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New County Health Data Spotlight Gaps in Child Care and Economic Security

Since 2010, the University of Wisconsin Population Health Institute and Robert Wood Johnson Foundation have released the County Health Rankings, which uses local data to rank the overall health of each county in the nation. The data used in the analysis offer a holistic look at health, considering both traditional health factors, such as diet, exercise, and access to care, and social, economic, and environmental factors such as education, housing, employment and air quality. All these factors are combined to calculate a ranking for each county, providing communities with local data that can help them understand influences on their health.

This year, the County Health Rankings included new data to spotlight the importance of pursuing economic security for everyone in a community. The COVID-19 pandemic exposed and worsened many barriers that women, people of color, and low-income families face, in many cases widening existing inequalities. The new County Health Ranking data help reveal the landscape of economic barriers that Colorado families face by showing the cost of child care, gender pay gap, and living wage for each county. 

Colorado County Health Rankings

Douglas County ranked as the healthiest county in Colorado in 2021, as it has for the past seven years. It had the highest score for quality and length of life. Pitkin, Eagle, Boulder, and Broomfield counties also ranked highly for health outcomes. (See Map 1.)

Otero County ranked lowest for health outcomes. Counties in the southern part of the state, including Bent, Saguache, Costilla, and Las Animas, tended to score worse than counties along the Front Range and Interstate 70 corridor.

It’s important to note that many counties that scored low on health outcomes have the highest poverty rates in the state. For example, Otero County has a poverty rate of 22.2%, while Douglas County had the lowest poverty rate at 3.2%. These differences highlight the importance of socioeconomic context to health outcomes.

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New Measures Spotlight Economic Needs and Inequalities

As the nation recovers from the economic effects of the pandemic, the County Health Rankings added new measures highlighting key economic barriers for families. Among these new measures are the child care cost burden, living wage estimates, and the gender pay gap. These data points were not included in the overall score but provide additional insight into health influences.

Affordable Child Care Remains Out of Reach

When the pandemic forced child care centers to close in early 2020, it sent a shock through the U.S. child care system, exposing the need for more accessible and affordable child care. The County Health Rankings highlighted the child care cost burden, which refers to the percent of median household income needed to pay for child care for two children, for each county. (See Map 2.)

What the Data Show

In Colorado, the average child care cost burden is 28%, meaning that over a quarter of every dollar earned by a median-income family goes toward paying for child care. In rural areas of the state such as Rio Blanco and Phillips counties, the child care cost burden is as high as 44%. In the two most populous counties, Denver and El Paso, the childcare cost burden is 31% and 26% respectively. (See Map 2.)

The U.S. Department of Health and Human Services indicates that once child care costs exceed 7% of a household’s income, it is no longer affordable. There is currently no county in the U.S. where the child care cost burden is below this national benchmark of affordability: The national average for child care cost burden is 25%. This stark fact highlights the need for more affordable child care options, not only in Colorado but across the nation.

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Why It Matters

A growing body of research highlights the connection between early child care and education and long-term health. For example, a study of two model early care and education programs found that participants in the programs were less likely to smoke as adults and had better indicators for cardiovascular and metabolic health.

Recent Policy Action in Colorado

This year, the Colorado legislature passed several bills to address the need for affordable child care and early childhood education. This included establishing a universal preschool program that provides 10 hours per week of free preschool for all Colorado children. The legislature also allocated $100 million from the federal government to develop and expand child care programming and workforce training across the state. These efforts will help support child care services in many rural areas of the state considered child care deserts.

Living Wage Per County Outpaces Minimum Wage

Studies show that low-wage workers were hit hardest by pandemic, not only facing high rates of layoffs, but also high risk of exposure to COVID-19 at their jobs. To highlight the needs of low-income workers, the County Health Rankings calculated the living wage per county, which is defined as the hourly wage needed to cover basic expenses and taxes for a household of one adult and two children. These expenses include food, child care, health care, housing, transportation and other necessities like clothes, internet, and cell phone service. 

What the Data Show

On average, the living wage in Colorado is $43.97 per hour, which is higher than the national hourly average of $35.80. The living wage in Colorado ranges from $33.60 per hour in rural Costilla County to $49.31 per hour in Eagle County, which is home to many ski resorts. (See Map 3.)

For comparison, the state hourly minimum wage in Colorado is $12.56 and the federal minimum wage is $7.25. 

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Why It Matters

Income is a strong predictor of health, making policy debates around minimum wages and wage stagnation relevant to public health policy. In recent years, public health researchers have started to study the effects that raising the minimum age can have on public health. Some studies suggest that raising the minimum wage can reduce smoking and obesity rates, highlighting the connection between income and health behaviors.

Recent Policy Action in Colorado

The last time that Colorado updated its minimum wage laws was in 2016, when voters approved an amendment to the Colorado constitution that increased the minimum wage incrementally over a few years. Now, the minimum wage is adjusted slightly each year based on the Consumer Price Index. For example the minimum wage increased from $12.32 to $12.56 between 2021 and 2022.

Women Earn Less than Men in All but One Colorado County

When the economic downturn of the pandemic hit in early 2020, millions of Americans lost their jobs. Women were hit particularly hard by job loss, with over 2.5 million more women losing their jobs than men in February through May of 2020. While there are many factors that contribute to women exiting the workforce, including the need to take care of a child, the gender pay gap plays a role. The County Health Rankings data calculated the “cents on the dollar” gender pay gap for each county in the U.S. 

What the Data Show

In Colorado, the average gender pay gap is 0.83, meaning that women earn 83 cents for every dollar that a man earns. This is slightly larger than the average pay gap for the U.S., which is 0.81. Across Colorado, women make less than men in every county except Rio Grande County. (See Map 4.)

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Why It Matters

In addition to the overall health impacts of lower incomes, earning less than their male counterparts for the same work can take a psychological toll on women. Research has shown that when women earn less than their male counterparts, their odds of having depression and anxiety are higher. Researchers speculate this may be due to women internalizing discriminatory acts as reflections of their self-worth rather than evidence of systemic biases.

Recent Policy Action in Colorado

At the beginning of 2021, the Equal Pay for Equal Work Act went into effect in Colorado. The act prohibits pay inequalities based on gender identity and race. The act also required employers to list salary ranges in job postings, post promotion opportunities, and protected the right of employees to discuss wages with other employees. Laws such as this one can increase transparency around wages, enabling women to understand how their compensation compares to that of their co-workers.

Addressing Inequalities to Improve Health

The County Health Rankings data help shed light on the health and economic needs of Colorado communities. Although Colorado has taken steps to address issues like the lack of affordable child care and the gap between wages and the cost of living, more action needs to be taken to eliminate these persistent and systemic barriers. Addressing these needs is important not only for attaining economic security, but for promoting health and healthy behaviors in communities. 

The first step to address a problem is understanding it, and as local leaders convene to make decisions about health and the pandemic recovery, this data can provide relevant and timely insight into the factors that affect the well-being of Colorado communities.

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