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1 Introduction1 On December 16, 2021, the Roundtable on Population Health Improve- ment held its fifth and final workshop of the year, titled Economic Innova- tions to Support Health, Equity, and Well-Being: Exploring Policies that Further the Well-Being of Care Economy Workers. The workshop was held entirely virtually via webcast. Kirsten Bibbins-Domingo, roundtable co-chair and vice dean for population health and health equity at the Uni- versity of California, San Francisco, welcomed viewers and offered a land acknowledgment on behalf of the National Academies hosts of the event, conveying gratitude and respect to the Nacotchtank Piscataway people and elders whose lands are occupied by the District of Columbia. Bibbins- Domingo provided a brief overview of the roundtableâs vision and mission, and past relevant work, including explorations of several facets of the eco- nomic drivers of health, from business and health care sector investments, to the design of tax policies to support the work of population health improvement. The present event, she noted, was taking place at a time of economic and social upheaval exacerbated by the pandemic and racial injustice that had recently risen to national attention in an unprecedented way, with hardships that intensely affected care economy workersâthose 1 The planning committeeâs role was limited to planning the workshop, and the Proceed- ings of a Workshop has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus. 1 PREPUBLICATION COPYâUncorrected Proofs
2 ECONOMICS OF CARING BOX 1-1 Statement of Task Economic factors are an important driver of health. A planning committee of the National Academies of Sciences, Engineering, and Medicine will organize and conduct a public workshop to explore research, practices, and policies (being considered or already implemented at the federal, state, and local level) relevant to the health and economic stability of families and of workers (e.g., in the care economy). Examples may include municipalÂ experiments with guaranteed income, a state law calling for a study of reparations for descendants of enslaved people, and the expansion of the federal child tax credit. The planning committee will identify specific topics to be addressed, develop the agenda, select and invite speakers, and moderate the discussion. A pro- ceedings summarizing the presentations and discussion at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines.Â who care for the youngest and the oldest members of society, as well as for people with disabilities. The workshop was planned by a small group led by roundtable member Kosali Simon, of Indiana University, and also including Jason Purnell of BJC Health, Rita Hamad of the University of California, San ÂFrancisco (UCSF), and Debbie Chang of the Blue Shield of California Foundation. Rachel Wick, also of Blue Shield of California Foundation (BSCF), provided additional assistance, along with roundtable staff Alina Baciu, Ayshia Coletrane, Alexandra Andrada, and Maggie Anderson. The planning committeeâs task is provided in Box 1-1. The organization of this proceedings follows the workshop agenda. Chapter 2 outlines historical and economic forces and the care workersâ movement that has been building over the past decade. Chapter 3 sum- marizes the presentations and discussion about challenges experienced by this workforce, and highlights some promising practices and models. Chapter 4 provides an overview and discussion of the policies and policy issues that shape the care economy of today, and potentially that of the future. Chapter 5 offers an overview of a brief practical exercise conducted via videoconference breakout groups, and some closing reflections. Each chapter includes brief highlights near the beginning, and overarching highlights drawn from the entire event are provided below. There are four appendixes, including references, workshop agenda, speaker and plan- ning committee biosketches, and select readings and resources provided in the workshop attendee packet. PREPUBLICATION COPYâUncorrected Proofs
INTRODUCTION 3 Highlights â¢ The care economy of the past and the present is built on the unpaid or minimally paid labor of women, and especially women of color and immigrants. Sexism and racism have always been built into the system, prominently in the Recon- struction Era New Deal policy that left agricultural and domestic workers out of the Social Security Act of 1935. (Melissa Boteach, Darrick Hamilton, Ai-Jen Poo) â¢ Poverty is a policy choice. (Hamilton) â¢ The history of care work in the United States is marked by missed o Â pportunitiesâ not only the Social Security and Wagner Acts of 1935 (Edward Baptist), but also the veto of the Comprehensive Child Development Act in 1971. (Boteach) â¢ Care work makes all other work possible (i.e., care workers allow parents to participate in the labor force). (Boteach, Poo) â¢ The health and well-being of care workers is intertwined with the conditions of their work, and the low pay of care workers creates a vicious cycle of interÂ generational poverty. (Mary Ignatius, Josephine Kalipeni) Half of child care workers live in families that use public assistance. (April Sims) â¢ Care workers deserve respect, dignity, training, support, protection, and pay and benefits that recognize their humanity, their contributions to society, and their value to families and communities. (Cannon) â¢ The pandemic highlighted the interdependence of care workers, other workers, and families and communities, and the intertwined nature of work, economic stability, health, and other social factors. (Kalipeni, Julie Kashen) â¢ We need to approach the challenges related to the care economy with a mind- set of abundance, not scarcity, because adequate financial resources are avail- able. (Kashen, Poo) â¢ The care crisis is not a womenâs issue, or an individual problem for families to solve on their own. It is, rather, a worker issue, and a societal issue that calls for societal, systemic, and structural solutions. (Kalipeni, Kashen, Sims) â¢ Narrative change is needed to change the culture on the issues of care work. That includes framing care work (1) as not merely a âwomenâs issueâ but a worker issue, (2) as necessary infrastructure requiring societal and public sector support in order to benefit the entire economy, and (3) telling stories about the humanity, dignity, and dedication of care workers. (Terrell Cannon, Poo, Sims) â¢ Coalition building is crucial to effectively work for policies that support worker health and well-being, but there is a long history of âdivide and conquerâ through which powerful interests pit would-be allies against one another. (Boteach, Sims) To avoid this, coalitions must be explicitly anti-racist and anti-sexist (ÂHamilton) and members of coalitions need to stand together and adopt an additive mindset, or a mindset of abundance, rather than one of competition and compromise premised on scarcity (e.g., choosing between child care and universal pre-K). (Baptist, Boteach, Hamilton, Kalipeni, Poo) NOTE: This list is the rapporteurâs summary of points made by the individual speakers identified, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They are not intended to reflect a consensus among workshop participants. PREPUBLICATION COPYâUncorrected Proofs
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