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Show Notes

In this episode, our hosts Bruce Lesley and Messellech “Selley” Looby chat with Dr. Mona Hanna-Attisha and Professor Luke Shaefer about “Rx Kids,” their innovative program to support pregnant women and infants in Flint, Michigan. Dr. Hanna-Attisha is a pediatrician and activist best known for leading studies that exposed the deadly levels of lead in Flint’s water supply.  Dr. Shaefer leads Poverty Solutions, an interdisciplinary initiative at the University of Michigan that partners with communities and policymakers to find new ways to prevent and alleviate poverty.  Their conversation with our hosts centers on the importance of  “Rx Kids,” which gives pregnant moms a prenatal allowance and support during the first 12 months of a child’s life. By supporting families during their most vulnerable window, the program aims to address a root cause of health equity and opportunity.

Read more from Dr. Mona Hanna-Attisha, Dr. Luke Shaefer, and about Rx Kids:

Stay up to date with Dr. Mona Hanna-Attisha and Dr. Luke Shaefer on social media. Follow them on Twitter, @MonaHannaA and @profshaefer. Donate to RxKids on Give Directly. 

To join the conversation, follow First Focus on Children on Instagram, LinkedIn, and Twitter. Connect with our hosts and tell us what you would like to hear on the podcast at:

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Want to be a voice for kids? Become an Ambassador for Children here. Connect with First Focus Campaign for Children for easy training on how to be a powerful advocate for children. Please consider donating to First Focus on Children to support our work and this podcast here.

Full Transcript

Selley Looby 0:03
The Flint water crisis started in 2014. When state and local officials in Flint, Michigan failed to apply corrosive inhibitors to the water supply from the Flint River. toxic levels of lead began leaching into the drinking water. Around 100,000 Flint residents were exposed. Lead has a huge effect on child development and can lead to long term intellectual and physical challenges and a higher chance of developing Alzheimer’s. And it’s important to remember that these are not just developmental delays. This reaches into all areas of brain development, touching even the ability to make good choices, healthy decisions, as well as cognitive function. In 2021, a total of 34 felony counts and seven misdemeanors came down on the former Governor Rick Snyder and eight other officials for their role in the crisis. To others were charged with involuntary manslaughter. 10 years after the beginning of the crisis, the legacy of distrust and anger remains in Flint.

Bruce Lesley 1:13
From First Focus on Children. This is Speaking of Kids… I’m Bruce Lesley.

Selley Looby 1:17
And I’m Messellech Looby. Speaking of Kids is a podcast that puts kids at the center of public policy.

Bruce Lesley 1:29
You may be wondering why we are taking back 10 years to talk about the Flint water crisis. But that’s where many of us first met one of our guests today, Dr. Mona Hanna-Attisha. She came to national prominence for her leading studies and exposing the lead levels in the Flint Water Supply. Today we welcome Dr. Hanna-Attisha and her colleague, Dr. Luke Shaefer, both tremendous champions for children in their own right. They are working at the intersection of public health and poverty is it impacts children. Today they will talk about their prescription for improving the lives of floods children, improving their health and reducing child poverty.

Selley Looby 2:09
Dr. Mona Hanna-Attisha is the Associate Dean for public health at Michigan State University. She is the founding director of the pediatric public health initiative in Flint, Michigan. She is reimagining how society can eliminate infant poverty with a first in the nation program RX kids. Dr. Hanna-Attisha is the author of the widely acclaimed book what the eyes don’t see a story of crisis resistance and hope in an American city.

Bruce Lesley 2:38
Dr. Luke Shaefer is a professor of social justice at the University of Michigan, at the University of Michigan. He is also the inaugural director of poverty solutions an interdisciplinary presidential initiative that partners with communities and policymakers to find new ways to prevent and alleviate poverty. His work has been supported by the National Science Foundation, the Bill and Melinda Gates Foundation and the US Census Bureau among other sources, and he’s the co author of the book $2 A day living on almost nothing in America.

Selley Looby 3:10
And we are so excited to jump into this conversation today with Dr. Mona and Professor Luke to talk about their new first of its kind program, RX Kids. Welcome! Dr. Mona, Professor Luke, we are so excited to have you today on our podcast. We’ll start with you, Dr. Mona, we’d love to hear a little bit about your backstory. Why did you decide to become a doctor? And in particular, why did you choose pediatrics?

