Household wealth data at the local level are generally not widely available, especially statistics disaggregated by race and ethnicity. Using machine learning, we estimate net worth and emergency savings data at the local, city, state, and national levels. We also disaggregate our estimates by racial and ethnic groups at the city, state, and national levels. We use machine-learning models trained on the Survey of Income and Program Participation (SIPP), a survey with detailed wealth information but too few observations for local estimates, to estimate emergency savings and net worth using the American Community Survey (ACS), which allows for state and local estimation. The imputations allow us to estimate the proportion of households with more than $2,000 in emergency savings and median net worth at the household level. We then aggregate household-level data to different geographic levels. Household wealth is a safety net. It protects families from unexpected expenses such as replacing a water heater and income shocks such as a jobless spell. Household wealth is also a springboard. It gives families the opportunities to invest in wealth-building opportunities like starting a small business or moving to an area with more opportunity. Understanding wealth is necessary for uncovering the barriers to wealth generation and designing policies that unlock opportunity for everyone. Two datasets, the Federal Reserve Board’s Survey of Consumer Finances and the US Census Bureau’s Survey of Income and Program Participation (SIPP), have detailed information about wealth and are typically used for national or state estimates (Bhutta et al. 2020). Unfortunately, little information is widely available about wealth at the local level, especially disaggregated by different racial and ethnic groups. This is because household surveys with adequate sample sizes for local estimation, such as the American Community Survey (ACS), do not include detailed information about wealth. We employ machine learning to leverage a smaller nationally representative survey with detailed questions about household wealth to impute household wealth onto the ACS, which allows for small area estimates. We released this novel dataset with the Urban Institute’s “Financial Health and Wealth Dashboard” in 2022. In particular, we use machine learning to estimate median net worth and the proportion of households with at least $2,000 emergency savings at the local level defined as Public Use Microdata Areas (PUMAs). We provide financial measures not only for a city, but also for subregions (Public Use Microdata Areas, or PUMAS) within many cities and for different racial and ethnic groups. City leaders and policymakers are able to use the dashboard to identify wealth disparities within cities. Because household wealth measures for subregions within cities are not typically available in public survey data, we use a machine-learning method to fill the gap in the existing survey data. We use household measures including net worth and emergency savings to better understand households’ wealth. Liquid assets—the sum of assets in checking accounts, stocks, bonds, and other liquid savings accounts—can indicate households’ resilience and ability to bounce back from financial shocks. Net worth—total assets minus total debt—can provide an overview of households’ economic well-being and their ability to pursue new opportunities. Overall, the 2022 financial health dashboard provides firsthand data and analysis to city leaders and policymakers for a better understanding of financial health, financial resilience, wealth, and debt within local regions in their cities and counties. They will also be able to compare their cities and counties with neighboring cities and counties. This works builds on previous asset and wealth imputation research. Using 2014 data, the Prosperity Now Asset Scorecard estimated the asset poverty rate, liquid asset poverty rate, and share of households with liquid assets for many cities in the US. The Federal Reserve Bank of “St. Louis’s Real State of Family Wealth”2 provides national-level average wealth for various demographic groups overtime. Using 2013 data, Ratcliffe and colleagues (2017) estimated the shares of unbanked and underbanked populations for different PUMAs in New York City. This project advances this literature by (1) looking at a broader set of asset outcomes; (2) estimating assets at the PUMA level throughout the country; (3) using more recent data than the literature; and (4) disaggregating the estimates by race and ethnicity when possible. Because PUMA boundaries are often smaller than city boundaries, our analysis sheds light on wealth disparities within cities.

