Applying a Life Course Lens for a Healthy and Inclusive ...
Transcript of Applying a Life Course Lens for a Healthy and Inclusive ...
Applying a Life Course Lens for a Healthy and Inclusive Economy
Bina Patel Shrimali, DrPH Research Manager, Community Development
Thriving Children, Families, and Communities Conference, September 27, 2021
Federal Reserve Bank of San Francisco 2Source: Flickr, Candice
Ask for today: Let‘s look with new eyes
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Today
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Your work and the economyPast, present, future: Leveraging what we know about life course critical time periods to design policy and practice• Early Childhood• Pregnancy
Closing the gaps will grow the economic pie
Potential gains from closing racial and gender gaps in the economy
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$2.6 Trillion
More output in U.S. economy in 2019 if labor market gaps were
closed
Buckman, Shelby R, Laura Y. Choi, Mary C. Daly, and Lily M. Seitelman. 2021. "The Economic Gains from Equity," Federal Reserve Bank of San Francisco Working Paper 2021-11.
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Inequities limit the full potential of our
economy.
Our future workforce is increasingly
diverse.
Equity is central to the SF Fed’s missionEquity ties to the Federal Reserve’s mandate for maximum employment
What do we stand to gain?https://fedcommunities.org/closethegaps/
SF Fed Racial Equity Primer
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https://www.frbsf.org/our-district/about/sf-fed-blog/racial-equity-primer/
Life course perspective:A Thriving Labor Force Starts at Birth
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The United States Ranks Low in Birth Outcomes Compared to Other CountriesPercentage of preterm births: United States and selected European countries, 2010.
MacDorman, MF, TJ Mathews, AD Mohangoo, and J Zeitlin. “International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010.” National Vital Statistics Report, September 24, 2014.
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Racial Disparities in Preterm Birth have Persisted Over DecadesPreterm Birth Rates, By Race And Hispanic Origin Of Mother,United States 1990-2013.
Martin, Joyce A., Brady E. Hamilton, Michelle J.K. Osterman, Sally C. Curtin, and T.J. Mathews. “Births: Final Data for 2013.“” National Vital Statistics Reports. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics,Division of Vital Statistics, January 15, 2015.
Babies are not blank slates
Othering(Structural Racism)
Neighborhood Conditions:Social and Economic Capital
Household Environment
Opportunities and Experiences across Life Course
Future Health and Economic Outcomes
Birth +
Early Childhood
Institutions and Policies(e.g. Redlining, Segregation)
Structural Inequities Life Course Model
Shrimali, et al
Othering is a set of dynamics, processes, and structures that engender marginality and persistent inequality across any of the full range of human differences based on group identities.
Examples: racism, sexism, ageism
(powell and Menendian, 2016)
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Questions?
Source: Mapping Inequality
Questions?
Fillmore
Potrero Hill
Bayview
Racism past and present shapes economic opportunity
Source: HOLC (1937) , Mapping Inequality
Hunters Point
Source: HOLC (1937), Mapping Inequality
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POVERTY ASTHMA POOR MENTAL HEALTH
The legacy of redlining shapes current disparities in economic opportunity and health
Note: Darker shaded areas represent higher rates of incidence. For adult population in 2018; Sources: ACS 2014-18, 500 Cities Project, CDC
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Indicators for San Francisco, 2018
Redlining practicesby banks and home
insurance agents
Racial steeringand block-busting
practices by real estate agents
Displacement caused by federal highway
construction and other urban renewal projects
Middle class and white flight to the suburbs
Discriminatory mortgage underwriting by the FHA/VA
Disinvestment andconcentrated poverty
in urban centers
What is at the root of residential segregation, economic inequities, and poor health?
Alameda County Public Health Dept.
Racial targetingof subprime loans
The racial wealth gap persists over time
Survey of Consumer Finances, Federal Reserve Board.
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$0
$50,000
$100,000
$150,000
$200,000
$250,000
1989 1992 1995 1998 2001 2004 2007 2010 2013 2016 2019
White Black Hispanic
Median Household Net Worth by Race, 1989-2019
The racial wealth gap persists across educationMedian Household Net Worth by Education and Race, 2016
Source: 2016 Survey of Consumer Finances. Note: “Some College” includes those with associates degrees; “College” refers to bachelor’s degrees and higher.
$11,000 $10,910 $13,810
$68,200$62,000
$102,850 $103,430
$399,000
$0
$100,000
$200,000
$300,000
$400,000
$500,000
Less than High School High School Some College College +
Black White
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Babies are not blank slates
Babies have our history in their biology
Income volatility in pregnancyFrom pre-pregnancy to the birth month, on average, U.S. households experience a 10.4% decline in total income
As expected, single mothers who live without other adults face significantly larger drops in household income (41.8%)
Wealth plays an important role in weathering income volatility
Stanczyk, AB. Greater Financial Supports Could Improve Household Economic Wellbeing around a Birth, UC Davis Center for Poverty Research, Volume 4, Number 7, 2014.
Life course perspective: Child care and the economy
Parents need child care to participate in the labor force
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U.S. workforce with children <18
67%
Children <6 with all available parents in the labor force
U.S. Bureau of Labor Statistics, April 21, 2020.
32%
Children under Age 6 with All Available Parents in the Labor Force in the U.S.” Kids Count Data Center, 2018.
Child care affects work decisions
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Changed jobs for higher pay Asked for a more flexible schedule
Switched from full-time to part-time schedule to save money on child care
63%
Made career / workforce changes based on child care costs
“This Is How Much Child Care Costs In 2019.” Care.com, July 15, 2020
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Child care enables women’s labor force participation
Labor force participation for men and women with children under six
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93%
64%
0%
20%
40%
60%
80%
100%
Men Women
“Employment Characteristics of Families.” U.S. Bureau of Labor Statistics.