Dr. Mona Hanna-Attisha 3:37
Oh, well, it is great to be here with you. We’re so excited to have this conversation. Wow. So my backstory. So I’ll share that in the next couple hours that we have together. You know, I think I saw medicine as really the most intimate form of caring for people. And then I chose pediatrics for many reasons, kids are joy, and fun, and inspiring and energizing. But the beauty of Pediatrics is our role in prevention. It’s not so much about taking care of the kid in front of us today. But it is about taking care of their tomorrow making sure that they can be and do anything that they want to be. So that’s what I love about pediatrics. I also love that this is a specialty where, you know, part of my job as a clinician, as an educator, as a researcher, but it’s also an advocate. So it is very much part of my job as a pediatrician to elevate the voices of children and in many different spaces. So it’s the best job in the world. I pinch myself that I get to do this work. I love that.

Bruce Lesley 4:40
Well we loved loved loved your book or our listeners that title of it is what the eyes don’t see a story of crisis, hope and resistance in American city. So can you tell our listeners about the Flint water crisis? And how you discovered this American tragedy, and what policy solutions are needed to improve child health and well being for the kids of Flint. But, you know, your solutions that I’ve heard you talk about in the past are also very universal. So, yeah, what are those things we should be doing?

Dr. Mona Hanna-Attisha 5:10
It’s been said that, you know, pediatricians are the ultimate witnesses to failed social policies. And it’s literally kind of in my exam rooms that I see this play out. And that’s kind of what happened with the Flint water crisis because of policy choices. Our water source was changed, it wasn’t treated properly, and an entire population of children were exposed to a neurotoxin. And this all could have been, you know, prevented my role, I brought to light the science that our kids were in harm’s way, research I never should have had to do, you don’t need research, like kids are being poisoned to protect them. So since then, you know, we’ve really kind of been working around the clock to put into place a path towards recovery, but really to inform policy to make sure that we do a better job preventing similar toxicities. And the toxicities are not just things like letting your water but it’s the toxicities of poverty and systemic racism and disinvestment, and, you know, lack of housing and nutrition and you know, all these different things that make our children sick. So we’ve been able to really, you know, inform policy, one of my favorite stories is, you know, the infrastructure act that just passed, invest in roads and bridges and broadband, but it’s also the largest federal investment in water infrastructure. And because of our advocacy includes the replacement of lead pipes across the country. So that’s one example of many where we’ve been able to inform policy, and to kind of really shift to our prevention, child centric science based focus.

Selley Looby 6:44
And Luke, you spent many years working on issues related to child poverty and family economics. Can you tell us in the audience, you know, what really brought you to hone in on child poverty and center it in your work?

Dr. Luke Shaefer 6:56
Well, my dad had a career crisis when I was in middle school, and we ended up for a long period, just not having a lot of money and knowing what it was like to worry about, you know, every month and paying the bills. Luckily, we had a grandma and grandpa that could help us out from time to time. So I could definitely recognize that I wasn’t growing up in the middle class. But I also sort of felt like I wasn’t born necessarily, because we didn’t have to ask for help at the welfare office. So that drove my interest to figuring out what we could do for families with kids. I started out in casework working in emergency relief, like helping families who were struggling to pay their rent, or were threatened with having their utilities shut off. And that’s incredibly important work. But I was just struck by the fact that every single month, I could be guaranteed that there’d be some families who couldn’t pay their rent, or they couldn’t pay the utility bill. And sometimes it was the same, but usually it was different families. But what was certain was, there would always be families who were struggling. So that really struck me as a structural cycle of poverty, it was really about what types of situations society puts people in. And so that’s what really drove my interest to work on policy. And think about all the ways that a city or a state, or the federal government can shifts policies to really empower families to live healthy and productive lives.

Bruce Lesley 8:22
And you have a great new book out too, which is called the injustice of place uncovering the legacy of poverty in America. So I will say that I’m in the middle of reading it. I was hoping to finish it before we talk to you today. But it’s awesome. And I just wanted you to tell us a little bit about the findings of your book and what policy solutions you are proposing, including, you know, the work you’ve also passed on on the importance of the Child Tax Credit, being fully refundable.

Dr. Luke Shaefer 8:51
And my first book in 2015, was called $2 a day, and it was about really, really poor families and the lack of having any money. So families might have food assistance. And, you know, there’s a great set of public charities out there that help families who are struggling, but what does it mean to not have any cash? And what kind of situation does that put families and when they need to buy toilet paper toothbrushes, or pay the utility bill or whatever it is, this next book was really about really, really poor places, once you start to look at places so this could be counties across the United States, or it could really even just be zip code, you know, within a county you can see these huge differences. You know, you’re talking about more than a decade difference in life expectancy, like really even how long you live, we’re talking about infant outcomes, like what are the challenges that you come into the world with, and you’re talking about social mobility. So in some places, the American Dream that if you grew up or you can rise to the middle class is alive and well. You see that in a lot of communities and other places. If you grew up poor you’re, you’re pretty much likely to be poor as an adult. So the new book, really try As to figure out some of the ways that we can address what’s going on in communities. And it really ties it back to history, a lot of times, we sort of give a nod to history. But then we proceed with our policy solutions, like all of our problems appeared out of thin air. And in the case of all of the places that we got to know, and in Kentucky, and then down in the Cotton Belt, and down in South Texas, the challenges really stem from things that have happened over decades and over centuries, and to really grapple with what’s going on, I think we have to take that into account.

