Society to cell: How child poverty gets “Under the Skin” to influence child development and lifelong health

Almost one in three children globally live in households lacking basic necessities, and 356 million of these children were living in extreme poverty as of 2017. Disasters such as the COVID-19 pandemic further increase rates of child poverty due to widespread job and income loss and economic insecurity among families. Poverty leads to unequal distribution of power and resources, which impacts the economic, material, environmental and psychosocial conditions in which children live. There is evidence that poverty is associated with adverse child health and developmental outcomes in the short term, as well as increased risk of chronic diseases and mental illnesses over the life course. Over the past decade, advances in genomic and epigenomic research have helped elucidate molecular mechanisms that could in part be responsible for these long-term effects. Here, we review evidence suggestive of biological embedding of early life poverty in three, interacting physiological systems that are potential contributors to the increased risk of disease: the hypothalamic pituitary adrenal axis, the brain, and the immune system. We also review interventions that have been developed to both eliminate childhood poverty and alleviate its impact on pediatric development and health. Pertinently, studies estimate that the costs of child poverty, calculated by increased healthcare expenditures and loss of productivity, are immense. We argue that investing in child development by reducing child poverty has the potential to improve the health and well-being at the population level, which would go a long way towards benefiting the economy and promoting a more just society by helping all individuals reach their full potential.