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Does moving homes predict who gets to better schools?

Author: Brett Theodos

| Posted: April 22nd, 2014

As we saw in yesterday’s post, kids in low-income neighborhoods frequently change schools, but does that help them get into better-performing schools?

In our newly released study of 10 low-income communities participating in the Making Connections initiative, we found that families who moved out of their school district were more likely to switch to a better-ranked school. In fact, it was the most important variable accounting for changes in school performance.

To begin, it’s important to understand that most children in these low-income neighborhoods initially attended strikingly low-performing schools. More than half the children (51 percent) attended schools ranked in the bottom 20th percentile of their state. Changing to a better-ranked school clearly mattered.


Three years after the first survey, we examined school ranks for children with a follow-up survey. School ranks remained largely the same, but the statistics mask some important changes for individual children—in both directions.

  • Residential mobility. The most important factor explaining changes in school performance was whether a child moved out of the school district where he or she had previously gone to school. This change was associated with an 8.9 point average improvement in percentile state rank, even when controlling for other factors. Yet children who moved homes within the same school district saw no improvement on average.
  • Parents’ education, employment, and finances. Higher parental education was associated with increases in school rank. And financial distress (defined as difficulty affording food) was significantly associated with children switching to worse-ranked schools. Children with an employed parent did no better than children whose parents were not working, however. And household income and housing tenure were not associated with changes in school performance either.
  • Racial differences. Relative to white children (and controlling for other factors like initial school rank), black and Hispanic children ended up in lower-ranked schools.
  • Age. A child’s age did not predict changes in school rank, nor did whether children made a nonpromotional (e.g. one elementary school to another) or promotional (e.g. elementary school to junior high) change.
  • Parents’ satisfaction with school. Parental dissatisfaction with their kids’ initial schools was not associated with their children getting to higher-ranked schools, even though less satisfied parents were more likely to have children who switched schools.

Previous research on the effect of school and residential moves on educational outcomes is mixed, probably due to heterogeneous national or state samples, with many moves being neutral or positive in terms of school quality. Our study affirms that many residential and school moves in low-income neighborhoods do not generally result in children attending higher-ranked schools and can actually lead to the opposite.

Children of families that move relatively short distances in response to financial distress or household compositional changes frequently move to schools that perform the same or worse. It is only when families move outside the originating school district that we see reliable gains in school rank.

In a final post in this series tomorrow, I explore what these findings mean for place-based initiatives, such as Promise Neighborhoods.

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Private school enrollment is on the decline in DC

Author: Graham MacDonald and Austin Nichols

| Posted: April 22nd, 2014

Over the past decade, private school enrollment among DC students has declined by over 65 percent, according to our analysis. Given that the number of high-income households in the District is increasing, tuition costs may not be a major factor in the change. Instead, the drop in private school enrollment could mean that more parents see public schools—both charter and traditional schools—as viable options for their children.

In 2001, approximately 7,600 students ages 5 to 13 attended DC private schools; by 2012, that number had fallen to fewer than 2,600 students. (Our analysis of school enrollment figures and Census population estimates includes all students attending schools other than public schools, so it may include some homeschooled students or early dropouts.)

We see this trend at all grade levels. Private school enrollment among elementary school–age children (ages 5 to 10) fell by over 78 percent (about 2,900 students) from 2001 to 2012, with most of this decrease occurring earlier in the decade.

Elementary Enrollment Graph

Enrollment in private school among middle school–age children (ages 11 to 13) fell by over 50 percent (about 2,100 students) over this same period, though most of this decline occurred fairly recently.

Middle Enrollment Graph

Private school estimates are difficult to measure for high school students because many students are held back in 9th grade and a number of students drop out at age 16. However, the data indicate that private school enrollment may be dropping rapidly among this population as well.

The preference for public schools is particularly strong among parents of elementary school children. Approximately 98 percent of elementary school children attend public schools in DC, compared with just 88 percent of middle school children.

Location matters

We also found that private school enrollment varies significantly by location, and as you may guess, is highly related to income. As of 2012, children in relatively affluent neighborhoods in Northwest and Capitol Hill have the highest rates of private school enrollment, while almost every child attends public school in other, less affluent areas of the city.

Elementary Enrollment MapMiddle Enrollment Map

DC parents are more likely to opt for public schools than they were just a decade ago, which could be connected to the city’s major investments in schools. The last two mayors have invested in new facilities, new programming, and higher pay for teachers to attract and retain a strong workforce, and have also supported the thriving public charter schools. The new mayor can easily continue this level of investment in education, but may need to work harder to ensure these promising trends in public education continue.