Background: The extent of food deprivation and insecurity among infants and young children—a critical phase for children's current and future health and well-being—in India is unknown. We estimate the prevalence of food deprivation among infants and young children in India and describe its evolution over time at sub-national levels. Methods: Data from five National Family Health Surveys (NFHS) conducted in 1993, 1999, 2006, 2016 and 2021 for the 36 states/Union Territories (UTs) of India were used. The study population consisted of the most recent children (6–23 months) born to mothers (aged 15–49 years), who were alive and living with the mother at the time of survey (n = 175,614 after excluding observations that had no responses to the food question). Food deprivation was defined based on the mother's reporting of the child having not eaten any food of substantial calorific content (i.e., any solid/semi-solid/soft/mushy food types, infant formula and powdered/tinned/fresh milk) in the past 24 hours (h), which we labelled as “Zero-Food”. In this study, we analyzed Zero-Food in terms of percent prevalence as well as population headcount burden. We calculated the Absolute Change (AC) to quantify the change in the percentage points of Zero-Food across time periods for all-India and by states/UTs. Findings: The prevalence of Zero-Food in India marginally declined from 20.0% (95% CI: 19.3%–20.7%) in 1993 to 17.8% (95% CI: 17.5%–18.1%) in 2021. There were considerable differences in the trajectories of change in the prevalence of Zero-Food across states. Chhattisgarh, Mizoram, and Jammu and Kashmir experienced high increase in the prevalence of Zero-Food over this time period, while Nagaland, Odisha, Rajasthan and Madhya Pradesh witnessed a significant decline. In 2021, Uttar Pradesh (27.4%), Chhattisgarh (24.6%), Jharkhand (21%), Rajasthan (19.8%) and Assam (19.4%) were states with the highest prevalence of Zero-Food. As of 2021, the estimated number of Zero-Food children in India was 5,998,138, with the states of Uttar Pradesh (28.4%), Bihar (14.2%), Maharashtra (7.1%), Rajasthan (6.5%), and Madhya Pradesh (6%) accounting for nearly two-thirds of the total Zero-Food children in India. Zero-Food in 2021 was concerningly high among children aged 6–11 months (30.6%) and substantial even among children aged 18–23 months (8.5%). Overall, socioeconomically advantaged groups had lower prevalence of Zero-Food than disadvantaged groups. Interpretation: Concerted efforts at the national and state levels are required to further strengthen existing policies, and design and develop new ones to provide affordable food to children in a timely and equitable manner to ensure food security among infants and young children. Funding: This study was supported by a grant from the Bill & Melinda Gates Foundation INV-002992.

Whereas there is a large literature evaluating the impacts of education, most of the focus until recently has been on getting to universal primary enrollment and under- standing the returns to basic education; but it misses the major shifts towards higher education in many fast-growing parts of the developing world over the last 20 years. Moreoever, it is not well studied how the impacts of higher education on various life outcomes evolve over an individual’s life cycle. In this paper, I study the returns to higher education in China using the reinstatement of the National College Entrance Examination (NCEE) in 1977 as a natural experiment, investigating the causal impacts of higher education on later life outcomes and well-being. I use two recent censuses (1990 and 2000) to investigate discontinuous changes in the likelihood of completing high school and attending college around a cutoff birth date. Through a combination of regression discontinuity and difference-in-difference methods, I find that cohorts that were more likely to complete high school and obtain a college education as a result of the reform were more likely to have a high-socioeconomic (SES) occupation in their early 30s and 40s. Also, more educated cohorts, and in particular women, tend to marry later. Individuals with higher education tend to delay childbearing, migrate more not only in their early 30s, but also, to a greater degree, their early 40s - plausibly due to greater opportunities of migrating towards the more-educated.

How did Progressive era reforms affect the lives of urban residents across U.S. cities? Some scholars argue that racist and nativist impulses permeated this movement, which primarily benefited white business owners. Others emphasize that reformers sought to improve urban living and working conditions and expand educational access, generating economic opportunity for disadvantaged groups. We answer this question leveraging new data on 455 U.S. cities from 1900-1940 combining dates of reform-style government adoption, deanonymized census records, voter turnout, and municipal budget data. Using a difference-indifferences design, we document the impact of Progressive reforms on political participation, public goods spending, and the relative socioeconomic well-being of black, immigrant, and working class residents visa -vis whites, natives, and business elites. While voter turnout decreased in reformed cities, we uncover only modest increases in earnings inequality across more and less advantaged groups and no significant differences in expenditure patterns as a consequence of reform.

