Connecting the dots: Improving child care workers’ conditions leads to better health, economic stability, and greater equity

image of a woman and child

This blog previously appeared in Health Affairs:

These are volatile times. The fast pace of current events, dangers of the COVID-19 pandemic, and uncertainty about the upcoming November 2020 election, and the high stakes for health, equity, and economic recovery are dominating our waking hours and keeping us up at night. The stress is real. And, the impact is not evenly distributed. The pandemic is exploiting and worsening existing inequities, by taking lives and livelihoods. It presents a challenge, a responsibility, and an opportunity.

This is a moment to seize the potential of focusing on child care workers as a linchpin for broader health and economic benefits.

Improving Child Care Workers’ Job Quality

Why child care workers? Blue Shield of California Foundation is focused on health, so what is the connection? To achieve our mission to make California the healthiest state and end domestic violence, we are zeroing in on the root causes, or social determinants, that shape the outcomes that lead to poor health and violence. Economic security is key to health, but it hasn’t always been addressed by those in the health sector or health funders, although that is changing. We are part of the evolution to expand the definition of health to encompass the economic, physical, and social conditions that individuals and communities need to be healthy.

Within the economic spectrum, the “care economy” is a critical and overlooked sector that includes the care of children, people with disabilities, and older adults. This growing sector can improve the health of those who receive care and allow their families to pursue professional and educational opportunities, and ultimately, achieve the economic security that supports a healthy life. This is a big topic, and there are many partners at the table, but we need a bigger table, and even more people involved.

Child care workers are a vitally important essential workforce that produces health intergenerationally, for both children and parents. The benefits of child care to early childhood developmentlong- and short-term child health, and parental employment are well established, but less attention has been paid to the well-being of the workers who produce these positive outcomes. The Blue Shield of California Foundation is supporting multiple efforts to improve child care worker wages, benefits, and job quality, which will enhance the lives of children, families, child care workers, and communities. It is a long-term vision for economic growth and stability that cannot be delayed.

Today, the child care field is on the verge of collapse, both as a result of the pandemic and decades of chronic public underfunding, uneven employer-paid child care, wage disparities for care workers—often by race and gender, and the high cost of living and doing business. Before the pandemic, 51 percent of American families lived in a child care “desert.” Three months into the pandemic, 82 percent of child care owners believed that their businesses would not survive another year.

Child Care Workers Are Diverse, Pivotal To Family Success

Child care is part of the infrastructure for family success, and yet, these workers often struggle to meet their own household needs. Nationally, the workforce is comprised of women (94 percent), immigrants (22 percent), and people of color (40 percent). Most are mothers (52 percent) themselves, and most rely on some form of public support (53 percent). Their low, often poverty-level, wages and poor working conditions are associated with food insecurity, chronic disease, depression, and stress. African American child care workers earn 14 percent less than their white counterparts earn. This critical infrastructure is, in effect, underwritten by the low wages of workers whose earnings must increase to stabilize the child care system.

Family child care is particularly important to communities of color and low-income families, who depend on trusted neighborhood providers to offer flexible services and hours that meet their needs. These small home-based businesses can be sources of economic stability and opportunity for low-income owners, parents, and communities—producing both economic activity and greater equity.

Across the country, families with an infant and young child spend more on child care than on food and transportation combined. Families earning less than 200 percent of the federal poverty level spend five-times more on child care than what is considered affordable—and such spending disproportionately impacts low-income families and families of color.

Meanwhile, the costs of operating child care facilities have increased, especially during the pandemic. Public investments in child care have traditionally fallen far short of the need, despite the fact that child care investments yield returns of 7–10 percent per annum as a result of the children’s increased earning potential over their lifetimes, and the reduction in social costs associated with lower educational attainment. Without more resources to expand child care access, our post-pandemic economic recovery could falter, or worse, exacerbate social inequalities.

Foundations Can Strengthen The Child Care Sector

Foundations have a critical role to play. In September 2020 Blue Shield of California Foundation made an initial investment of $2 million to support child care workers and strengthen the child care infrastructure in California, including:

  • Expanding a promising business incubator program that helps workers operate successful family child care businesses,
  • Building networks of family child care owners and experimenting with methods to reduce costs, increase access, and strengthen professional supports,
  • Supporting research on the positive relationship between the well-being of child care workers and the children in their care, and
  • Advancing research and advocacy strategies to encourage new investment in universal family care, which spans child care, paid family and medical leave, and long-term services and supports. 

Rebuilding the child care field calls for re-envisioning operations, empowering owners and workers, and connecting those improvements to the health of children, their families, child care workers, and the many communities, who have all been undercut by the COVID-19 pandemic. We need to champion a mindset that recognizes the operators as small business owners and the workers as child development experts and that values the health that the child and the caregiver produce for each other. As a society, we need to invest in child care at a level commensurate with the value of improved health outcomes for millions of families and the value of our economic stability and recovery.

I invite you to join in this exciting and inspiring work to connect the dots that lead from child care workers to children’s health to their families’ economic stability and to greater health and opportunity for all.

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