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Suggestions for housing finance reform

Author: Laurie Goodman and Ellen Seidman

| Posted: April 21st, 2014




A major step toward meaningful housing finance reform, the Johnson Crapo discussion draft (S.1217), is scheduled for markup on April 29. Two of the bill’s important features, however, are cause for concern: the dual structure for private capital and the mechanics of the affordable housing flexible incentive fee. In our new commentary, we explain our concerns, and suggest solutions for both sets of issues.

The problems with dual structure

One of the goals of housing finance reform is to increase the supply of private risk capital in the housing market. Today, about 80 percent of new mortgage originations are backed by the federal government, while the other 20 percent are almost entirely in bank portfolios. Yet in 2002, before the housing bubble, the government share (of a much larger market) was slightly over 50 percent. Johnson Crapo, like the initial version introduced by Senators Bob Corker (R-TN) and Mark Warner (D-VA), provides for a catastrophic government guarantee to support the liquidity of certain mortgage-backed securities (MBS). In both bills, the guarantee can be accessed through either of two channels: (1) by well-capitalized credit insurers (“guarantors”) and (2) by entities who pool mortgages into securities (“aggregators”) through individual capital markets structures (“capital markets execution”). In theory, the two channels should increase competition and reduce mortgage interest rates.

In practice, the dual structure raises three major concerns:

  • It will be close to impossible for regulators to ensure that the capital markets execution is backed by capital of equivalent quantity and quality as that backing the guarantors. Capital markets investors are on the hook for 10 percent on a given deal; guarantors are on the hook until they go out of business, with excess capital from some groups of loans absorbing the losses from others. The result: in good times, the capital markets execution will both attract the lowest risk loans and dominate the market.
  • Because capital markets are volatile and fickle, their dominance during good times may well be followed by flight during periods of uncertainty. We are concerned that when that happens, the guarantors will be unable to ramp up quickly enough to keep the market operating and housing credit available—this is the situation we would have seen in 2008 had Fannie Mae and Freddie Mac not been available.
  • Because of the variety of potential capital markets structures, and the amount of information private investors will demand to put their capital at risk, those MBS will likely not be eligible for the To Be Announced market. The result will be reduced liquidity in a market that is critical to both interest rate lock-ins for consumers and portfolio management by many fiduciaries.

We conclude that the capital markets execution adds excessive volatility, complexity, and uncertainty to the housing finance system, and recommend that it be deleted in favor of the guarantor channel.

Johnson Crapo establishes a series of strategies relating to affordable housing and “the broad availability of mortgage credit,” including the creation of an affordable housing fee in section 501. To incent aggregators and guarantors to serve underserved markets, the bill has an incentive structure for the fee, which must average 10 basis points (bps) on all guaranteed MBS. While innovative and intriguing, it poses some concerns:

  • The fee would be determined after the close of each year, a process that makes it highly unlikely that the incentive’s benefit will be passed through to borrowers, reducing the incentive to increase the supply and affordability of loans to underserved markets.
  • The fee attempts to incent activity in up to eight market and product categories and requires that aggregators and guarantors be evaluated in three different ways, including against each other. It is unclear how guarantors (who are likely to be quite diversified) and aggregators (who are more likely to be small and specialized) can be ranked together. And the calculation’s complexity will dampen the fee’s incentive impact.
  • The bill’s requirement that the highest fee not exceed twice the lowest, combined with the fact that the fee is only charged on guaranteed MBS and the requirement that all fees average 10 bps, reduces the effect of the incentive on both market participants and borrowers.

The impact of the incentive could be improved by structuring it as a fee schedule, known in advance, for serving underserved and other markets. If underserved markets were 10 percent of the total market, and loans to adequately served markets were assessed at 15 bps, the cost of mortgages for underserved markets could be reduced by 35 bps, thereby incenting both primary and secondary market participants to offer underserved markets prices that compensate participants for any additional risk and are attractive to borrowers.

Johnson Crapo represents important movement toward housing finance reform.  We hope our suggestions will help the process.

House photo from Shutterstock.

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Does moving homes mean changing schools?