Governments, civic society, businesses, and citizens all strive to make cities more livable. However, evidence about what aspects of cities actually contribute to the subjective well-being of their residents is incomplete. This paper examines the links between life satisfaction and indicators of the “quality” of U.S. metropolitan areas such as leisure/cultural opportunities, crime, climate, transportation, racial/ethnic diversity, incomes, cost of living, income inequality, the environment, healthcare, population growth, and political affiliation and polarization. Using mixed-effects regression and controlling for individual demographics, data on 9,498 respondents in 161 U.S. metropolitan statistical areas (MSAs) suggest that MSA characteristics have little relationship with life satisfaction. The only consistently significant characteristics are the natural log of median MSA per capita income, which is negatively associated with life satisfaction, and climate quality, which is positively associated with it. The association between the percentage of the population voting Republican and life satisfaction is negative but only borderline significant. Further, principal components analysis shows that MSAs with characteristics similar to California's Central Valley or the Texas/Mexico border are actually associated with higher life satisfaction. The finding that subjective well-being tends to be higher in places with better climates is well-supported by prior literature; past research also helps explain why poorer places may be happier, since people tend to be happier when their income compares favorably to their peer group's.

Rurality is often viewed as presenting challenges to community sustainability, well-being, and equity. To address the unique challenges of rural areas, policies and practices have been designed specifically for application in places designated as “rural”. Yet what is “rural”? Some recent measures of rurality have gone beyond a dichotomous rural-urban divide conceptualization of rural communities. However, most measures still emphasize proximity to metropolitan areas and population density as the primary components of rurality. Few studies consider the critical role that services and amenities play in the life of a community. We suggest a new measure based on the concept of sustainable development that integrates measures of environmental, social, and economic resources. We present the Community Assets and Relative Rurality index for census block-groups in the coterminous United States and illustrate how this measure is consistent with existing measures of rurality yet offers additional insight into issues of sustainable rural development.

The Appalachian Mountain Club (AMC) and several partners within the Pennsylvania Highlands Trail Network (PHTN) are working to expand accessibility of trails, parks, and open spaces to accommodate users with varying sets of abilities. As part of their mission, the Appalachian Mountain Club and the network of organizations that make up the Highlands Trail in Pennsylvania, envision a world where the outdoors occupies a place of central importance in every person’s life and believe that the outdoors is for everyone, especially in recognizing the numerous health benefits related to outdoor recreation for physical and mental well-being. Equity and accessibility are the integral components to advance this work, recognizing that the outdoor recreation and conservation industries have more work to do in expanding access to create holistic community integration in the engagement process. To make nature accessible is to protect it. When the outdoors is made as accessible and inclusive as possible, all individuals regardless of their race, color, national origin, age, ability level, religion, gender, or sex are provided a shared sense of belonging and community.

More than 8.1 million Americans with disabilities qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Individuals with disabilities were particularly vulnerable to COVID-19, which may have altered individual and household behavior. Research on the impact of COVID-19 on individuals with disabilities and their families remains limited. Authors analyzed 2020 National Health Interview Survey data. Logistic regression models were applied, controlling for the effects of age, race, sex, income, education, employment, and health status. Households with SSI/SSDI beneficiaries with disabilities were associated with significantly greater odds of delaying or forgoing medical care and receiving needed personal and household care at home due to COVID-19 compared with households without beneficiaries. The health and well-being of households with individuals with disabilities may require more robust and inclusive social work initiatives that aim to reduce adverse pandemic impacts.

