health

Economic inequality is growing in America and economic mobility is declining. Most observers agree these are worrisome trends, but there is no consensus about solutions. In highly polarized public debates, some say that the government’s role should be limited to ensuring equal opportunity. Others emphasize the need for policies to encourage more equality. We believe that these extremes present a false dichotomy; a middle ground is possible. By looking for ways to further “school readiness,” citizens and policymakers can come together in support of giving all children what they need to take advantage of opportunities to learn and prepare for success in later life.

To Reduce Future Economic Inequality, Ensure That Children Succeed in School

Policy leaders from both sides of the aisle should be able to agree that can young children need to gain the basic attitudes, skills and knowledge required to succeed in school. Children will not enter the labor market on equal terms if stark inequalities begin to hold them back even before age five. Many children who are not ready for school cannot realize their potential – and that makes no economic sense for our country. Failure at school leads to losses of income and tax revenues as well as higher costs for social services, policing, and incarceration. Put another way, differences in school readiness influence kids’ capacities to take advantage of opportunities – and contribute to society – over the course of their whole lives.

Can we address educational disparities simply by make schools themselves more equal? If all schools had the same financial resources and the same number of teachers for every 100 students, and if all teachers were well-compensated and well-motivated and trained, would students from all groups have the same chance to perform well? The answer is no, according to available research. Even school systems of comparable quality cannot produce fair results when some children arrive at the first day of class unprepared to learn. To be ready to learn, youngsters must already have certain language, motor and social skills, and they must be able to pay attention, follow directions, and control their emotions. A lot must happen before the first day of kindergarten.If all schools had the same resources and the same number of teachers, and if all teachers were well-compensated and well-motivated and trained, would students from all groups have the same chance to perform well? The answer is no. more...

The suicide of a young person is always a tragedy, an event deeply mourned by the youth’s family and community. Sadly, the prevalence of this kind of tragedy is greater than many might think. Data from the Centers for Disease Control and Prevention for 2005 through 2013 indicate suicide has been the third or fourth leading cause of death for people ages 10 to 14, and the second or third leading cause of death for young people ages 15 to 24. Within these age groups, suicide rates can be further differentiated by race. Although suicide incidence has tended to be lower for Black youth than for other demographic groups, today suicides of African American children and young adults are on the rise. In order to understand how to reverse this worrisome new trend, a complex set of factors need to be examined.

Suicide by Race, Age, and Gender

In the total U.S. population not taking age into account, whites have the highest rate of suicide followed by American Indians and Alaskan Natives, and Asians and Pacific Islanders. Blacks and Hispanics have the lowest rates of suicide. For young people, the highest rates of suicide-related deaths occur among American Indians and Alaskan Natives. Rates of suicide for Black youth and the overall Black population tend to be lower than these other demographics – but things have changed recently. more...

And What Can Be Done To Make Jobs and Family Life More Predictable

For decades, work-family activists have pressed for policies to give workers flexibility. Some workers, most of them relatively affluent, have seen gains. They have won the ability to adjust their schedules, to choose how many days a week to work, and even to work from home. But as my colleague Dan Clawson and I document in our new book, Unequal Time, many employers in the United States are turning the concept of work schedule flexibility on its head. For employers using disturbing new tactics, “flexibility” means that employees – especially low-wage workers – must come in whenever the boss wants and can be sent home whenever demand is slack.

Unpredictable Schedules and Insufficient Hours 

News stories have featured the chaotic schedules of young people working in retail, cleaning, and fast food jobs – many of whom must come to work with just one day’s notice or work split shifts. About a third of young adults do not know their schedule more than a week in advance. But similar problems are faced by workers of all ages. Unpredictable schedules are becoming the new normal for many U.S. employees – ranging from low-wage nursing assistants to well-paid physicians. In the retail and health care sectors, many workers must call in the night before to find out if they will be needed – and if they will earn the wages they have counted on getting. At a nursing home we studied, for example, one out of three shifts turned out to be different from the official schedule planned in advance. more...

The wonders of family dinners are routinely celebrated in magazines, television shows, and other popular media. Many would have us believe that a family gathered to eat a healthy, home-cooked dinner at the end of the day is the answer to many of the ills that afflict modern America – including rising rates of obesity, family dysfunction, and a disengaged citizenry. The call for good parents to cook dinner for their families is mostly directed at women. This message reflects prevailing but often unrealistic standard for “good mothering.”   more...

U.S. efforts to ensure safe and healthy food are falling short. Even as more than 49 million Americans lack access to adequate nutrition, corporations are aggressively marketing unhealthy foods that contribute to epidemics of diet-related diseases. Many of the 30 million workers in the food industry face unsafe conditions and do not earn enough to support themselves and their families. The production and transport of food often spurs pollution and global warming.