Author: Brett Theodos

| Posted: April 21st, 2014

Children in low-income communities often change schools and move residences.  Using data from a panel study of households in 10 cities participating in Making Connections, the Annie E. Casey Foundation’s national place-based initiative, our new research reveals how residential moves connect to school changes within distressed neighborhoods.

In the low-income communities studied, students often switch schools. Over three years, 78 percent of children changed schools. While 56 percent of those children switched from a lower to higher educational level like elementary school to junior high (a promotional change), 22 percent changed within their same level (a nonpromotional change). The remaining 22 percent remained at the same school in both periods. Thus, half of the children who could have stayed at their original school switched.

Although less prevalent, housing moves were also common among low-income children. Approximately 55 percent of the children moved homes over the three years, far above the national rate. Switching schools in these neighborhoods was linked with residential mobility—although not as tightly as might be commonly understood. While the “school changers” moved homes more often than the “school stayers” (59 percent vs. 41 percent), both moves also occurred independently for many children and households.


Moving homes was the highest for kids that switched schools within their educational level, but even for this group, 31 percent of children who made nonpromotional school changes did so without making a residential move. And looking at school stayers, we see that even 41 percent of these children moved homes.

School changing was more prevalent for some children than others:

  • White children switched schools less than black or Hispanic children.
  • Children in owner-occupied homes switched less than those in rented homes.
  • Household income was not higher or lower on average for school stayers or changers.
  • Kids with parents who received safety net programs such as SNAP and public housing were more likely to change schools.
  • Parents’ educational attainment was not linked with whether their children switched schools.
  • Kids with parents reporting greater satisfaction in their schools were more likely to stay.

These patterns of residential and school mobility collectively add up to neighborhoods and schools that are fluid, not static, in nature. But are policy and practice set up to accommodate this flux?

Stay tuned for tomorrow’s post on whether school switches actually helped kids reach higher-performing schools, and if so, under what conditions. In a third post, I’ll explore how place-based programs like Promise Neighborhoods should grapple with the mobility issue.

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Many DC children are struggling to breathe. Is bad communication to blame?

Author: Marla McDaniel

| Posted: April 18th, 2014

AC_header-01Could simply fixing gaps in communication between doctors and schools be a key to reducing the impact of asthma on poor kids?

A lot of research shows that not getting the right—or consistent—care causes conspicuous health disparities that fall neatly along racial, ethnic, and economic lines. For many kids with asthma, their condition is managed not by routine care, but by regular emergency trips to the hospital while struggling to breathe.  Unfortunately, if you’re a low-income African American or Latino child with asthma in DC, your asthma experiences are more likely to include one of those terrifying trips.

Access, quality of care, and poverty are part of the story, which my colleagues and I highlight in a series of blog posts and our new report. But our report also highlights the problems created by miscommunication—or worse, no communication—between the professionals and caregivers children need most to manage this chronic and life-threatening illness. Could focusing on communication make things much better for kids?

It takes a team to manage children’s asthma. It takes medical professionals, parents, schools, and the patients themselves.  But our report finds several places where communication lapses routinely occur.AC_dots-03Doctors need the time to educate parents and patients about the different kinds of medications and make sure they understand that some need to be taken every day indefinitely, no matter how the child is feeling. IMPACT DC , the Children’s National Health System program that sees patients who come to the emergency department for asthma-related issues tries to tackle this problem.AC_dots-04But to keep children well, IMPACT DC needs to be able to hand off the care to community providers who can take the time to follow up with parents and patients to make sure that they are following these instructions. And parents need to understand and help their kids stick with the medications and care plan—and to speak up when they are confused.AC_dots-05Finally, doctors and parents need to make sure that the adults at school—where kids spend most of their daytime hours—know about each child’s asthma diagnosis and individual plan. School nurses can help kids remember to take their daily medications and use their emergency inhalers before exercise—and when they feel symptoms coming on.

We know how to manage children’s asthma, and we know everyone we need on the team. Now we need to make sure the team works together. AC_footer-02

Illustration by Daniel Wolfe, Urban Institute. 

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In Indian Country, improved housing starts with a good foundation

Author: Nancy Pindus

| Posted: April 18th, 2014

Why include economic development in a report about housing in Indian Country?  Anywhere in the U.S., the local economy drives economic wellbeing and people’s ability to improve their housing conditions, and Indian Country is no different. Both on and off tribal lands, employment and business opportunities affect housing needs, including people’s ability to afford, maintain, and form new households. Our new HUD-funded study of American Indians and Alaska Native (AIAN) housing conditions provides the latest information on economic development in Indian Country—and why it matters for housing.

