5

Practical Exercise and Closing Reflections

During the closing session of the day, Rita Hamad, social epidemiologist and family physician in the Institute for Health Policy Studies in the Department of Family and Community Medicine at University of California, San Francisco, provided summarizing comments drawn from a breakout group discussion during a break in the agenda. Workshop registrants were invited to register separately for a small group discussion that involved reviewing the evolving Equitable Economies Policy Library.¹ The library is curated by the Well Being in the Nation (WIN) Network Equitable Economies Cooperative, convened by Well-being and Equity in the World (WE). Approximately two dozen participants in the small group exercise discussed policies that they considered important to care economy workers.

Hamad commented on the importance of the conversations about supporting essential workers in the care economy. She then turned to sharing some insights emerging from the practical exercise led by the WIN Network. By way of background, she shared that Soma Saha and Anne Ekedahl, the facilitators of the breakout discussion, introduced WIN as “a growing strategic network, working together to advance intergenerational well-being and equity and, in particular, to change the culture and systems that perpetuate legacies of trauma and exclusion to ones which create dignity and inclusion.” The Equitable Economies Policy

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¹ The library is hosted by Community Commons at https://www.communitycommons.org/entities/cba0eacc-13d9-4cb7-a378-1b3d9468a8a2 (accessed July 6, 2022).

Database, she added, is intended to orient people to policy strategies and options that can help bring the nation closer to an equitable well-being economy for all.

The database contains 123 policies in 11 impact areas (see Figure 5-1). Small group conversations focused on considering which policies could work to support care workers. Hamad shared that, for example, the earned income tax credit (EITC) provides $60 billion in benefits each year but is not available to immigrant workers who are not permanent residents or citizens and requires completing complex tax forms. The child tax credit is a powerful policy that has the potential to halve child poverty, but it is on the brink of expiring (and has since expired). TANF or Temporary Assistance for Needy Families is another policy designed to alleviate poverty but it is temporary and only targeted at families with children.

Hamad shared some additional ideas from the small group activity. Some participants spoke about other types of policies, such as micro-lending practices, small business opportunities, and opportunities for worker-owned cooperatives. Other participants suggested a focus on equity across geographies, informed by disparities seen among urban, rural, and suburban areas. An additional conversation focused on ensuring sustainability of short-term employment or economic opportunities such as grants and initiatives, and on employment-related improvements such as matched retirement plans and portability of benefits such as health insurance in order to delink it from a specific employer.

Hamad introduced Raymond Baxter, trustee of the Blue Shield of California Foundation, to deliver closing remarks. Baxter said that essential workers are not paid or supported in a manner commensurate with their value and importance. He traced the workshop arc, beginning with the history and economic forces that constructed “this unjust part of a more broadly inequitable economic system” with a through line “from the reproductive labor extracted from enslaved people where parents cared for their owners’ children and grandmothers raised their own grandchildren to make that possible, practices that remain startlingly embodied still today.” Earlier presentations also highlighted the gendered nature of care work, and the missed opportunities and deliberate policy decisions that excluded agricultural and domestic workers from the protections offered to other types of workers.

“About 82 percent of nannies, housekeepers, and home care workers entered the pandemic without a single sick day accrued,” Baxter said, and care workers, whose work of course cannot be performed remotely, were not prioritized for government loans, vaccines, or personal protective equipment. Some quit their jobs to care for family members, and the entire system of care collapsed. A central insight emerging from the crisis was a sense of “our mutual interdependence to create a better society built on respect and dignity and valuing each other.” The final panel discussed a host of policy solutions, from universal pre-K and child care to secure retirement and the right to organize.

In closing, Baxter underscored that the policies discussed, and being considered at the federal level, were complementary rather than a menu from which to pick and choose. The complexity of the problem called for a comprehensive approach. Before thanking all participants, Baxter remarked that in 2013, the Roundtable hosted a workshop on building a social movement around health and equity. The workshop features many powerful examples of how a movement is building toward an equitable care economy. It is clear that this movement, like those around racial justice, education, housing, and civic engagement, is inextricably intertwined with improving the health of the nation. The question “we are left with,” Baxter said, “is whether, as a nation, we will finally step up to these choices as has much of the world or whether we will again repeat the missed opportunities of the Reconstruction, the New Deal, and the 1960s.”

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