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

Federal Reserve Bank of San Francisco 3

Today


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


$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.


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


https://www.frbsf.org/our-district/about/sf-fed-blog/racial-equity-primer/

Life course perspective:A Thriving Labor Force Starts at Birth

11

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.

12

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)

15

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


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


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


Child care enables women’s labor force participation

Labor force participation for men and women with children under six


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


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



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


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%


Mothers who contributed at least a quarter of total household earnings


64%72%

0%

25%

50%

75%

100%

U.S.Nebraska


Labor force participation rate of women 20+


Source: Bureau of Labor Statistics, Employment status of the civilian population by sex and age, chart from @keds_economist


Child care workers struggle to make ends meet

Child care workers earn low wages


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


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.


Child care is hard to afford

Child care costs as a percentage of income in Nebraska


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


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


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%


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


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]

https://www.frbsf.org/community-development/

Applying a Life Course Lens for a Healthy and Inclusive ...

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