In the 1990’s, Indian Country’s economic development improved substantially, attributed in large part to the shift in U.S. government policy furthering self-determination for tribes by allowing them to control more jobs, take over program and activity operation, and better allocate federal funds to meet their needs. With more freedom to select their own path, many chose to strengthen their own governance to foster entrepreneurship.

Until the recession in 2008, Indian Country’s economy continued to prosper and even outperform the rest of the nation in some growth indicators:

  • New business ownership outpaced the rest of the US. The number of Native-owned businesses increased nationally by 7 percent, growing from 102,000 in 1992 to 201,000 in 2002, compared to just 2.9 percent for all U.S. businesses. This growth continued over the next few years and by 2007, there were 237,000 Native-owned businesses.
  • Employment grew faster than the national average. From 2000 through 2007, employment in Native counties (contain all or part of one or more tribal areas) grew by 303,000 per year. The Native American county growth rate was 1.4 percent per year, dwarfing the 0.36 percent average for all non-Native American counties.


  • Lending to support economic development increased. Native Community Development Financial Institutions (CDFIs), including loan funds, credit unions, and banks, improve access to capital  by providing credit and other financial services to underserved tribal communities. The number of certified Native CDFIs grew from only three in 2000 to 72 by mid-2012. Since 2002, the Treasury’s CDFI Fund has awarded more than 175 grants totaling $31 million to Native CDFIs, which serve nearly 100 tribal communities.
  • Businesses and economic development activities diversified. Tribally-owned business expanded and diversified both on and off reservations to include more hotels, resorts, golf courses, manufacturing, oil extraction companies, natural resources, and wild game hunting. Gaming has also been an important force behind economic growth in selected areas of Indian Country, though a large share of revenues flow to a relatively small number of tribes and benefit a small percentage of the AIAN population.

And then came the recession. Though their economy was strong through 2007, the recession hit Indian Country hard. From 2007 to 2010, the number of jobs dropped by 3.0 percent per year compared with a 2.3 percent drop annually for the rest of the country.  The effects were uneven across regions: places that performed best earlier in the decade typically faced the sharpest reversal later on. And despite a cushion from federal subsidies, competition for federal and state funds, a loss of private revenue, and the overall need to do more with less took a toll on CDFIs.

Is there hope for housing? The economic progress that began in the 1990s may have stalled in 2008, but the improved economic and government infrastructure provides a much more favorable environment for economic development and entrepreneurship. Native CDFIs have used various federal economic development funding sources, such as New Markets Tax Credits and corporate funding, to support small business lending and attract manufacturing companies to reservations.

The opportunities to expand business financing  as well as entrepreneurial energy hold promise for economic development in Indian Country. New data collection under way in our housing study will further explore the relationship between economic development and housing.

More research is available on the Urban Institute’s new Native American Communities landing page 

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How data can help us meet global needs for public services

Author: Sarah Rosen Wartell

| Posted: April 17th, 2014




As the global population continues to rapidly urbanize, government, enterprises, and residents are beginning to use data more regularly to tackle pressing urban challenges. Embracing data can help to develop and eventually achieve the Sustainable Development Goals, which will succeed the Millennium Development Goals when they expire in 2015.

That’s why I was heartened to see such emphasis on the rigorous and creative use of data at last week’s World Urban Forum (WUF) in Medellin, Colombia. Each year, the United Nations Human Settlements Programme (UN-Habitat) convenes WUF to discuss issues facing cities and communities around the world. This year’s forum focused on “Urban Equity in Development – Cities for Life.”

As a speaker on WUF’s Basic Services: Local Businesses For Equitable Cities dialogue, I had the chance to discuss how data can empower the private sector to help improve basic services and infrastructure in quickly growing cities around the world.

By making data more available and accessible, governments at various levels can highlight market opportunities for services with social benefits

Even in extremely low-income areas, there is an economy, but residents usually pay too much and get too little. If there were better information about the needs and purchasing power of these communities, it could prompt better businesses to bring in higher-quality services to meet the demand.

For example, in the United States, NGOs and the government documented neighborhoods where people had limited access to fresh foods. Research revealed the SNAP benefits that poor residents received were frequently spent outside the neighborhood or at fast food providers.

Having that information at hand can allow community development financial institutions to lend capital to bring in stores that offer fresh food to poor communities. Increased competition improves the quality of service. Investors are better able to lend when they have evidence of aggregate purchasing power, even if each consumer has only a few dollars to spend.

