Health of Children and Parents: Understanding and Addressing the Crisis Families Face in the Global

Economy

Dr. Jody Heymann M.D., Ph.D.

March 2, 2006

Findings from:

Forgotten Families

Ending the Growing Crisis Confronting Children and Working Parents in the Global Economy

(Oxford University Press, 2006)

For further information on these studies contact:

Jody Heymann, MD, PhD

Founding Director

McGill Institute for Health and Social Policy

Project on Global Working Families at Harvard jody.heymann@mcgill.ca, (514) 398-3978

Demographic and Laborforce Transformations

• Transformation in both men’s and women’s labor over the short and long term

• Movement away from laboring where children can accompany, away from work where adults control hours to work where supervisors determine hours and families not present

• Movement of first men then women into industrial and post-industrial laborforces

Transformation in women’s paid labor

The percentage of the paid labor force that is made up of women increased between 1960 and 2000 from:

• 26 to 38% in the Caribbean• 16 to 33% in Central America• 17 to 25% in the Middle East• 23 to 31% in North Africa• 31 to 46% in North America• 27 to 43% in Oceania• 32 to 41% in Western Europe• 21 to 35% in South America

Caring for Children

Providing an Environment that Promotes Healthy Development

“I would like to work fewer hours. . . . and I would like to leave work earlier to be able to spend more time with her. Children aren’t raised well when one has to work all the time.”

Global Commonalities:

Families Talk About Work-Family Time Conflicts

“I can’t be with them all the time to share with them about life, to tell them the values of life and how to guide them. . . . We don’t really have enough time to be together….I do not have enough time to spend with them at home and to guide them.”

“I had to work ‘til nine. … I had to make food, and Joe had to go and warm the food up. He had to help Melvin … with his homework [and] sometimes Sandra. Then they had to do their chores and clean the house. He had to make sure Melvin was going to bed. And then I found he was yelling at them. Melvin would cry a lot. … There’s no supervision there, so of course he’d be like yelling like he’s the boss and telling them what to do, or being, he was technically sort of kind of raising my kids. He’s 11 years old, and he’s raising his brother and sister. I wasn’t there enough.”

Parents talk about having to leave their preschool children in inadequate care

“We left the child at home with her grandmother. She was old, so she could not care for the child as a mother could. But there was nothing we could do when our family faced economic difficulties. After the child would go, I cried a lot. I was very worried.”

“I do have very serious problems with [the baby-sitter] because she leaves the child alone and she doesn’t even lock up the house. She just goes. I just have to keep moving on because I can’t afford any better help. I’ve always had problems with household helpers because of the amount of money that I can afford to give them.”

“One day I came back and I asked her to watch [Tricia] and I left her. But when I came back, [the baby-sitter] had gone back to sleep. The lady had my daughter on this mattress with no sheets.”

“Occasionally the principal would want to talk to me about something … How can I do that?... What am I going to do? Go all the way home and come all the way back [afterwards, to work] just to meet with [the principal]? You know I couldn’t do that [during the workday].”

Families Talk About Work and their Children’s Education

“For example, for language class, I try hard to teach my child how to spell this and that, so that he knows more; I intend to do it but I can’t make it a reality. Teaching my child, I’m too tired. There’s the economic part of it, and then there’s the influence of my work. So I’m exhausted and I can’t make it a reality; I can’t teach my child in a complete way. I really want to, but I can’t.”

“The bad thing is that the job is really demanding… When she comes back from school, she has to clean and do that which I should have done before work… The problem is with the older one. When she comes to my work, I give her the keys and tell her, “Do a, b, and c when you get home.” I think this is affecting her school work. It’s just too much for a kid of her age to do. But I have no choice.”

27

9

48

3

19

4

0

5

10

15

20

25

30

35

40

45

50 Had to leave childhome alone or in thecare of an unpaidchild

Relied on paid childfor child care

Frequency Children Are Left Alone or in the “Care” of Other Children

Source: Data from Project on Global Working Families in-depth interviews with working caregivers. Analysis is based on households with a 0-5 year old.