Bruce Lesley 10:33
So Dr. Mona, both of you have in your work really focused on place, and location is important factors in child wellbeing. If we can change public policy, how does that affect kids?

Dr. Mona Hanna-Attisha 10:45
Yeah, you know, so much of what I do as a pediatrician, flan is, especially after the water crisis is is asking kind of families and victims to do more, you know, read more to your kid and sign up for this program. And you know, this place has a free backpack program on this day and do this home visiting port, they’re all good things. But it’s very individual focused. And once again, asking the oppressed to do more, you know, be stronger, you know, you can overcome the insurmountable. And I think the way that kind of my work has evolved is really taking a step back and looking at what we can do at a community level, to build resilience in a community rather than really focusing so much on building resilient children. And that’s where kind of the policy work needs to be. And it’s not something we often think about in health or health care. So we need you know, stronger environmental regulations, we need to raise the minimum wage, we need paid parental leave, we need, you know, more investments in public health rather than in health care, which is a sickness based and kind of reactive system. So there’s a lot that we can do at a community level that is policy based to protect children that we inadequately do right now.

Selley Looby 12:00
I feel like I’m like doing mental high fives, like every five seconds. Professor Luke, do you have anything to add here?

Dr. Luke Shaefer 12:08
I like to say that in our social safety net, if a mom wants to go out and find someone who can tell her all the things she’s doing wrong in her life, she has infinite possibilities. And I think if we spend a little bit more time thinking about what we can do differently, as a community to really come alongside families that that we would get better results. One of the chapters in our book is about government corruption. So in every one of the communities that we were in, there were examples of folks in charge, who were really not looking out for families and maybe looking out for themselves. And that goes back centuries. Again, it didn’t just appear out of nowhere. And sometimes that can be used to sort of blame poor communities for their own problems. But we could go back into the Appalachian Community, we’re in and see examples from 150 years ago, sometimes the same families who were in charge, you know, doing the same kinds of things. So when we go to very poor communities, and we ask community leaders, you know, what are your biggest challenges, they almost always point to the shortcomings of poor residents. You know, they’re not working hard enough. They’re not doing what they should. And they never point to these, you know, examples of government corruption, which a lot of time the dollar amounts are just way bigger. So I think it’s just a matter of sort of, like, where do we turn the lens? And, you know, what is our approach and the approach of looking at the community, I think, you can have much more impact, you can have impact at scale, you can empower families. And I think the results are going to be so much bigger.

Dr. Mona Hanna-Attisha 13:46
Bruce, if I can add like so, you know, I started out as a pediatrician, caring for kiddos, right. And I love my work, and I still see patients and, you know, within a year of being a pediatrician, I quickly got frustrated. I’m like, why am I taking care of a child with a gunshot injury? And we’re not addressing gun violence? And, and why do I keep taking care of kids who are hospitalized with, you know, they can’t breathe with asthma exacerbations, and we’re not addressing air quality. So it’s all of these things that pushed me to go back to school and get my, you know, public health degree in health policy, but really pushed me to take a step back and look at what needs to be done at the population level, to better care for our children.

Selley Looby 14:27
And on that note, you know, Dr. Mona, you came up with the idea of RX kids, which is amazing prescription for health, hope and opportunity. Can you tell us a little bit more about this idea, and how your knowledge about science and history informed this initiative and what brought you together to team up with Professor Luke for this amazing project?

Dr. Mona Hanna-Attisha 14:50
Oh, I love this project is pure joy. It makes me and so many folks so happy. So for a long time. Um, as a pediatrician, I have literally wished for the ability to prescribe away poverty, an antidote to poverty. I, you know, we do so much for our patients, we have literacy programs and an embedded social worker and a WIC office and mental health care and, you know, all these things that we do. But we are not addressing a root fundamental cause of health and equity and opportunity. And that is poverty. And I am tired of shrugging my shoulders, I’m tired of not being able to do anything about poverty. I’m like, we didn’t do a child loans program and Flint, and I’m like, I have no idea how to do this. So I’m like, how am I gonna do this? I’m like, oh, empty, like the one of the world national experts on child poverty happens to be in our state. So I blindly emailed him, like, Hey, you don’t know me, but like, what do you think about you know, doing a child poverty program, a child allowance program and fled.

