The social determinants of health are often thought of as social, economic, and environmental factors that affect health outcomes. These factors are often described as being upstream or downstream (Woolf & Braveman, 2011; Braveman, Egerter, & Williams, 2011; Bharmal et al., 2015). Upstream factors are those that set the causal pathways in motion, whereas the downstream factors are closer to the health outcomes. For example, a child who is consuming an over-abundance of sugar-sweetened and fatty foods, which may, in turn, lead to obesity, would be an example of a downstream determinant of health. In contrast, resources such as education, income, and neighborhoods with few or no grocery stores would fall under the category of an upstream social determinant of health.

In trying to address and reduce health disparities within an individual, it becomes critical to address the role of upstream determinants of health in the persistence of disease within those communities in which individual resides (Woolf & Braveman, 2011; Braveman, Egerter, & Williams, 2011). Furthermore, as we begin to understand how upstream determinants of health contribute to health disparities within specific populations, we need to be mindful of how they affect adult behavior and how they affect the health and well-being of children, as heal- thy behavior begins in childhood (Francis et al., 2018). To that end, we must start to examine the research that addresses the prevalence of health disparities within children and the connection between health disparities and the social determinants of health during the early years (Tolliver, 2010).

The conditions under which children are born expose them to environments that can place them on a positive or negative life course (Moore, McDonald, Carlon, & O’Rourke, 2015). To date, there has been a large body of research that has demonstrated that early life experiences can positively or negatively affect brain development, socio-emotional functioning, health, and early learning (Crosnoe, Wu, & Bonazzo, 2012; Woolf & Braveman, 2011; Braveman, Sadegh-Nobari, & Egerter, 2011; Braveman, Egerter, & Williams, 2011; Phillips & Shonkoff, 2000). Young children are growing up in low-income households where social and economic resources are strained fare less well with respect to physical health, socio-emotional, cognitive, and behavioral developmental outcomes than their more affluent peers (Hertzman, 2010; Woolf & Braveman, 2011). Moreover, African- American and Hispanic children are often less likely to be in excellent or good health than their White peers, placing them at a disadvantage to develop into healthy adults (Flores, Olson, & Tomany-Korman, 2005). Furthermore, it has also been demonstrated that health disparities are linked to school readiness (Currie, 2005). For example, children who experience chronic health problems such as untreated cavities are less likely to do well in school and often have behavior problems. These children are often from low-income families, with African-American and Hispanic toddler and preschool-aged children having more untreated dental cavities than their White peers (Currie, 2005). Thus, African- American, Hispanic, and poor children are not only on a trajectory for experiencing poor health outcomes; they are also on course for having limited academic success, a foundation that will prove to be deleterious for positive adult growth and development (Currie, 2005).

Despite these outcomes, few studies have examined the relationship between disparities in health and early childhood experiences within the context of downstream and upstream social determinants of health, in particular, the health and early childhood experiences for African-American and Hispanic children living in poverty.

In order to address this gap in the research, the purpose of the present study was to examine the association among access to healthcare, living in neighborhoods with exposure to multiple risk factors, and the educational and health outcomes for young African-American and Hispanic children. More specifically, the questions assessed were as follows: 1) What is the prevalence of access to health care, dental care, and mental healthcare for African-American and Hispanic children 3 - 5 years of age?; 2) What is the prevalence of parental concerns about receptive and expressive language, and the behavior of African-American and Hispanic 3 - 5-year-old children?; 3) What is the relationship between access to medical healthcare and living in neighborhoods with detracting elements and the overall health for African-American and Hispanic children 3 - 5 years of age?; 4) What is the relationship between access to medical health care and living in neighborhoods with detracting elements and the physical health of African- American and Hispanic children 3 - 5 years of age?; 5) What is the relationship between access to dental healthcare and living in neighborhoods with detracting elements and the oral health for African-American and Hispanic young children 3 - 5 years of age?; and 6) What is the relationship between access to mental health care and living in neighborhoods with detracting elements and the behavioral health and educational outcomes for African-American and Hispanic chil- dren 3 - 5 years of age?

The data for this paper comes from the 2011/2012 National Survey of Children’s Health. The NSCH is a national survey conducted via telephone in English and Spanish and provides a wide range of information about children’s health and well-being. A total of 95,677 surveys were collected nationally for children between the ages of 0 - 17 years. Survey results were weighed to represent the population of non-institutionalized children at the national and state levels ages 0 - 17. The survey is sponsored by the Maternal and Child Health Bureau of the US Department of Health and Human Services and the National Center for Health Statistics of the Center of Disease Control and Prevention (Child and Adolescent Health Measurement Initiative, 2012). The data is housed on the Data Resource Center for Child and Adolescent Health (DRC) which provides access to public data on the status of children’s health and health-related services for children, youth and families. Further details about the survey can be found on the Data Resource webpage (DCR, n.d.).

The demographic data for the survey includes indictors for US children by age group, sex of the child, the race and ethnicity distribution of the child population, the level of the child’s household income, and quality of the neighborhood. The sample for the current study included data for 1496 African-American and 2451 Hispanic children 3 - 5 years of age. See Table 1 for weighted and unweighted demographic data for the sample.

Statistical analyses were performed using the SPSS Complex Survey Samples software. To account for the complex sampling design of the NSCH all estimates were weighted and adjusted in the analysis unless specified in the results. The survey weight represents the population of non-institutionalized children ages 0 - 17 nationally and in each state (NSCH, n.d.)

Descriptive statistics were computed for children 3 - 5 years of age to assess their overall health and the prevalence of their access to healthcare, dental care, and mental health care. Table 2 provides estimates for the overall health of children 3 - 5 with the majority of children reporting to being in excellent or good health. That said the number of children reported to being in fair or poor health is highest among Black children at 5.4% and Hispanic children at 4.9%.

Table 3 provides estimates describing the overall condition of 3 - 5 year old

children’s teeth. In general the majority of children were reported to have teeth that are in excellent, very good, or good condition. The number of children reported to have teeth in fair or poor conditions was highest among Hispanics 13.5% children and Black children 6.6%.

Table 4 provides estimates for access to preventative medical care for children during the past 12 months. In general the majority of children had access to 1 or more visits in the past 12 month. Among the children reported to having no preventative visits lack of preventive care was highest for Hispanic children at 16.4% and Black children at 12.3%.

Table 5 provides estimates for access to preventative dental care for children during the past 12 months. In general the majority of children were reported to have had access to 1 or more preventative visits in the past 12 month. Among the children reported to having no preventative visits lack of preventative care was highest for Black children 30.3% and White children at 27.8%.

Table 6 provides estimates for access to mental health care by children during the past 12 months. In general the majority of children were reported that they needed treatment or counseling but did not receive it with Hispanic and Black children reporting the highest need for care 67.4% and 61.7 respectively, but not receiving it.

Table 7 provides estimates for parent’s expression of concern over the ability of their children to understand language. Hispanic and White parents expressed more concern about their children’s abilities with African-American parents expressing less concern.

Table 8 displays the estimates for parent’s expression of concern over the ability of their children to make speech sounds and expressive themselves. Again White and Hispanic parents expressed more concern about their children’s abilities to express themselves than African-American parents who expressed less concern.

Table 9 presents the estimates for parent’s expression of concern about the learning, development, or behavior of their 3 - 5 year old children. White and Hispanic parents expressed more concern about their children’s learning, development, and behavior than African-American parents who expressed less concern.