Per

cent

age

Of

Fam

ilies

Who

…

27

9

48

3

19

4

0

5

10

15

20

25

30

35

40

45

50

Mexico Botswana Vietnam

Had to leave childhome alone or in thecare of an unpaidchild

Relied on paid childfor child care

Frequency Children Are Left Alone or in the “Care” of Other Children

Source: Data from Project on Global Working Families in-depth interviews with working caregivers. Analysis is based on households with a 0-5 year old.

Per

cent

age

Of

Fam

ilies

Who

…

Seguro Social provides childcare for workers in the private formal sector

Public policies provide formal childcare

Vietnam had more families overall with access to formal childcare, and the differences across income groups were smallest due to the availability of public services. 57% of lower-income families in Ho Chi Minh were able to send a child to formal childcare, as were 62% of higher-income families.

Caring for sick children

Global Commonalities

“One morning, Andrew didn’t want to go [to school sick] and I made him go. Because I made him go, I had to come and get him – school wouldn’t let him walk home. If I’d kept him – [at home, by himself], I wouldn’t have had to leave work.”

“I am also often sick. I often worry. I worry about my son being sick, my family’s economic situation… I have to worry about my son’s childcare fee, the rent, my son’s health-care fees, and the like. I think a lot; therefore, sometimes, my memory is reduced. I often forget. Although I go to work, I am always thinking of my son.”

“The last time she was in the hospital, I knew she was ill and she had to go to urgent care. They gave her medication, and she still wasn’t getting any better. I took her to the baby-sitter. I told her, “She has to have her medication.” The problem is that the day-care provider doesn’t give her medication when she’s supposed to. So the last time when my daughter was ill, I knew that if I’d been on top of everything it wouldn’t have gotten that bad. She ended up having to be in the hospital for a whole week.”

“At half past seven, when I was going to work, my last born was sick. He was vomiting, had diarrhea and stomach complaints. I left him with my neighbor, but the neighbor didn’t care for my child. She just left him there vomiting. Immediately when I came home I thought my child looked worse. I took him to the hospital around half-past six, and he was tired and pale. I had wanted to leave the job, but then I thought, what would I give the child?”

“My daughter was sick back in the fall. She got real sick. It was a combination of asthma and just a real bad cold. I remember I had to get in to work and so I left her home. She needed me here, but I felt like I had to be at work.”

“We need money. My child is sick and I would be happy to stay home, but I need money. I cannot even take one day a week because I’m afraid I will be fired.”

Statistics

• 61% of working parents in Baltimore had left a sick child home alone or in someone else’s care.

• In Botswana, 32% of working parents had either left a sick child home alone or sent a child to school or day care sick.

• In Mexico, 18% of working parents had either left a sick child home alone or had sent a child to school or day care sick.

• In Vietnam, 27% of working parents had either left a sick child home alone or had sent a child to school or day

care sick.

Policies in caring for sick children

Solutions can be found in countries with less economic resources:

• In Mexico paid sick leave benefits at 60% wage replacement rate of up to one year are guaranteed through a social security system, Seguro Social.

• 16% of working parents report having to leave a sick child home alone.

• In Vietnam federal law guarantees paid sick leave benefits at 75% wage replacement rate to workers for 30 days and for young children for 15 days (20 if under 3 years of age).

• In Ho Chi Minh City, 7% of working parents report having to leave a sick child home alone.

• In the United States there is no federal paid sick leave policy for workers or their children’s health.

• In Baltimore, 58% of parents reported they could not stay home with a sick child.

Situation around the world

• 49 nations from around the globe provide paid sick leave for care of children.

• Of the countries for which duration data were available, 46% mandate that employers guarantee one to ten days or more of paid leave.

• 54% guaranteed 11 days or more of paid leave.• 3 countries mandate paid leave of 31 days or more.