Dr. Luke Shaefer 15:56
And he said, I mean, in many ways, I just been waiting for this email just sitting by my email waiting to hear from Dr. Mona, because this is exactly what I wanted to do. So I had been studying child allowances all across the world, like country after country has a program like this, it starts with this very simple logic that raising kids is expensive, and society has a reason to come alongside parents in that work. And one way to do that is to provide us some money every month that families can be empowered to spend on their rent, on their utilities, on their food, on books, and toys, on childcare, whatever they think is going to be the thing that helps their kids the most. And every country that does this, we see child poverty just plummet. And we see food hardship plumbing, we see families and kids do better in so many ways. We embarked on this for a short period of time here in the United States and 2021, with the expanded Child Tax Credit, which I know you all have been champions of and talked a lot about. And so you know, the evidence that we brought child poverty to historic low food hardship went to the lowest level we’ve ever recorded, people’s credit scores went to the highest level they’d ever been, because people used the money to pay off their bills. So you know, this huge amount of evidence supporting this really the evidence based policy of evidence based policies. So Monique called me up, we came up and had lunch and started to talk about it. And of course, we would love to do it for every good all the way up to 18 —

Dr. Mona Hanna-Attisha 17:26
— like normal in other countries.

Dr. Luke Shaefer 17:29
But that gets really expensive, really, really fast. So we looked at, you know, under five, and God, we would love to do it there. If there’s a donor out there that wants to fund that, like we’ll do it tomorrow. But really we honed in on this first year of life, and that prenatal period to as this incredibly important period of cognitive development and baby’s brains doubling in size. I know now that I hang out with pediatricians on a daily basis.

Dr. Mona Hanna-Attisha 17:55
So it also turns out that that this Maternal Infant window, which I didn’t know is also the most economically vulnerable window. We know that families with the youngest children are poor, but it’s actually it actually peaks around childbirth. So right before babies born, moms often lose income. And babies are expensive, they need stuff. And after the baby’s born, childcare is expensive parental leave policies are lacking. So that really persists until the first year of life. And for me as a pediatrician that is maddening. Like this is the most critical neurodevelopmental period in the child’s life. But it’s also the most economically vulnerable period. So RX kids will be prescribing a one time prenatal allowance and mid pregnancy $1,500. And then as $500 a month for the first 12 months of life. So it’s a maternal kind of infant universal child allowance program. So this has never been done before. It’s for the whole city, there is no income testing, because fundamentally, this is about how we are supposed to care for each other.

Bruce Lesley 18:58
Yeah, absolutely. Well, I think one of the great things that you guys have really hit on here is that at the moment when kids probably need the greatest investment, right? Yeah, that’s when families are the poorest. I mean, you guys have this amazing chart on the poverty level of kids who are infants is the highest of all so right in the life course that’s when we need to be making the most investments and we’re actually do the opposite.

Selley Looby 19:27
Coming up after the break, Dr. Mona and Professor Luke explain why they chose to make the RX Kids program universal.

Leila Nimatallah 19:41
Making the world a better place for all children can seem like an impossibly huge task. Some of you may be thinking, I’m just one person, what could I possibly do to make a difference? I’m Leila Nimatallah, Vice President of advocacy and mobilization at First Focus on Children. And I’m inviting you to join us and become one of our volunteer advocates, whom we call our Ambassadors for Children. Ambassadors are our most active child advocates who raise critical issues with the US Congress, and with the administration related to child policy and funding decisions, both for kids in the US and worldwide. But don’t take my word for it. We asked one of our ambassadors to share her experience.

Katie Landa 20:32
I am Katie Landa, I live in New York City. I currently work as a researcher for an institute called the Child and Family Research Center at the University of Illinois, Urbana Champaign. I joined the ambassador program because it’s important to me to participate in working towards public policies that support children and their families. And I would encourage you to become an ambassador, if you would like to become a part of a very supportive and warm network of people that values teaching and learning and activism towards creating a more just and caring country. Thank you.

Leila Nimatallah 21:23
So please join us won’t you check out campaign for backslash ambassadors, on how to become a First Focus on Children Ambassador, and to link up with our fabulous community of committed child advocates.

Selley Looby 21:49
First Focus on Children is a bipartisan advocacy organization dedicated to making children and families the priority and federal policy and budget decisions.

Bruce Lesley 21:58
First Focus on Children moves beyond individual issues to serve a more important role child advocacy, we educate lawmakers and the American public about the issues facing children.

