Culture of Health Blog

For children and families, last year’s expansion of the Child Tax Credit provided crucial support, helping them afford basic needs like food, clothing, and housing. Yet this historic policy achievement that almost immediately reduced child poverty was fleeting. Just six months after the first payment went out, the opportunity to help children thrive abruptly ended. The expanded policy was never extended, and these families are now right back where they started.

Research shows that long term, sustained cash assistance has the greatest impact, confirming that this policy should be permanent. As we mark Tax Day here are four reasons why the expanded Child Tax Credit should be permanent:

1.  Reduces the number of children living in poverty. (That should be reason enough).

Even in a nation as wealthy as the United States, 10 million children experience poverty. The damaging effects of the conditions of poverty are relentless: hunger, homelessness, substandard schooling, and a lack of access to healthcare and child care. The populations hit hardest by the pandemic are the same ones experiencing the highest poverty rates: Black, Hispanic, and Indigenous children and their families.

On a host of issues ranging from commercial tobacco regulation to public health authority, paid sick time to advancing the health of children and families, a policy tool known as preemption can impede local decision-making. Preemption is when a higher level of government, such as a state legislature, restricts the authority of a lower level of government, such as a city council. Depending on how it is used, preemption can either support or undermine efforts to advance health equity.

In one example of the latter, we know that health and economic well-being are intertwined, which is why raising the minimum wage has been used across the United States to advance health equity for workers in low-wage industries. In 2016, the majority-Black city council of Birmingham, Ala., passed an ordinance raising the minimum wage from $7.25 to $10.10 per hour. But the new minimum wage never took effect because the majority-White state legislature responded with a law preventing municipalities from setting their own minimum wages. It effectively nullified Birmingham’s ordinance.

Eight years later, Alabama still follows the federal minimum wage of $7.25 an hour. At that wage, someone working 40 hours a week, 52 weeks a year, earns about $15,080. Birmingham decision-makers recognized in 2016 that $7.25 an hour is not a living wage. Yet to this day the state still prevents the local government from acting.

Families around the country, mine included, are feeling fortunate to have our kids back in school after a turbulent, unpredictable couple of years. Students, teachers, and school officials were forced to navigate unexpected changes.  For most, the ongoing shifts from virtual to in-person learning were stressful and added to many other pandemic-induced hardships. Through it all, school districts quickly spearheaded innovative approaches to ensure they could continue to serve much-relied-upon school meals to students. They implemented “Grab and Go” models allowing parents to pick up meals in school parking lots or other community hubs; loading up school buses with meals and dropping them off at stops along neighborhood routes; and delivering meals directly to students’ homes.

Schools were able to offer this continuity and flexibility because when the Covid-19 pandemic forced nationwide school closures—and hunger and food insecurity spiked—Congress passed the Families First Coronavirus Response Act and CARES Act in 2020. 

Provisions in these laws provided the U.S. Department of Agriculture (USDA) with authority and funding to implement waivers that permit schools nationwide to serve meals to all students free of charge (also known as universal school meals). The measures also allowed schools flexibility to help ensure that meals are provided safely during a public health emergency. That includes distributing meals to families outside of the school setting and temporarily serving meals that meet the less stringent nutrition standards of the Summer Food Service Program, which require fewer fruits and vegetables than USDA’s current nutrition standards for school lunch.

Thirty-five local non-profits will be awarded up to $40K to work with local data to dismantle structural racism via a new funding opportunity.

Editor's note: This funding opportunity is now closed. 

Life is harder than it has to be for families where grandparents or other relatives step up to care for children when their parents can't. Our family-supportive policies and systems were designed to serve “traditional families,” with services aimed at “parents” and foster families, not relatives who step up. These families face unnecessary barriers to getting the support children need to thrive. This is especially true among Black and American Indian families, who make up a disproportionate share of the 2.6 million families in the United States where children are growing up without parents in the home. The pandemic has made things worse. COVID-19 has robbed thousands of children of their parents and sent them into the care of relatives.

What happened to the Brown family of Baton Rouge, La., helps to tell the story of grandfamilies, also known as kinship families, which form when children are separated from parents through life events like death, illness, incarceration, or deportation. After a horrific onslaught of gun violence killed four members of their family, Robert and Claudia Brown took custody of three grandsons. They fought for 12 years to adopt the boys.

