Poverty is the main reason children experience poor health. As a pediatrician I see evidence of this every day. I am particularly impressed by how a little extra family income results in fewer premature births, less child maltreatment, and fewer teen pregnancies. Numerous studies have shown that even small boosts in family income translate into important health benefits, including buying more healthy food, and reduced family stress.

That is why a number of the bills that are currently moving through the Legislature this session have the potential to dramatically improve children’s health on these islands. They include the bills to enact a living wage (Senate Bill 789 and House Bill 1191) — provided it is a real living wage offering real financial relief immediately, not $2.40 cents in five years, as one of the bills proposes. The SNAP Double Up Food Bucks (SB 390) is asking for a state appropriation to allow users of SNAP (Supplemental Nutrition Assistance Program) to get double credit when buying Hawaii-grown fresh produce. It has been piloted on the Big Island, and there are a few other states that are already running such programs. This is a win-win-win situation. Parents can buy more food, children consume better food, and local growers see an increased demand for their produce.

It is easy to take comfort in the tremendous strides science has made on behalf of children: immunizations now prevent the most serious childhood infections; advanced therapies cure almost all children with leukemia; surgeries can now fix many infants’ birth defects before they are born.

However, recent scientific research shows how the environment, especially chronic stress associated with poverty, is responsible for biologic changes in children and adults. These biologic changes make children more susceptible to a variety of diseases, and make adults more likely to develop high blood pressure and diabetes, and engage in alcoholism and other self-destructive behaviors.

Many would not be too surprised to learn that life expectancy in some poor countries is 30 years less than rich countries. However, it is shocking that in the United States there is more than a 20 year difference in life expectancy between poor and rich counties. Equally shocking is the fact that when reviewing 20 Western, industrialized countries, children in the United States are the ones least likely to survive long enough to attend kindergarten. The huge income differences and high poverty rate in the United States, compared to other wealthy nations, are the major responsible factors.

The environmental culprits threatening health are called the social determinants of health. They include poverty, hunger, inadequate housing, transportation difficulties, unsafe neighborhoods and family violence. The more children experience these challenges, the more likely they are to become ill, do poorly in school, and engage in risky behaviors. And it is clear that adults with a lifetime of these challenges die sooner than those without.

Hawaii’s high cost of living, including rentals that call for more than a third of too many workers’ incomes, have led to the highest rate of homelessness in the nation. Hawaii has one of the highest rates of poverty (when measured properly) in the nation. Most states do not tax groceries. The fact that Hawaii does is another cause of family financial stress.

This year the Legislature has the opportunity to reduce the burden placed on children because of these social determinants. As a doctor I see the price too many children pay in the form of ailments that can be traced to poverty. I urge lawmakers to enact a real living wage to help my most vulnerable patients have a better shot at life. We cannot afford to fail our children.

Dr. Robert Pantell is medical director of the Child Advocacy and Protection Center, Kapiolani Medical Center for Women and Children.