This paper estimates experimental impacts of a supported work program on employment, earnings, benefit receipt, and other outcomes. Case managers addressed employment barriers and provided targeted financial assistance while participants were eligible for 30 weeks of subsidized employment. Program access increased employment rates by 21 percent and earnings by 30 percent while participants were receiving services. Though gains attenuated after services stopped, treatment group members experienced lasting improvements in employment stability, job quality, and well-being, and we estimate the program’s marginal value of public funds to be 0.64. Post-program impacts are entirely concentrated among participants whose subsidized job was followed by unsubsidized employment with their hostsite employer. This decomposition result suggests that encouraging employer learning about potential match quality is the key mechanism underlying the program’s impact, and additional descriptive evidence supports this interpretation. Machine learning methods reveal little treatment effect heterogeneity in a broad sample of job seekers using a rich set of baseline characteristics from a detailed application survey. We conclude that subsidized employment programs with a focus on creating permanent job matches can be beneficial to a wide variety of unemployed workers in the low-wage labor market.

There are significant costs to rising unemployment. For workers, particularly those being paid low wages, higher unemployment rates nationally are associated with worse employment prospects, health outcomes, and general well-being. In 2020, these dynamics played out rapidly. The COVID-19 pandemic brought a massive shock to the labor market and the unemployment rate climbed from 3.5 percent, a low level not seen since the 1960s, to 14.7 percent.1 By July 2022, 28 months after the start of the crisis, sizable public investments helped foster a remarkably rapid turnaround and bring the unemployment rate back to its prepandemic level. The speedy recovery of the US economy, in contrast to the slow rebound after the Great Recession, minimized many of the severe problems of sustained high unemployment. By understanding the dynamics of high unemployment, policymakers, practitioners, and employers can work to alleviate its detrimental consequences. This report summarizes existing research on the effects of rising unemployment on three different areas: first, on workers, their workplaces, remuneration, and job quality; second, on the social factors that are indirectly affected by rising unemployment, such as enrollment in education, health outcomes, crime rates, and family well-being, particularly for low-income workers; and third, on the wider economic effects of unemployment on social spending, productivity, national income, and future unemployment rates. One strand of research explores the impact of long-term employment on factors such as income, labor market attachment, and health (Nichols, Mitchell, and Lindner 2013). This paper aims to frame the parameters of a different but complementary research area: the impacts of rising unemployment at large, both in the short and medium term. The contemporary labor market is unusually tight and provides a prime opportunity for researchers to better understand the benefits of low unemployment as well as the risks of rising unemployment. This report serves as a first step in that process and as a potential foundation for future research.

Objectives: The COVID-19 pandemic has profoundly affected the lives of people globally, widening longstanding inequities. We examined the COVID-19 pandemic’s impact on employment conditions by race/ethnicity, gender, and educational attainment and the association between such conditions and well-being in older adults in the United States. Methods: Using data from the Health and Retirement Study respondents interviewed between May 2020 and May 2021 when they were ≥55 years of age, we examined intersectional patterns in COVID19-related changes in employment conditions among 4,107 participants working for pay at the start of the pandemic. We also examined the compounding nature of changes in employment conditions and their association with financial hardship, food insecurity, and poor self-rated health. Results: Relative to non-Hispanic White men with greater than high school education (>HS), Black and Latinx men and women were more likely to experience job loss irrespective of education; among those who did not experience job loss, men with ≤HS reporting Black, Latinx, or ―other‖ race were >90% less likely to transition to remote work. Participants who experienced job loss with decreased income or continued in-person employment with decreased income/shift changes had greater prevalence of financial hardship, food insecurity, and poor/fair self-rated health than others. Discussion: The impact of COVID-19 on employment conditions is inequitably patterned and is associated with financial hardship, food insecurity, and adverse health in older adults. Policies to improve employment quality and expand social insurance programs among this group are needed to reduce growing inequities in well-being later in life.