Selley Looby 22:09
To learn more about our work and ways that you can become ambassadors go to

Bruce Lesley 22:15
Coming up later, in State of Play. We’re inviting Cara Baldari, our Vice President of Family Economics, housing and homelessness, at First Focus to talk about child poverty in America.

I love that this is a Michigan State Michigan collaboration and and see here in Washington, you know, we deal with the Republicans the Democrats fighting and hey, if Michigan State Michigan come together, right? Like, Oh, can we do this for kids?

Dr. Mona Hanna-Attisha 22:42
Yeah, that’s pretty amazing that we’re working together. But I think also like, we’ve seen a lot of interest from all sides of the aisle for this program, red states and blue states. So folks in Indiana and North Carolina, that lots of other states want to do this. And I think this especially interest in the kind of the prenatal piece from more conservative folks. But also people are okay with this, because it ends at 12 months. So you lose some of the typical arguments about cash assistance in terms of back to work and dependency. So lots of kind of broad interest has developed for this program.

Dr. Luke Shaefer 23:19
In that partnership, that partnership of UVM and MSU. You know, I hope symbolizes our believes that like, when it comes to families with babies, we should all be coming together. Yeah, so the biggest part like RX kids is an unconditional cash transfer. It’s for every family in the city, we’re not picking a few winners, you know, like 100 families and a lottery or anything, everyone. But we’re also going to be inviting organizations across the city to think about what more can they do? Or you know, what different things can they do to really come alongside and support and empower families with the youngest kids?

Bruce Lesley 23:56
Why did you guys decide to make it universal? Like you could have chosen to really just focus on poor kids understanding that there’s a limited amount of money, but you really, you’ve made this commitment to make a universal credit.

Dr. Mona Hanna-Attisha 24:10
I can start and then you pass it on to Luke, I think there’s a few reasons. And the first I kind of alluded to that, that this is what we should be doing. This is how we should be caring for moms and babies. So part of this work is Yes, about economic stability and all the outcomes that we hope to look at. But it’s also about rebuilding that social contract between kind of government and institutions and residents. That’s one reason we wanted it to be universal. And I think the second reason it’s, it’s more efficient. Our application form is really short. You know, when you have any kind of means testing or eligibility requirements. It’s more of an administrative burden. We’ve have like libertarians who are excited about this kind of work because it’s less you know, bureaucracy, when it’s universal.

Dr. Luke Shaefer 24:57
I’ve really come to appreciate that when we mean stuff. So when we income test, we actually are also sending very subtle signals of what we think of families. So the messaging becomes very different it becomes, you aren’t handling your business. And so we’re gonna give you this money. And, and usually, just because of our long term history, like, going back to, you know what I was saying this all didn’t appear out of thin air. But once we put an income test in place, we spent an awful lot of time guarding that, you know, applications, you know, as Mona mentioned, like, you start to add questions, you’re like, Oh, well, what if they have assets? Oh, what if they have a car. And so each time you do that you’re sending signals to the families that you don’t trust them, that the aid has a different form. And so interestingly, there are some studies that show when you universalize, a program, the biggest impact is increasing takeup among the people who are already eligible. So it’s not the biggest impact is making it available to everyone, it’s, it’s actually increasing the number of families who could have gotten it before, but didn’t either because the process was arduous, or they didn’t like the way it made them feel. I just mentioned one other thing, which is when we give a benefit to one family, and we say, oh, to another family, you’re above the line, and you aren’t gonna get it. But they’re struggling to it turns out raising kids is really expensive, whether it’s putting food on the table, or that formula that costs a lot because a child special needs diapers, when we put an income test in place, we create animosity between people who are below it, and people who are higher above that threshold. And so I think that’s a big part of why the child tax credit was so popular, in many ways, we’re doing the exact same thing that we did with our welfare program. Except without this, this means test this income test, we’re giving it to very poor kids working, or kids, upper middle class kids. And we’re saying we care about all the kids. And you know, I think you can put an income test up at the very, very top. But anytime you exclude people, I think you reduce the number of people who care about the program. And so going more universal, I think it makes it a more popular program and a more stable program over time.

Selley Looby 27:23
To that point, Professor Luke, you’ve done a lot of research that has demonstrated that the development of kids is critical to their long term success, and that poverty really impedes that. Can you explain why that is?