Outside the United States paid sick leave is widely available and often for at least a week:

• 153 nations from around the world provide sick leave for working adultso 126 countries provide sickness benefits for at least one weeko 95 countries have paid sick leave for one month or moreo 76 countries provide paid sickness benefits for at least 26 weeks

or until recoveryo The vast majority provide it with at least 50 % wage replacement

rate

Gender Disparities

Balance of Family Responsibilities (US)

78

13

44

15

4

30

0

10

20

30

40

50

60

70

80

90

% o

f w

orki

ng a

dult

care

give

rs r

epor

ting

that

...

Women

Men

they do more household chores than their spouse or partner

they are unable to rely on their spouse or partner for help w ith

a serious problem

family members (beyond their spouse or partner) make too

many demands

69

36

87

52

83

44

0

10

20

30

40

50

60

70

80

90

100

Brazil Mexico Russia

Dual earner mothers

Dual earner fathers

Mothers in Dual Earner Households Are More Likely to Average 60 or More Hours of Paid and Unpaid Work Weekly

Per

cent

age

of F

amili

es w

ith H

igh

Tot

al

Wor

k H

ours

Source: Data from national household surveys. Analyses in the above figure are based on households with a 0-14 year old child. Note: Total work hours equal the sum of employed hours, housework, and caregiving. The Brazil figures are underestimates because no data was available specifically on caregiving hours.

Lack Basic Fringe Benefits (US)

59

4640

4540

47

56

3230

47

33

41

0

10

20

30

40

50

60

70

Lack sick leave Lack vacationleave

Lack sick andvacation leave

Have less than 1week of sick leave

Have less than 1week of vacation

leave

Have less than 2weeks of sick and

vacation leaveBenefits

% o

f w

ork

ing

adu

lt c

areg

iver

s w

ho.

..

Women

Men

Bars represent parents w ho lacked benefits some or all of the time they w orked betw een 1990 and 1996 (1996 is most recent data available at time of study)

36

2526

19

43

36

0

5

10

15

20

25

30

35

40

45

Were unable to get paid leave Were unable to get paid leave orflexibility

Did not have access to healthinsurance through job

Female Male

Lack Decent Working Conditions (Global)

Source: Note: Data from Project on Global Working Families in-depth interviews with working caregivers. These analyses are based on households with a 0-17 year old child.

Perc

enta

ge o

f Pa

rent

s W

ho…

12

2

43

27

49

28

1210

51

44

0

10

20

30

40

50

60

Lost job promotions or haddifficulty retaining job

because of need to carefor sick children

Lost pay when respondentcared for sick child

Lost pay or lost jobpromotions or had

difficulty retaining jobsbecause of need to care

for sick chidren

Lost job promotions or haddifficulty retaining jobs

because of othercaregiving respoinsibilities

Reported that caring for asick child or other

caregiving responsibilitiesled to difficulties at work

Female Male

Women More Likely to Report Facing Job Penalties (Global)

Source: Note: Data from Project on Global Working Families in-depth interviews with working caregivers. These analyses are based on households with a 0-17 year old child.

Perc

enta

ge o

f Pa

rent

s W

ho…

Lack Basic Fringe Benefits (US)

76

5852 53

57

6863

4236

4945

5254

3126

47

32

4240

2822

39

1924

0

10

20

30

40

50

60

70

80

90

Lack sick leave Lack vacationleave

Lack sick andvacation leave

Have less than1 week of sick

leave

Have less than1 week of

vacation leave

Have less than2 weeks of sick

and vacationleave

% o

f w

ork

ing

ad

ult

car

egiv

ers

wh

o..

.

0-25%

26% -50%

51% -75%

76% -100%

Family Income

Bars represent parents w ho lacked benefits some or all of the time they w orked betw een 1990 and 1996 (1996 is most recent data available at time of study)

Job Inflexibility (US)

38

68

54

83

71

33

62

50

74

53

28

59

47

74

48

14

3830

63

34

0

10

20

30

40

50

60

70

80

90

Decide when to takebreaks

Choose starting andquitting time

Change starting andquitting time (among

those who canchoose)

Work at home on aregular basis

Take days off for sickchildren

% o

f wor

king

adu

lt ca

regi

vers

who

can

not

...