Residents can collect data on their own communities that benefit government and private service providers

It is difficult for the public or private sector to provide services to communities in which existing amenities, challenges, and infrastructure are not well documented. Citizen-generated information can supply the data needed to inform service provision and investment decisions.

In Solo City, Indonesia, the nonprofit Solo Kota Kita asks local leaders to submit basic information about their communities: number of households, water use, school attendance, land tenure, and more.

The data are turned into a Mini Atlas, a neighborhood profile accessible to all citizens. With assistance from USAID, UN-Habitat, and the Ford Foundation, the city government sponsors this program  and uses the data to support policy design and public projects.

Entrepreneurs can support basic public services with creative data collection methods

Cell phones and other basic information technology can generate information that both government and the private sector can use to target basic services where needed and deliver them more efficiently.

I recently learned about NextDrop, a business in the southern state of Karnataka in India. There, people used to sit around waiting for the unpredictable moment when water services would flow. Now citizens pay a small fee to receive text messages when water will be switched on, so they can be ready to collect water to meet their immediate needs.

In another example, data collected by a company called ShotSpotter could have application in cities around the world. ShotSpotter uses sensors to gather information about gunshots in various cities in the United States to aid policing and help decisionmakers develop crime-fighting strategies. Researchers with the Urban Institute’s Justice Policy Center are also using this data to help improve the quality of policing in urban neighborhoods.

Principles for data and service delivery

These are just some of hundreds of examples of how public or citizen data can strengthen government and private sector service delivery. But whether government is a data provider or user, it has a core responsibility to embrace the power of data to improve lives of residents and make cities more equitable. I believe governments must establish:

  • an open data culture,
  • a respect for evidence-based policy,
  • a norm of openness and transparency, and
  • a system of accountability to ensure that open data leads not merely to new business opportunities, but to improvement in the services and opportunities available to citizens.

No matter who collects and provides the data, these principles facilitate the spread of information—information that will improve private and public provision of services and citizens’ basic quality of life.

As the international community turns its attention to the creation of the Sustainable Development Goals, it must embrace the growing capacity for data collection and take advantage of the opportunities it presents.

Photo by the Urban Institute's Sharon Carney, of Sarah Rosen Wartell at the World Urban Forum.

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Beyond affordability: rental housing problems in Indian Country

Author: Jennifer Biess

| Posted: April 17th, 2014

Last month, we released an interactive map illustrating the pervasive lack of decent and affordable rental housing for extremely low-income (ELI) households in the US. We identified the size of the deficit between the number of decent, affordable units and ELI households for every county. Surprisingly, counties that include Native American tribal lands, which have persistently high poverty and unemployment rates, are some of the places where the shortfall is smaller. But does that mean that housing problems are less severe in Indian Country?

The map below shows the locations of tribal areas throughout the continental US and Alaska where nearly one million American Indians and Alaska Native (AIAN) alone individuals lived in 2010.


Consistent with the affordability map, we found that housing is more affordable for Native American renters living in larger tribal areas (data unavailable for smaller areas) than the national average. About 38 percent of AIAN renter households living on larger tribal areas were cost burdened (paid 30 percent or more of their income for housing) compared to the national renter average of 51 percent.  Further, the average rent for Native American renter households living on larger tribal areas was about half the national average at about $440.

But there’s another way to consider those same numbers. Even though the average rent is very low, nearly 4 in 10 AIAN renter households pay more than 30 percent of their incomes on housing. That’s still a problem – a poverty problem (32 percent of Native Americans live in poverty in tribal areas, more than double the national rate for non-Natives).

And cost isn’t the only issue to consider when thinking about housing problems in Indian Country. While most US housing units have complete kitchen and plumbing facilities – meaning hot and cold running water, a flush toilet, and a tub or shower, a sink with a faucet, a stove or range, and a refrigerator – higher shares of households in Indian Country do not. On larger tribal areas, 3.3 percent of AIAN renter households lacked complete plumbing, four times the national rate. In Arizona and New Mexico 10 percent of all AIAN households lacked complete plumbing, and in Alaska the share was even higher at 18 percent. These shares have gone down over the decade, but remoteness, challenging climates, and lack of infrastructure mean any progress is hard won and difficult to maintain.

