Op-Ed: It's Time to Make Child Care a Health Benefit

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Meghan Fitzgerald, RN, MPH, DrPH, is an adjunct associate professor with the Columbia University Mailman School of Public Health and a private equity investor. She has decades of experience working in the healthcare field, ranging from frontline patient care to advising prominent healthcare firms. Here, she explains why government-funded child care should be viewed as a benefit, as well as a gain for the economy.

While child care expenses in America are increasing exponentially, government spending on early care and education is nearly nonexistent. Low-income parents who pay for child care are spending up to a third of their household incomes on child care. Parents need help, and young children need preschool. But the government is providing very little of both.

This has repercussions, especially during the pandemic. Parents have been forced to stay at home to care for and teach their kids as national labor shortages mount.

Like most economic problems that get our collective attention, leadership and incentives can solve this. It is time to prioritize and allocate early childhood resources the way we deploy other benefits like Medicare, social security, and scientific research.

It is time to reimagine child care and preschool as health benefits.

The United States spends about $34 billion on early child care and education. According to the Center for the Study of Child Care Employment at U.C. Berkeley, roughly $22.2 billion comes from the federal government and $11.8 billion comes from local governments. This means about 0.33% of our gross domestic product (GDP) is allocated to child care for ages 2 and under—less than half of the 0.74% average of other countries with developed economies.

Building Healthier Futures

According to a 2019 analysis, there are clear health benefits for kids who attend early care and education (ECE) programs. These programs are linked to improved nutrition for kids, higher immunization rates, and better access to preventive care. 

What Is an Early Care and Education ECE) Program?

Early care and education settings refer to arrangements where young children are cared for and/or taught by people who are not their parents or primary caregivers at home.

So why aren’t all parents and caregivers taking advantage? While federally-funded programs like Head Start serve about a million children 0 through 5 each year, there are over 23 million children in that age group in America. Access is limited, and that’s a problem.

Nearly 20% of children aged 2 and under are living in homes with material hardship, like lack of medical care, little access to food, and no internet access. In fact, according to the Center on Budget and Policy Priorities, during the height of the pandemic, 18 million adults said their household didn’t get enough to eat, and 4 million homes with children lacked the internet necessary for at-home schooling. ECE programs can help provide all of these resources.

The government helps support older adults with their health care, nutritional, and caregiving needs via programs like Medicare. Why not do the same for young children by making child care and preschool federally-funded health programs as well?

If end-of-life needs such as homecare, prescriptions, and as of late, hearing aids require our public assistance, the same should be true for beginning-of-life needs like literacy, nutrition, and preventive care.

Reaping Economic Benefits 

Government-funded child care would also be an economic benefit.

Evidence shows that children who attend a range of pre-k programs are more ready for their school journey than children who do not. Ongoing surveillance continues to show that preschool helps children develop literacy, language, and math skills faster than children who don’t have the opportunity to attend school before kindergarten. And as a result, they’re better prepared for both a healthy and successful life.

In addition, Americans would receive an additional benefit as taxpayers if young children had universal child care or pre-k opportunities. Currently, parents forgo roughly $30 to $35 billion in income from leaving the labor force to care for kids. These lost wages translate to $4.2 billion of lost tax revenue each year. This is especially true among women; recent data shows over 300,000 women over the age of 20 left the workforce entirely in September.

What Is the Solution?

One area for innovation is labor. Today, staff compensation is the largest cost component of pre-k programs, followed by facility costs, which often come with regulatory burdens. Nationally, the median hourly wage for early education teachers is $12.12. Even before the pandemic, many states were struggling to find workers. California purged a third of its workforce at the height of the pandemic, and today, this workforce is 10% smaller. 

If we value a pre-k investment, we must value the worker in charge of that result and pay for the value accordingly.

Berkeley researchers estimate the costs of a transformed system—where teachers are properly compensated and high-quality programs are available to all families—would require an annual investment ranging from $337 to $495 billion.

A combination of federal, state, and private funding is needed to create and sustain such a program. 

Several states and companies have heeded the call to action. For example, over the summer, California dedicated funds to “transitional kindergarten,” a program for kids who are developmentally between preschool and kindergarten. The state committed $2.7 billion to expand free transitional kindergarten to all 4-year-olds across the state by 2025. 

The Biden administration has proposed universal preschool for 3- and 4-year-olds, allowing states to expand child care access to around 20 million children a year. The proposal is part of Biden’s Build Back Better Framework, which is being debated now. 

Regardless of politics or socioeconomic status, most people agree on the merits of things like infant car seats, anti-smoking campaigns, prenatal visits, cancer screenings, and access to clean water. Like any of these initiatives, we need to view preschool education as a social good that puts all citizens on an early track to leading healthy, productive lives. As America’s population grows older and needs more care, it is in our personal and national interest to ensure our next generation is given all the tools to succeed in life. 

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Morrissey T. The effects of early care and education on children’s health. Project HOPE; 2019. doi:10.1377/hpb20190325.519221

  2. Statista. Number of children in the United States in 2019, by age group. 2020.

  3. Isaacs JB, Lou C, Hahn H, Lauderback E, and Quakenbush C. Public spending on infants and toddlers in six charts. Urban Institute. May 2019.

  4. Duke Center for Child and Family Policy. The current state of scientific knowledge on pre-kindergarten effects. 2017.

By Meg Fitzgerald
Meghan Fitzgerald, RN, MPH, DrPH, is an adjunct associate professor with the Columbia University Mailman School of Public Health and a private equity investor.