Improving the Health of All Americans by Focusing on the Early Years of Life

Improving the health of all Americans requires broadening our view beyond medical care. Our chances of becoming sick and dying early are greatly influenced by powerful social factors including income and education.

Facts and Figures

Child care services are costly for families: 

  • In every region of the United States, the average infant care costs exceed average family food costs. 
  • In every state, the cost of child care for two children is comparable to the average monthly mortgage payment. 
  • In 2008, the annual cost for center-based infant care ranged from $4,500 to $14,600 across the United States; the annual cost of center-based care for a 4-year-old ranged from $3,400 to $10,800.
  • Low-income families devote 15% of their income to child care services, while higher-income families spend 7% of their income.

Oversight and quality standards for child-care centers and providers are insufficient for ensuring the safety, health and well-being of children in care:

  • Twenty-four states do not regulate family child-care providers who care for three or fewer children.
  • Only thirty-two states explicitly forbid smoking within child-care facilities.

Child-care workers and early childhood educators are often inadequately trained and poorly compensated: 

  • Eleven states lack a minimum education requirement—not even a high-school diploma—for teachers in centers, and 15 states require less than two years of training for child-care center directors.

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