Dr. Luke Shaefer 27:36
So you know, kids, especially in that first year, but up through the life course, they’re developing, and so much of what it impacts us when we’re older, is shaped by our experiences early in life, as we’re sort of learning about the world, as our bodies are growing. And so you can think of all of the reasons related to economic instability that impact kids. So if I, if I have a stable place to live, I know where I’m sleeping, I’m going to sleep better food, if I have a stable source of food, I’m going to do better in school. So you can sort of see these ripples that are going out into every single part of life. And so when we intervene earlier, and we come alongside families, we can have the longer impact of changing the life course right, sort of reshaping the scope and setting kids up to succeed over time.

Dr. Mona Hanna-Attisha 28:29
There’s a great article that Luke cites $1,000 investment in the first year of life, reaps greater earnings in their 30s.

Dr. Luke Shaefer 28:38
Yeah, paper in the Quarterly Journal of Economics shows this, just you know, that extra $1,000, in that first year, pays dividends and earnings and people’s 30s.

Bruce Lesley 28:49
I think so often in children’s policy, everything’s so siloed. Right? So people think about after school or you know, early childhood or youth development programs, what’s so incredible about the work that both of you have done is you really get the holistic nature of kids. You both have, have tackled these issues in your own sector, but you think about it so much more broadly. What sort of makes you think about the kids more holistically, then I think, in most, most of our field, people really do kind of only, you know, delve into their one issue.

Dr. Mona Hanna-Attisha 29:28
Yes, Bruce, I agree with you. We don’t look at kids holistically. I keep myself up at night. Like why don’t we care about kids in terms of our policies, our inaction on things like climate change and gun violence and cuts to WIC and SNAP and Medicaid, and you know, how we fund education, environmental, but like there’s so many examples of how we fail to care for kids. And you know, this is an example of how we can do better but kids need a seat at the table. Like we need a secretary for children. We need that White House office for kids like we He need a voice for kids that brings together these silos because what’s not just in HHS is also an education. And it’s an here and here and here. And there’s not this consistent voice for children. We know we’re crossing disciplines. And I think it’s been, we’re raising money for this program. And you know, it’s been frustrating for foundations because like, what was it’s not just early childhood, it’s also like racial equity and its economic development, and its democracy building, like you fit into so many buckets, I’m like, yes, the world of children is intersectional, we have to take a step back and see how we can you know, holistically support them.

Bruce Lesley 30:37
100% Professor Shaefer, do you have anything to add?

Dr. Luke Shaefer 30:42
Yeah, I think I would just say that the the siloed approach is, it’s a selfish approach, right? It’s like, we’re gonna make kids wrap around the way that our work is structured and think about only what we’re doing and you just miss so much. And I think trying to see the hole can help you understand your, your own work more, I can help you understand how it fits in and, and really, that’s how kids live their lives. And so we really need to wrap ourselves around how kids lives work, and not, you know, around the way our work happens to be structured.

Selley Looby 31:17
I love that. So this last question, you guys are going to have good answers for me. I could already feel it. We’ve been asking all our guests. What songs albums do you turn to You know, after you’ve been up all night thinking about gee whiz, like, why aren’t people thinking of kids when you get up? What songs what albums like what’s your go to for inspiration?

Dr. Mona Hanna-Attisha 31:39
Well, we are hosting a concert. So RX Kids in the public celebration is on Valentine’s Day, because this is fundamentally about how we love our mamas and babies. So there’s going to be love songs throughout the night in celebration of this program. So we’re working on that playlist right now. So there’s lots of songs, but they’re mainly like love songs. And Luke is actually a performer and I’m gonna, I’m gonna have him answer that question first.

Dr. Luke Shaefer 32:09
Oh, man, this project gives me so much joy. And I literally can’t talk about it without smiling. So I find myself going into a lot of you to, you know, beautiful day, in the name of love all of those. But also, there’s a great Aladdin song, a whole new world. And so that is also on this thing going through my head. It’s all sort of thinking about, like, really, we could live in a different world, the way things are, it doesn’t have to be that way. And I think the Child Tax Credit showed, I mean, in a short amount of times, we made families a lot better off. And so that’s a way we could live. And really, this project, there’s so much to be completely depressed about and sad about in the world right now. And this is a program that we hope brings hope, hope to families in Flint, but also to our funders, you know, any funder out there? It’s really happy when they fund this project. And people all over

Dr. Mona Hanna-Attisha 33:10
Yeah, I’m not gonna add anything, because that was beautiful.

Bruce Lesley 33:15
Yeah, I have a song, I agree with his song.

Selley Looby 33:20
Our playlist is going to be strong, we will provide you the playlist. As of now it has Aretha Franklin to Afro beats.

