Ann McNamee reads a book with a boy during a free child care program for fire victims in Los Angeles in January. Universal child care has significant public health benefits.
Photo by Gina Ferazzi, courtesy The Los Angeles Times/Getty Images
“It's really about choosing to see child care as a public good, like the valuable profession that it is, as something that matters for public health, families and the economy and then funding it like we mean it.”
— Julie Kashen
As a former kindergarten teacher, Casey Peeks could spot it the moment her students walked into the classroom each fall.
Children who had attended a high-quality child care or early-learning program arrived more confident, more socially and academically prepared and better equipped for the expectations of kindergarten. Those without any early learning experience struggled, and that gap often widened over time.
“Access to early childhood education comes as close as you can to what is like a magical, one-stop shop that can drastically improve early childhood well-being,” Peeks, who is now senior director of early childhood policy at the Center for American Progress, told The Nation's Health.
As more American families buckle under crushing stress, financial strain and the daily scramble to secure safe care for their children, public health experts say one of the most effective prevention strategies is universal child care, which offers free, quality care for all families. By easing chronic stress, stabilizing family finances, reducing isolation, and supporting employment and mental health for parents, universal child care addresses the conditions that fuel poor health. It also strengthens early childhood development and promotes health equity for women, low-income families and communities of color.
Decades of research show that high-quality early learning during the first five years of life supports healthy brain development and sets children up for better long-term outcomes. Universal child care increases access to developmental screenings, nutritious meals, early-learning environments and consistent caregiving, all of which improve cognitive and social outcomes. In communities where child care is affordable, more children are immunized, better screened for developmental delays and ready to enter kindergarten, public health experts say.
When child care is affordable, parents — especially mothers — are better able to manage responsibilities that would otherwise harm their sleep, social connection and mental stability, experts say. With universal child care, mothers are more likely to work, attend school, advance their education, maintain their income and engage in health-protecting behaviors such as exercise, medical appointments, therapy and community life.
In reality, child care costs push more than 134,000 families into poverty each year, particularly low-income households, single parents and parents of color. In fact, since 1990, child care costs have increased nearly twice as fast as other family expenses. The effects of financial strain are well documented: chronic stress increases the risk of depression, cardiovascular disease and immune dysfunction.
With the advent of universal child care in the state, New Mexico plans to hire thousands of educators.
Photo by FatCamera, courtesy Getty Images
According to a Centers for American Progress analysis, of the more than 5.1 million families with young children that pay for child care each year, 2.2 million — or about 43% — pay unaffordable rates, defined by the U.S. Department of Health and Human Services as more than 7% of income. In fact, families pushed into poverty from the expenses typically spend almost 28% of their income on child care.
Affordability is only part of the crisis. Most Americans live in what researchers call “child care deserts,” where the supply of licensed child care providers is too low to meet the needs. The shortage affects most of the country, but rural areas, low-income neighborhoods and Hispanic communities in particular face the steepest barriers, with families struggling to find and afford care.
And even where care exists, another structural barrier remains. Fair compensation for workers should be a pillar of child care, public health experts say. The child care workforce is made up mainly of women of color, and wages remain among the lowest in the care economy.
“That reality leads to higher turnover, which undermines children's stability and well-being and sends ripple effects through classrooms, families and communities,” said Julie Kashen, director of women's economic justice at the Century Foundation. “Without sustainable wages, universal child care cannot truly deliver on its promise to families.”
Kashen's vision includes health care benefits for teachers, paid sick leave, expanded career pathways and working conditions that reflect the skill and responsibility involved in caring for young children.
“It's really about choosing to see child care as a public good, like the valuable profession that it is, as something that matters for public health, families and the economy and then funding it like we mean it,” Kashen told The Nation's Health.
Relief may be coming. Across the country, policymakers, researchers and communities are increasingly weighing universal no-cost child care to reduce family hardship, expand workforce participation and improve public health outcomes for children, parents and teachers.
New Mexico recently became the first state to make the leap, approving a system that eliminates income limits and guarantees free care for every family. Hailed as a break- through in equity and early-childhood investment, the program uses the state's land-grant permanent fund to finance early childhood services and provide free child care access for all, no matter their income.
New Mexico's journey started 15 years ago, when advocates were searching for a solution that would be bold enough and large enough to improve outcomes for children, said Jacob Vigil, MSW, chief legislative officer for New Mexico Voices for Children.
“At the time, New Mexico consistently ranked 50th, or close to 50th, in child well-being, education and health,” Vigil said. “We asked ourselves, ‘What is the one big thing we can do to move the needle?’”
Women who have access to free child care are more likely to work, advance their education and attend medical appointments.
Photo by FujiCraft, courtesy iStockphoto
Officials estimate New Mexico families will now be able to save an average of $12,000 per child per year. To meet increased demand, the state plans to add about 14,000 child care slots and hire thousands of educators, offering higher reimbursement rates for programs that pay workers at least $18 an hour and provide hours that meet working families' needs.
New Mexico's universal child care model is drawing national attention, with some states and cities seeking guidance as they develop their own plans. Connecticut recently passed a bill making child care free for families earning under $100,000 per year, and not more than 7% of income for those earning more. Massachusetts has made significant investments in building out the supply of child care.
Vermont is investing additional dollars and creating a new payroll tax to help pay for child care. And voters in New York City recently elected Mayor Zohran Mamdani on a platform centered on sweeping affordability reforms, most notably his pledge to create universal, no-cost child care for every family, regardless of income, neighborhood or work status.
New Mexico's journey benefited from the state's substantial oil and gas revenue, but financial resources alone were not enough, Vigil said.
“It took a decade-and-a-half of organizing across the state — including parents, providers, policy groups and grassroots leadership — to convince policymakers the investment was worthwhile,” Vigil told The Nation's Health.
Among them was Matthew Henderson, who helped carry New Mexico's push for universal child care from planning to legislation to law.
“Universal child care's impact on children and parents' health is immense when implemented correctly,” said Henderson, executive director of Albuquerque, New Mexico-based OLÉ Education Fund, a grassroots member organization of families working to strengthen communities around the state.
“The reduction in stress for working parents is significant,” Henderson told The Nation's Health. “Having a safe learning environment for a child at the peak of brain development has important ramifications for the child's mental and physical health for the rest of their lives.”
For more information, visit www.nmececd.org/universal and www.americanprogress.org.
- Copyright The Nation’s Health, American Public Health Association