In the 1930s, the Home Owners’ Loan Corporation (HOLC) graded the mortgage security of urban US neighborhoods. In doing so, the HOLC engaged in the practice, imbued with racism and xenophobia, of “redlining” neighborhoods deemed “hazardous” for lenders. Redlining has caused persistent social, political and economic problems for communities of color. Linkages between redlining and contemporary food access remain unexamined, even though food access is essential to well-being. To investigate this, we used a census tract-level measure of low-income and low grocery store food access from the US Department of Agriculture Food Access Research Atlas, redlining data from Mapping Inequality Project, and demographic data from the American Community Survey. We employed generalized estimating equations with robust covariance estimates to analyze data pertaining to 10,459 census tracts in 202 US cities. Tracts that the HOLC graded as “C” (“decline in desirability”) and “D” (“hazardous”) had reduced contemporary food access compared to those graded “A” (“best”). Increases in contemporary census tract proportions of Black, Hispanic, or other racial/ethnic minority residents, as well as disabled residents, were associated with reduced food access. Increases in contemporary proportions of residents age 75 years and older or those without a car were associated with better food access. Tracts that underwent housing redevelopment since being graded had better food access, while those undergoing gentrification had reduced food access. Results suggest that issues of redlining, housing discrimination, racism, ableism, displacement, and food inaccessibility are deeply intertwined.

OBJECTIVES: The COVID-19 pandemic has profoundly affected the lives of people globally, widening long-standing inequities. We examined the COVID-19 pandemic's impact on employment conditions by race/ethnicity, gender, and educational attainment and the association between such conditions and well-being in older adults in the United States. METHODS: Using data from the Health and Retirement Study respondents interviewed between May 2020 and May 2021 when they were ≥55 years of age, we examined intersectional patterns in COVID-19-related changes in employment conditions among 4,107 participants working for pay at the start of the pandemic. We also examined the compounding nature of changes in employment conditions and their association with financial hardship, food insecurity, and poor self-rated health. RESULTS: Relative to non-Hispanic White men with greater than high school education (>HS), Black and Latinx men and women were more likely to experience job loss irrespective of education; among those who did not experience job loss, men with ≤HS reporting Black, Latinx, or "other" race were >90% less likely to transition to remote work. Participants who experienced job loss with decreased income or continued in-person employment with decreased income/shift changes had greater prevalence of financial hardship, food insecurity, and poor/fair self-rated health than others. DISCUSSION: The impact of COVID-19 on employment conditions is inequitably patterned and is associated with financial hardship, food insecurity, and adverse health in older adults. Policies to improve employment quality and expand social insurance programs among this group are needed to reduce growing inequities in well-being later in life.

In North Carolina, many women have made great strides towards economic equality. More women are earning bachelor’s degrees and the number of women entrepreneurs is growing. Yet not all women have equal access to these opportunities and the support they need to thrive, leaving many struggling to achieve financial and economic security. In the context of the COVID-19 pandemic and the economic “she-cession,” it is more important than ever to address poverty issues and barriers to opportunities for women in North Carolina. Access to quality education, responsive health care services, and dynamic business networks can help women thrive in the workforce and achieve economic success. These systems can help women bridge the divide between poverty and economic opportunity. This report provides data and analysis on several aspects of North Carolina women in the areas of poverty, economic security, access to opportunities, and support that helps women and families achieve economic stability. Data for this report was calculated based on a composite index generated from four key indicators: (1) health insurance coverage, (2) educational attainment, (3) business ownership, and (4) poverty rates. All 50 states and the District of Columbia are ranked on the composite score and component indicators. This report also examines data on topics such as poverty by household type, home ownership and houselessness, the number of public assistance recipients, and the impact of the pandemic on women in North Carolina. Each of these indicators are key components of poverty and opportunities for North Carolina women. Without adequate education, public support, or opportunities for advancement and entrepreneurship, women and families are more likely to face conditions of poverty. Throughout this report, data are analyzed by counties in North Carolina (when available) and disaggregated by racial and ethnic groups. Most of the data referenced in this report comes from 2019 and the year of data collection is noted. This report outlines the baseline of poverty and opportunity in North Carolina prior to the COVID-19 pandemic and shares emerging data on the impact of the pandemic. The final installment in a series of four publications, this report provides data and policy recommendations to improve the status of women in North Carolina—with a focus on poverty and opportunity. The first three reports focused on employment and earnings, health and wellness, and political participation. This series aims to provide critical data that can help build economic security and overall well-being among women in North Carolina. The reports serve as a resource that may be used to make data-driven decisions about how to shape public policies, prioritize investments, and set programmatic goals to improve the lives of women and families. This Poverty and Opportunity report highlights the status of women at the intersections of health, financial well-being, and education. These factors play a major role in determining the overall economic security of women and their families.