Bruce Lesley 33:28
So we just want to thank you guys so much for being with us today. And for all you do, like you’re not only do amazing work all the time, but now you’re doing this whole other project on top of all that great work. And so, you know, I hope that our ex kids is wildly successful. But not only that, that I hope is exactly what you said. I hope that people see this as inspirational and not only do other locations, take it up, but I owe Congress that they restore the fully refundable child tax credit or make, you know, a universal credit the way you guys are talking about it. And we give this to everybody. Yes, it’s what we need to do. So

Dr. Mona Hanna-Attisha 34:09
yes, we agree. We agree. So much.

Dr. Luke Shaefer 34:12
Thanks to both of you for your leadership in this field and speaking on behalf of kids. Thank you.

Selley Looby 34:22
In today’s state of play, we’re welcoming Cara Baldari, our Vice President of family economics, housing and homelessness at First Focus. Welcome, Cara.

Cara Baldari 34:31
Thanks so much for having me.

Selley Looby 34:32
So we’ll jump right into it. You know, we just wrapped up with Dr. Mona and Professor Luke, such a fun interview. And they are on an undertaking an innovative effort, you know, through their kids RX initiative to support pregnant women and infants in Flint, Michigan, you know, as someone that leads family economics, in your opinion, why is this effort so important? And what can it inform about us cutting child poverty in America?

Cara Baldari 34:59
I mean, I think This program is so important because we know that cash transfers, like what we’re going to see in the RX program make a huge impact for kids, both in the short and long term. And so we know that the the money received from this program for families in Flint is going to have, you know, hugely consequential and positive impacts for the children of Flint. And, you know, I think we’re gonna get into all the evidence that’s out there already, you know, further on, but we already have a mountain of evidence that when households with children receive an increase in income, you know, such as through a cash transfer, the parents and caretakers in the household spend it on resources that improves their children’s well being and their healthy development. We also know that as a result of this increased income, we see reduced stress in the household, you know, which gives parents and caretakers more bandwidth for their kids, which makes sense, right? When you’re not constantly worried about how you’re going to put food on the table right are covered the next bill, you have a little more capacity, right to spend time with your kids. And I think this program will also just add to the evidence we already have about the positive impacts of cash transfers and assistance for kids and I think will really be helpful in building the momentum that we need to get a permanent National Child Benefit Program established, we saw re a temporary cash assistance program passed in the American rescue plan act in 2021. But we know those payments have since expired. And so we need to keep up the momentum to get a permanent program established. And I think this program will just help to show why cash transfers are so important.

Bruce Lesley 36:42
I think that one of the things too, that we’ve really learned over time, as you pointed out here is cutting child poverty really does impact every aspect of the lives of kids. And, you know, as you have done, you know, amazing work in leading the Child Poverty Action Group here in the United States. One of the things I remember us doing was really looking at lessons learned from other countries. And we had numerous conversations with folks like in the UK and the work they’ve done. And so why would this be important to us? And what lessons can we learn from those other countries like the UK and Canada? Who have successfully cut child poverty in the past?

Cara Baldari 37:25
Well, yeah, I mean, the US has long had a higher rate of child poverty than other wealthy countries, because we have failed to sufficiently invest in our kids. And so I think we’ve long been inspired by other countries, right? Who have said, we’re going to make child poverty a priority, right, and then have made more progress than we have in reducing child poverty because they made it a priority. We started the US Child Poverty Action Group, right in 2016, which I can’t believe it’s been around that long. But we knew that we needed to bring advocates together who were separately advocating for child poverty rate across different sectors to come together and unify to say, you know, us needs to make child poverty reduction of priority. And so the goal of the group is to set a national child poverty reduction target in the US, we have the goal now of cutting it, at least in half way, our child poverty rate at least in half, within five years, and there’s national legislation, the Child Poverty Reduction Act, that would codify such a target, right and take steps to improve data around child poverty. So we cut child poverty nearly in half in the US in 2021, right, because we passed policies through the American rescue plan, such as improvements to the child tax credit, right, that got cash immediately in the hands of families, like the RX program will do. But lawmakers let that program, let those improvements the Child Tax Credit, expire, and now we’re seeing increases in child poverty. So, you know, we got our child poverty rate to be more on the level of what we see right in other wealthy countries. But now we’re backsliding. So clearly, we need to build more political well, we need more accountability. Setting a target is really helpful to doing that. Just having that goal, right gives a tool to advocates to hold lawmakers accountable to keeping it on on top of their list when we know they have a lot of other things that are calling their attention. And so we continue to advocate for such a target both for the Biden administration to establish a target as well as right Congress to codify a target into law. And we think that’s a really important step towards passing all of the policies that we know are needed to reduce child poverty in the long term. We know child poverty is a political choice, right? We can make progress when we have the political will. And it’s not just other countries that have set targets. There are child poverty targets in place in New York, in Puerto Rico, in California in some form, and you know, so all of those places are, are taking really significant steps towards child poverty reduction. So there’s momentum, we know that a lot of states have passed their own child tax credits, right, that are reducing child poverty on the state level. So, you know, we have to keep up the momentum. And again, I think a target is a really important tool to doing so.

