An HIA of expanding access to preschool in Cincinnati, OH.
Executive Summary
Proposal: To ensure that every child in Cincinnati has access to two years of high-quality, affordable preschool through a local, sustainable funding stream.
The people of Cincinnati face a fork in the road. They could choose to invest in their shared future by increasing access to high-quality preschools for all children. Or they could continue on the current path, with nearly half of their children starting from a disadvantage on their first day of kindergarten. Our research shows that expanding access to preschool would improve the health of Cincinnati’s children and families, making Cincinnati a healthier, wealthier and more equitable city.
Recommendations
- Expand access to high-quality preschool programs to all children
- Prioritize to reach those most in need, such as children living in poverty
- Assure high-quality preschools and teachers through adherence to preschool program and training features that research has proven to be successful
- Utilize a trauma-informed approach to discipline that incorporates an understanding of the source of the behavior problem, in preschool and beyond, rather than zero tolerance policies such as suspensions and expulsions
- Assure that high-quality preschools are geographically distributed throughout the city
We find that if expanded access to preschool were implemented for a decade…
- Over 20,000 more children would have access to preschool,
- including more than 9,000 vulnerable children living in poverty.
- Parenting stress would be reduced.
- Child abuse and neglect would be reduced by 27%.
- More than 500 children would not be held back a year.
- More than 500 children would not be in special education.
- Nearly 3,500 more students would graduate high school.
- Over 4,000 fewer crimes would take place.
- These 20,000 more children would grow up to earn about $9,000 more per year.
- This adds up, over 10 years and 20,000 children, to nearly $1.8 billion more in earnings.
Cincinnati Today: The Landscape for Children
Children in some neighborhoods of Cincinnati can expect to live nearly 20 years less than children in other neighborhoods.
Cincinnati ranks 31st in the nation and 5th in the state of Ohio for its child poverty rate. The rates for child poverty, single-parent households, and crime for Cincinnati are all nearly double the national rate. One potential reason for the high proportion of children living in single-parent households may be incarceration of parents. In Ohio, it is estimated that 10% of children (271,000) have a parent who is incarcerated.
Cincinnati is one of the least economically mobile cities in the nation. This means that children who are born into poverty in Cincinnati will have very little chance to break out of it, unless something changes.
The Current Path: Limited Access to Preschool
The majority of three- and four-year old children in Cincinnati do not attend preschool. Of Cincinnati’s approximately 9,150 preschool-aged children, only 44% are enrolled in preschool.
For many families, preschool is unaffordable. In Ohio, a family with two children living below the 150% poverty level paid 51% of their income for the annual cost of two children in childcare/preschool.
Parents are burdened down with the cost of preschool … it impacts everything about their lives. They need to go to a place that’s good for their children so they can go to work comfortably, but they can’t afford it.
Children who do not attend preschool are more likely to have lower readiness scores in kindergarten, require more special education, more likely to repeat a grade, and less likely to graduate high school. This explains why nearly half of Cincinnati’s children are academically unprepared for school, as measured by the Cincinnati Public School 2014 Kindergarten Readiness Assessment.
When children enter school already behind, they are more likely to struggle and drop out. High school graduation rates in Cincinnati are unacceptably low, according to Ohio’s Department of Education. Lower high school graduation rates lead to lower wages and more crime.
Enrolling a child in preschool can provide parents a respite from parenting stress. When parents do not have this opportunity, the ongoing stress can mani- fest in parental depression, decreased emotional attachment between the child and caregiver, as well as increased child neglect and abuse. In 2014, 2,149 children were victims of abuse or neglect in Hamilton County.
Traumatic childhood experiences, such as having a parent who is incarcerated or being subject to or witnessing violence, are associated with poor behavioral health and dropping out of high school. It is estimated that 10-15% of preschool children have chronic behavior problems. If these problems are not addressed early, they can persist through later school years. Sixty-five percent of children with emotional and behavioral disorders drop out of high school.
Why Lack of Preschool Matters to Health
Traumatic experiences, lower levels of education and income, and incarceration all exact a toll on physical and mental health, which can contribute to increased healthcare costs. People with low education levels can expect to die 7 years earlier, on average, when compared to people with higher levels of education.
If Cincinnati does nothing to change preschool access for its children, it can expect future outcomes similar to or worse than those today.
Due to multiple structural forms of discrimination, growing up in poverty, in a single-parent household, or with a parent who is incarcerated are all more common experiences for children of color. These experiences increase the odds of negative physical and mental health outcomes and lead to a vicious cycle that continues through multiple generations, further contributing to ongoing inequities.
- 44% of white kindergartners are low-in- come, compared to 91% of African American kindergartners.
- In Ohio, the average K-12 suspension rate for white students is 5%, compared to 16% for black students.
- Compared to white children, African-American children are seven times more likely to have a parent incarcerated.
- Incarceration of men leads to an increase in single-parent households headed by women.
- 13% of children in married-couple families live in poverty, compared to 64% of children living in single-parent families.
The Better Path: Expanded Access to Preschool
The good news is that there is compelling evidence that expanding access to high-quality preschool for Cincinnati’s children would help address these challenges.
Children who participate in high-quality preschools score better on kindergarten readiness assessments and begin to learn the crucial behavior management skills that are essential for school and life success.
I see a big difference between my older kids and the ones who had a head start with preschool.
In preschool they learn a bunch of … social-emotional skills they need to be successful in kindergarten … They at least learn how to sit in a group with other people and have a constructive conversation, and how to attend a task, how to move through the routine of a school day.
Preschool has lasting effects throughout the child’s school experience. Studies show children who attend high-quality preschool have less need for special education services, less grade retention, fewer behavior problems, and higher rates of high school graduation, which in turn lead to higher wages and less crime.
Especially if they’re living in poverty or in a very abusive home … their lives are so stressful… Even a three hour break from each other, it’s almost like a stress vacation.
Preschool can improve family relationships to the point that it reduces child neglect and abuse by over half. Forty-year old adults who attended preschool as children are still more likely to say their family rela- tionships are better than those who did not.
In addition to preventing child neglect and abuse, preschools can be an early opportunity to identify and intervene when such problems are already occurring.
At another center I had 88 kids, and it seemed like I had to deal every morning with a child being beat up, black eyes and everything. Kids will say ‘Come here Ms. Flora, can you pray with me in the bath- room? He just did this to me last night.’ I’m talking about broken ribs and everything.
Why Preschool Matters to Health
Compared to those who did not participate in preschool, adults who participated in high-quality preschool as children have better overall health. They have lower rates of substance abuse, depressive symptoms, and disability. They are more likely to have health insurance. They also are less likely to become parents during their teenage years.
Preschools can also have a direct impact on health. They can improve nutrition and physical fitness through the programs and services they offer.
Preschools also often help to identify mental and behavioral problems, language and speech issues, oral health problems, and abuse and neglect.