AIAN households are also more likely to live in overcrowded housing situations (more than one occupant per room) than households nationally. On tribal areas, 13 percent of AIAN alone renter households are overcrowded, more than double the six percent national rate. We don’t know the extent to which Native Americans choose these living situations because of cultural preferences for intergenerational living arrangements or as an effort to make housing more affordable, but either way the housing units in which they live may not be large enough to comfortably accommodate their residents.

To improve housing conditions on tribal land, we need to better understand housing conditions there as well as these local and cultural factors. We are currently conducting the first study of its kind on Native American housing needs in nearly 20 years, of which this analysis is a part as well as a nationally representative survey of Native American households on tribal land, visits to 24 tribes and other efforts that collectively will shed light on these issues.

More research is available on the Urban Institute’s new Native American Communities landing page

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In Washington, DC, is childhood asthma part of a poverty trap?

Author: Zach McDade

| Posted: April 17th, 2014




When I was a kid in Boulder, Colorado, one of my soccer teammates had asthma, but, like a lot of kids with that condition, it didn’t slow him down. Although asthma affects nearly 1 in 10 children, it is a well-understood and highly treatable disease.

It’s therefore concerning that so many low-income kids—often black or Latino—in Washington, DC, suffer regular, negative consequences of asthma (among the highest rates in the nation). I suspect that’s because it’s yet another example of the pernicious cycle of poverty. In fact, research shows that children from low-income families have far less control over asthma and higher morbidity from the disease than their higher-income peers.


Evidence is mounting that poverty is a vicious cycle that produces other negative outcomes, which in turn deepen poverty. For example, children born into poverty are much likelier to be poor adults, and so their kids are likelier to be poor. The rise of long-term unemployment has plunged many families into poverty, and being in poverty increases your chances of being unemployed for a long time. Austerity measures like sequestration cuts to unemployment insurance and food stamps all compromise family finances and deepen the cycle.

Is the same thing playing out with asthma in DC? A qualitative study by my Urban Institute colleagues sheds some light on the problem.

Poverty puts up barriers to treating asthma

For DC’s large low-income population, it’s clear that where you live matters for getting effective asthma treatment. Families in many communities have poor access to transportation to the doctor. They also have fewer available doctors. And many low-income, especially single, parents cannot take time away from work during doctors’ business hours.

What’s more, much low-income housing comes with a host of asthma triggers, whether it’s proximity to pollution or other toxins in the neighborhood or, as many interviewees reported, exposure to dust, mold, or other negative conditions within the home.

Asthma can also get in the way of a child’s education because these problems get compounded at school. Low-income kids tend to need even more vigilant asthma monitoring and treatment at school, for which most schools are simply not equipped. And when low-income families either don’t have the resources to get a second school inhaler or the bandwidth to ensure that kids carry one every day, asthma problems can compound at school.

But asthma can also lead to greater poverty

Poverty can worsen asthma, but worse asthma, in turn, can deepen a family’s poverty.

Many parents reported that, in order to care for their children’s asthma, they had to take time off from work. But many low-income parents don’t have paid time off or flexible schedules, so they were fired for taking too much time or quit preemptively because they knew they would get fired anyway.

So, for many families, there is a direct tradeoff between treating a child’s asthma and being employed. If they choose treating the asthma, they can lose their income, making it even harder to get good medical care, move into a healthy home and neighborhood, and afford the necessary medication and equipment to treat asthma.

A byproduct is that those families often end up getting expensive, publicly funded treatment in the hospital’s emergency department.

Can we break the cycle?

To be clear, these stories are anecdotal and do not constitute a statistically sweeping claim. But they add to the growing mountain of evidence that poverty is a trap with a clear conclusion: if we spend money now to break people out of the trap, then they’ll be healthier, more productive and self-sufficient, and in less need of support later.

It’s an investment: spend some now, save more later.

There are some obvious ways to break a poverty-asthma trap. We can more vigorously enforce housing quality regulations and mandate that employees with documented asthma needs be exempted to care for their children. We could also incentivize clinics to maintain non-standard hours and work with organizations like ImpactDC – an emergency department intervention program - to build better asthma-treatment routines into low-income neighborhoods and schools.

Image: Standing outside her home on East Street in downtown Raleigh, N.C., Lonnette Williams, right, talks Wednesday, Oct. 5, 2005, about living in Raleigh's South Park neighborhood. Children living in low-income areas like South Park, which has particularly poor quality air, are at greater risk of asthma problems. (AP Photo/Karen Tam)

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