Selley Looby 40:16
And you know, Cara in all the work we do it’s cross sector, right? It’s we don’t look at one issue in isolation. I think child poverty is definitely one of those issues that intersect with several other issues. In a previous podcast, we had the opportunity to actually speak with Dr. Kirabo Jackson. And you know, his whole frame and research around money matters and investments in children, especially in the areas of early childhood and education, have both, you know, short term and long term outcome for children. From your perspective and research on cutting child poverty. What does the research tell us about the impact this may or may not have on, you know, an array of child outcomes?

Cara Baldari 40:16
Yeah, I mean, I think as I referenced earlier, we have a lot of evidence to show that money matters for reducing child poverty, right? First focus advocated for a National Academy of Sciences study on child poverty that was released in 2019, called a roadmap to reducing child poverty. That included a whole long list of studies that show right that when families again receive an increase in income, such as through cash transfers, that kids do better in the short and long term. And again, that’s through a few different pathways. It’s because parents and caretakers in the household spend that money on resources that benefit kids. And we saw that in the example of the improvements for the child tax credit, right, when families got monthly payments, for the first half of 2021. They spent it on food, they spent it on diapers, they spent it on housing costs, right, they spent it on educational materials for their kids, or new clothes for school, and all these things, nourish kids, right, they help improve their physical health, they allow them to focus in school, and so they do better in school, all of the things that we know, right that kids need to do well, and the studies we have, you know, for the long term show that when kids are in a household that receive an increase in income, they have better physical health as adults, right, they have lower rates of asthma, again, they do better in school, their test scores are higher, right? You know, pregnant people who receive these payments, while they have a child in utero, there’s higher birth weight for the child, right, which is directly associated with higher earnings as adults like, and all these things sound logical, when we give kids resources, right, that helped their physical and mental health, they do better. And so we know that this money is an investment in kids, right? It’s not just it’s not a handout, it’s a hand up. And it impacts our greater society. You know, child poverty costs our country upwards of 1 trillion, that’s with a T $1 trillion a year. And so we can really improve our economy in the short and long term, by investing in our kids. It’s a no brainer, you know, it’s like the best investment we can make. Right? You know, First Focus, we believe every single child right deserves the chance for a happy, healthy, joyful life. We have huge racial disparities in child poverty, because we have long lasting inequities in our society. And we know that investments such as cash transfers, like what we’re seeing with RX program, right, really reduce those disparities, and really can help all kids thrive. So, you know, we have all the evidence we need, it’s great to continue to build it right, like through programs like the RX, but we know what works, we just have to keep the heat up on our lawmakers currently, advocates at First Focus like myself, and so my colleagues, many of the other partner organizations we work with are right now right advocating for Congress to pass a deal that would make improvements to the child tax credit that would help more kids in need. So this is all happening in real time, and we feel encouraged that we will continue to see progress.

Bruce Lesley 44:20
So thank you for joining us today on the state of play and on our podcast. We really appreciate it.

Cara Baldari 44:25
Thanks again for having me.

Selley Looby 44:27
Thank you, Cara.

Bruce Lesley 44:33
This is Speaking of Kids… Thanks for listening. I’m Bruce Lesley.

Selley Looby 44:36
And I’m Messellech Looby special thanks to our guests Dr. Mona Hanna-Attisha Professor Luke Shaefer and Cara Baldari.

Bruce Lesley 44:44
Speaking of Kids as a podcast by First Focus on Children.

Selley Looby 44:47
Elizabeth Windom is the Supervising Producer and Julia Windom is the Associate Producer.

Bruce Lesley 44:49
Leila Nimatallah is the Advocacy and Mobilization Producer and the Senior Producer is J. Woodward,

Selley Looby 44:59
Our theme music Don’t Look Twice by Sam Barsh.

Bruce Lesley 45:02
For more information about this week’s episode go to You can find all of our links in our show notes.

Selley Looby 45:05
If you have any thoughts, questions or interest in becoming a First Focus on Children Ambassador, email us at speaking of kids at

Bruce Lesley 45:18
And please follow rate and review on Apple podcasts, Spotify, or YouTube.

Selley Looby 45:22
Speaking of Kids is produced by Windhaven Productions and BlueJay Atlantic.

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