The Browns struggled through trauma, grief, and loss. They scrambled to pay lawyers while supporting three growing boys. They blew through retirement savings. They didn’t know about services or support that could have bolstered their mental health and financial security.

Maria Gomez was 13 years old when she immigrated to the United States with her widowed mother to escape violent political turmoil in Colombia. They landed in Virginia on a snowy day with no boots, no coat, and not speaking a word of English. Together, they faced many challenges while navigating their new life. In spite of them, Maria’s gratitude and drive to give back led her to a nursing career. She ultimately joined a group of advocates in launching Mary’s Center to address gaps in access to healthcare and structural barriers that many immigrants face.

Today, Mary’s Center uses an integrated model of healthcare, education, and social services to serve patients at five clinics and two senior wellness centers in Washington, D.C. and Maryland. In 2012, President Obama presented Maria with the Presidential Citizens Medal, the second highest civilian honor in the United States.

After an illustrious career, Maria retired in December of 2021. She shared reflections on how she has led efforts to serve a diverse population and insights into the challenges our healthcare system and nation face. In this interview, Maria discusses how she shaped a system of care that aims to build trust with patients and provide integrated care that addresses more than medical needs.

We are proud to live in one of the most racially and ethnically diverse states in the nation. Our home state of New Jersey is also a national leader in areas such as expanding health care coverage, enacting paid family leave, and maintaining low smoking rates.                                                       

Unfortunately, however, these bright spots are offset by glaring disparities with roots in our nation's long history of racism that persists to this day. For example, a Black woman in New Jersey is seven times more likely to die from pregnancy-related causes than a White woman and Black babies are more than three times more likely than White babies to die before their first birthday.

The COVID-19 pandemic exposed and worsened these inequities, especially along racial/ethnic lines.  

In addition to the role played by social determinants of health, a major contributor to these disparities is a state public health system strained for decades by lack of funding and insufficient coordination across health and related sectors. Experts agree the system lacks the capacity to simultaneously achieve its core missions while equitably responding to and managing public health emergencies such as the COVID-19 pandemic.

As a mother of two girls, I often wonder what would it look like if women didn’t have to exit the workforce to cover childcare? If men taking paternity leave was the norm, rather than the exception? If our kids had more female and LGBTQ role models to look up to in elected office?

I became hopeful last year when the White House launched the United States’ first-ever National Strategy on Gender Equity and Equality—a concerted effort to make these “what ifs” a reality.

While we have seen important advances toward gender equity in the U.S, most improvements in employment, education, and income happened before the turn of the century. Progress has dwindled or stalled entirely in the past decade. The COVID-19 pandemic, which has forced women out of the workforce in record numbers, is a stark reminder of the gender inequities that still exist. It's time to reinvigorate our nation’s fight for gender equity.

As a practicing social worker, I believe that mental healthcare is a right, not a privilege. LGBTQ+ and persons of color face numerous barriers to finding affirming mental healthcare and often experience racism and/or discrimination while accessing those services. Through support of the Robert Wood Johnson Foundation’s Health Policy Research program and in collaboration with my research partner Liana Petruzzi, I’m working to help shape a health and mental healthcare system where racism, homophobia, and transphobia are not tolerated or perpetuated.

The COVID-19 pandemic forced us to look at how trauma, stress, and a public health crisis combine to influence our mental health and wellness. This new reality drove the nation to significantly increase its investment in telehealth services. Now in our third year of the pandemic, we must reflect and ask ourselves if that investment is working, and more importantly, if it is equitable. We have a serious opportunity to better meet the needs of Black, Indigenous and People of Color (BIPOC) individuals and communities—needs that must not be ignored. 

For many months, our society has grappled with defining our “new normal.” The COVID-19 pandemic has exposed and deepened inequities that undermine well-being. Combined with a worldwide outcry for racial equity, we have been challenged to reconsider how the United States defines “progress.”

Our nation’s traditional story of progress has been limited to measures like economic growth and employment. When leaders tout our country’s successes, they cite GDP numbers, job growth, and unemployment rates.

On an individual level, a person’s bank account balance, the car they drive, and their generational wealth are heralded as markers of success. These benchmarks only tell a fraction of the human story. They also overlook how structural racism has undermined economic opportunity for communities of color among other outcomes.