0-25%

26%-50%

51%-75%

76%-100%

Family Income

57

48

21

12

46

38

35

22

38

28

67

46

0

10

20

30

40

50

60

70

Had difficulty caringfor kids when sick, dueto work responsibilities

Left sick children homealone

Left sick child alone orsent to school/day care

Experienced anynegative impact of ownworking conditions on

children's health

Experienced difficultiescaring for sick children,

and either left sickchild home alone orsent to school sick

Lost pay because ofneed to care for sick

children or left childrenhome alone

Parent's income <$10 a day

Parent's income ≥$10 a day

Low-income Parents at Greater Risk of Experiencing Difficulties Caring for Their Sick Children

Source: Data from Project on Global Working Families in-depth interviews with working caregivers , 1999—2001. Analyses in the above figure are based on households with a 0-17 year old.

Perc

enta

ge o

f Pa

rent

s W

ho…

28

55

26

44

22

9

32

13

0

10

20

30

40

50

60

Sent child to formal childcare

Relied on informal careprovided by a paid adult

Relied on informal careprovided by an unpaid child

Left child home alone

Parents have middle school orless educationParents have high school or moreeducation

Parents with Limited Education More Likely to Have Poor Child Care Options

Source: Data from Project on Global Working Families in-depth interviews with working caregivers. These analyses are based on households with a 0-17 year old child.

Perc

enta

ge o

f Pa

rent

s W

ho…

The “Perfect Storm”

Major demographic transitions over the past 50 years:

• Urbanization

• Labor Transformation

• Globalization

• children home alone

• children in care of other young children

• increased illness and injury rates

• educational disadvantages magnified

• lost wages

• lost chances of exiting poverty

•gender inequities magnified

Demographic shifts far outpaced societal response with high toll on children and

parents

Implications for US and the world

• There is now an unprecedented level of competition for jobs – and global movement of jobs. The greatest job loss from the United States to other countries began with the manufacturing sector. However, the job loss is now widespread in the United States and includes jobs in the service sector, as well as low-skilled entry-level and high-skilled professional jobs.

• Jobs are not only being lost now from Europe, the United States, Canada, and similar economies, jobs are also being lost from middle-income countries.

• Moreover, the movement of jobs has spurred a downward spiral in working conditions.

Myths Feeding Inaction• Myth 1: We Don’t Know What Works

In fact, there is extensive evidence regarding what would make a difference in the health, development and education of children. Among the many policies and programs that we know would make a difference are paid parental leave, early childhood care and education, and paid leave for children’s health needs.

• Myth 2: Improvements Can’t Reach Workers in the Informal Sector

Workers in the informal sector can be insured and paid leave provided through cooperative arrangements. Moreover, many of the parents interviewed landed in the informal sector when they were unable to keep formal sector jobs while caring for their children.

• Myth 3: No Affordable Solution

Addressing the needs of working families globally will cost money, but it is affordable. Most of the programs and policies required have self-scaling costs, that is, their costs are lower in poor countries than in affluent countries.

• Myth 4: Bad Jobs Are Better than No Jobs, and Action Threatens Bad JobsBeing better off – if that “better off” still means living in misery – is not an adequate

reason to stop fighting for improved conditions. Furthermore, if we ignore bad jobs, the global economy will race to produce more.

• Myth 5: Parents Can Solve the Problems AloneAs the stories and statistics in Forgotten Families show, working parents around the

world are forced to make untenable choices between earning a living and caring for their children.

• Myth 6: Individual Countries Have No ChoiceIn actuality, individual countries have passed into law protections vital to the welfare of

working parents in every region around the world. In some areas, such as paid maternity leave, enormous progress has been made over the last century.

• Myth 7: There’s No Way to Move Forward GloballyCollective action holds many advantages in the context of a global economy. Collective

action would allow countries to set a humane floor on working conditions and prevent nations from competing for capital, factories, and jobs by guaranteeing conditions that are unsustainable for those working, their children and families, and societies.