In classic economic theory, when markets fail to meet human needs, government steps in to protect the public. Today’s U.S. public food programs and regulations amount to an incoherent and ineffective jumble – but fixing them could contribute to a healthier, more prosperous and sustainable American food economy. more...

Each year, 48 million Americans suffer from illnesses caused by dangerous microbial pathogens lurking in the food they eat. For most people, food poisoning just leads to temporary stomach aches or diarrhea. But the effects can be much more serious. According to the Centers for Disease Control and Prevention, more than 125,000 Americans are hospitalized and 3,000 die each year from pathogens in our food. Estimates of the cost of food borne illness exceed $75 billion a year – taking into account the cost of health care and lost time on the job for people who get sick. The actual suffering and economic cost could be much greater, because many incidents of mild illness caused by tainted food go unreported.

That eating dinner can result in disability or death comes as a shock to most Americans. Most of us believe that the United States fixed these problems more than a century ago, after Upton Sinclair’s famous book, The Jungle, revealed the ghastly facts about unsafe methods of commercial food processing for a mass market economy. But in fact, the rules and regulations we assume will protect us are inadequate. Duplication and gaps in government responsibilities leave Americans highly vulnerable to a variety of risks from industrial food production. more...

Since the Civil Rights Act of 1964, the United States has used the force of nationwide law to prohibit discriminatory treatment in the job and housing markets, in government and educational institutions, and at stores and facilities serving the general public. Many legally proscribed forms of exclusion and ill treatment are directed against people because of their race, ethnicity, national origin, religion, gender, age, and disability status. To this day, efforts continue to extend protections to additional groups, including gay, lesbian, bisexual, and transgender people.

Core American values of fairness and equality inspire nondiscrimination measures, but there is also an important health rationale. Research has repeatedly confirmed what common sense suggests: when people are subjected to discriminatory acts ranging from subtle putdowns to outright harassment or exclusion from opportunities, their personal wellbeing suffers. Discrimination contributes to health inequalities – and fighting bias can reduce them.

The Harmful Effects of Discrimination

Discrimination typically refers to unfair treatment of people on the basis of social identities defined by race, gender, sexual orientation, ethnicity, or religion. Many Americans report facing discrimination that constrains their livelihood – for example, when they are unfairly fired or denied a job or promotion, when they are denied a bank loan or medical treatment, or when they are discouraged by a teacher from pursing further education. Banned by law, such blatant forms of discrimination also affect victims’ health by depriving them of jobs, medical treatments, and other benefits and opportunities that keep them out of poverty and open doors of opportunity. more...

In 2006, the Massachusetts legislature passed and Governor Mitt Romney signed into law a health care reform with subsidized health insurance coverage for low-income people, a health insurance exchange to help people not otherwise covered choose among available plans, an individual mandate requiring residents to obtain coverage if affordable, and an expansion of Medicaid to include children and long-term unemployed adults. The reform in Massachusetts turned out to be a blueprint for the Affordable Care reforms passed by Congress and signed by President Barack Obama in 2010. ObamaCare, as the federal reform law is sometimes called, is only now going into full effect, as debate continues to swirl about its provisions and its likely effects. No one can tell what the national reform’s impact on Americans’ health will turn out to be, but we can get an idea of possible benefits by looking at what is known so far about the aftermath of the earlier Massachusetts reforms. more...

The Affordable Care Act aims to extend health insurance to tens of millions more Americans through two major routes: by giving people information and in many cases tax credits to help them purchase private insurance plans offered on state or national “exchanges,” or online marketplaces; and by giving the fifty U.S. states plus the District of Columbia additional federal funds to expand their Medicaid programs to insure all low-income people just above as well as below the federal poverty line. States have a key role in implementing health reform. Each state can choose to run its own exchange marketplace and help its residents learn about their options for purchasing affordable plans. Each state also decides whether or not to accept new federal subsidies to expand Medicaid (covering 93% of the costs from 2014 through 2022). What states do—or refuse to do—makes a big difference, as a comparison of the nation’s two largest states, California and Texas, makes clear. California is leading the way in showing that Affordable Care can work, while authorities in Texas are obstructing implementation with gusto. more...

New England is a compact and relatively liberal region, and its six states—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut—all had relatively high levels of health insurance coverage before the Affordable Care Act. Yet rates of prior coverage still varied, and these states have made different choices about implementing reform.

Leading into 2014, each U.S. state had two key decisions to make: whether to use federal funds appropriated by the Affordable Care Act to expand its Medicaid program to include people just above the poverty line; and whether to set up and run its own exchange, an online market place where residents can comparison shop for private health insurance plans and find out about their eligibility for federal subsidies to help pay the premiums. more...