers and our public groundwater.

We need to innovate diapers that cause less waste, are more easily recycled, educate users to follow directions, AND are more affordable. You can help by locating a diaper bank near you, helping a non-profit sign up as a distribution center, or sharing your innovative ideas with the hashtag #DiaperGap.

When healthy babies flourish, women flourish, families flourish, and society flourishes. Closing the #DiaperGap can help.

Kyle Pfister is founder of Ninjas for Health, a startup imagining creative and technological solutions to tangled public health issues. You can follow the team’s adventures on Twitter and Instagram.

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