Mothers who contributed at least a quarter of total household earnings
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28%
1967
Glynn, Sarah Jane. Breadwinning Mothers Are Critical to Families’ Economic Security.” Center for American Progress, March 29, 2021.
66%
2019
Black and Native American mothers are more likely to be main contributors to family income
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Glynn, Sarah Jane. Breadwinning Mothers Are Critical to Families’ Economic Security.” Center for American Progress, March 29, 2021.
30%
37%
41%
53%
55%
68%
26%
26%
20%
22%
19%
17%
Asian or Pacific Islander
White
Hispanic, any race
Multiracial
Native American
Black
Main Contributor Contributes at least 25%
Low-income mothers are more likely to be main contributors to family income
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69%
46%
36%
32%
29%
26%
26%
20%
22%
19%
Lowest income quintile
Second income quintile
Third income quintile
Fourth income quintile
Top income quintile
Main Contributor At Least 25%
Glynn, Sarah Jane. Breadwinning Mothers Are Critical to Families’ Economic Security.” Center for American Progress, March 29, 2021.
Mothers who contributed at least a quarter of total household earnings
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64%72%
0%
25%
50%
75%
100%
U.S.Nebraska
Glynn, Sarah Jane. Breadwinning Mothers Are Critical to Families’ Economic Security.” Center for American Progress, March 29, 2021.
Labor force participation rate of women 20+
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Source: Bureau of Labor Statistics, Employment status of the civilian population by sex and age, chart from @keds_economist
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Child care workers struggle to make ends meet
Child care workers earn low wages
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Whitebook, Marcy, Caitlin McLean, Lea J.E. Austin, and Bethany Edwards. “Early Childhood Workforce Index 2018.” Center for the Study of Child Care Employment, University of California, Berkeley, 2018.
Center-based wages by race/ethnicity
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Whitebook, Marcy, Caitlin McLean, Lea J.E. Austin, and Bethany Edwards. “Early Childhood Workforce Index 2018.” Center for the Study of Child Care Employment, University of California, Berkeley, 2018.
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Child care is hard to afford
Child care costs as a percentage of income in Nebraska
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19%
Infant Care
“Child Care Costs in the United States.” Economic Policy Institute, July 2019. https://www.epi.org/child-care-costs-in-the-united-states/.
37%
Infant and Four-Year Old Care
Infant care cost as a percentage of minimum wage earnings in Nebraska
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67%
Infant Care
“Child Care Costs in the United States.” Economic Policy Institute, July 2019. https://www.epi.org/child-care-costs-in-the-united-states/.
U.S. public subsidies that reach eligible low-income families
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Child Care and Development Block Grant. Vogtman, Julie. “Undervalued: A Brief History of Women’s Care Work and Child Care Policy in the United States.”
15%
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Source: PSID from US Department of Treasury The Economics of Child Care Supply in the U.S. https://home.treasury.gov/system/files/136/The-Economics-of-Childcare-Supply-09-14-final.pdf
Evidence For Financial Security During Pregnancy
International evidence on cash transfers• Increase birth weight• Reduce perinatal, neonatal, and infant mortality
US evidence from EITC studies• Increases in birthweight• Improved self-reported maternal mental and physical health• Decreased biomarkers of physical and mental stress• Reductions in maternal smoking • Improvements in nutrition
Manitoba pregnancy income support
Fernald, Lia CH, Paul J. Gertler, and Lynnette M. Neufeld. "Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades." The Lancet 371.9615 (2008): 828-837.Hoynes, Hilary, Doug Miller, and David Simon. "Income, the earned income tax credit, and infant health." American Economic Journal: Economic Policy 7.1 (2015): 172-211.Wicks-Lim, J., & Arno, P. S. (2015). Improving population health by reducing poverty: New York’s Earned Income Tax Credit (Working Paper No. 377). Political Economy Research InstituteHamad, Rita, and David H. Rehkopf. "Poverty, pregnancy, and birth outcomes: a study of the Earned Income Tax Credit." Paediatric and perinatal epidemiology 29.5 (2015): 444-452.
Summing it upIntervening during pregnancy and early childhood could reduce toxic stress related to financial instability and to reduce health inequities
Racialized history in the U.S. plays a role in the disproportionate impacts today
This impacts our labor force and the potential of the economy
How can we design for well-being over the life course?
Source: Pillars of Well-Being, Prevention Institute, September 2017
BELONGING/ CONNECTEDNESS
Sense of acceptance and being part of a community
CONTROL OF DESTINY
Sense of purpose, ability to influence events that shape
life’s circumstances
DIGNITY
Sense of one’s value, honor, and respect
HOPE/ASPIRATION
Belief that something better is possible and achievable
SAFETY
Experience of security, possession of a sense of
stability
TRUST
Belief in the reliability, truth, ability, or strength of self and
others
Call to Action
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Your leadership is important for the economy of the futureWhat can be done differently during critical time periods of development?
Questions?
Source: Flickr, Candice
Healthy Food
Good Schools
EmpoweredResidents
Parks And Activities
Public Spaces
Housing
A Healthy And Inclusive Economy:
What Is Your Role?
Child Care
Financial Security
Transport-ation
Inclusive Policy-making
Meaningful Employment
Wealth-building
Clean Air
Medical Care
Thank [email protected]@bina513
The views expressed are those of the author and not necessarily those of the federal reserve bank of san francisco or the federal reserve system.
Thank youhttps://www.frbsf.org/
Keep in Touch: Find me on LinkedIn or Twitter (@bina513), [email protected]