People with disabilities tend to participate in fewer out-of-home activities, raising concerns about their well-being. This paper investigates travel and activity barriers faced by people with disabilities using data from the American Time Use Survey from 2008 to 2019. Our dependent variable of interest is a measure of realized accessibility known as a travel time price: that is, the number of travel minutes associated with each minute of out-of-home activity time. In using this measure, we first confirm that out-of-home activities are associated with greater subjective well-being, that travel is associated with relatively low well-being, and that travel time prices are negatively associated with life satisfaction. We next find that people with disabilities typically pay a travel time price premium 50 percent higher than those without disabilities for all out-of-home activities, and 11 percent higher for work trips. These premiums narrow but persist when accounting for personal characteristics and travel mode. We discuss the unique contributions of simple linear and multiple regression results, given that disability is so closely linked to personal characteristics like employment, income, and marital status. We then disaggregate the results by type of disability and close by presenting ideas for removing transportation and activity barriers for the heterogenous population of people with disabilities.

Population ageing has been a major and growing concern1 among policymakers over the last two decades since the adoption of the 2002 Madrid International Plan of Action on Ageing (MIPAA). This report reviews the actions taken by Caribbean countries and territories2 to address the issue over the last five years and, more generally, over the twenty years since the adoption of the MIPAA. With the pace of demographic change continuing to accelerate over the next decade and the number of older persons continuing to increase in all Caribbean countries, further and more far-reaching actions will be required to realise the plan’s vision of a “society for all ages” and to take advantage of the opportunities that ageing presents. Ageing is a long-term demographic trend affecting virtually all countries of the world although the process is more advanced in some countries than others. In the Caribbean and Latin America, populations have a relatively young age structure compared to those in North America and Europe. In 2021, the old age dependency ratio (65+/(15–64))3 was 14 for the Caribbean,4 compared to 12 for Latin America, 26 for North America and 30 for Europe. In the Caribbean (as in Latin America), the pace of demographic change is accelerating. The old age dependency ratio for the Caribbean increased from 10 in 2000, to 14 in 2020 and will increase to 20 by 2030 and 28 by 2045. Between 2020 and 2045, the number of persons aged 65 and over in the Caribbean will double while the size of the working age population (aged 15 to 64) will remain roughly unchanged. Population ageing is relatively more advanced in Barbados and many of the associate member countries including Curaçao, Martinique and the United States Virgin Islands, while it is less advanced in Antigua and Barbuda, Belize, Grenada, Guyana, Saint Vincent and the Grenadines and Suriname. However, all Caribbean countries will see their significant increases in their old age dependency ratios over the coming two decades and beyond. Ageing is a consequence of the demographic transition from the high fertility, high mortality societies of the past to the low fertility, low mortality societies of the modern world. Along with increased life expectancy, the completion of this demographic transition also lowers population growth and leads, ultimately, to a more stable population structure. Demographic ageing should therefore be seen in a positive light and as a fundamental part of the development process. The increasing number of older persons and their longevity present both new challenges and opportunities for societies and for policymakers. Challenges include increasing pension and healthcare costs, the greater need for long-term care services, and the increasing number of persons suffering from non-communicable diseases. There is also increasing recognition of the contribution that older persons can (and do) make to economic, social, cultural, and political life and the opportunity this presents. Fully realising this contribution will depend on stronger protection for the rights of older persons, including protection against age discrimination, social exclusion, isolation and elder abuse. To take one example, the proportion of persons aged over 65 in Bermuda is projected to increase from 16.9 per cent in 2016 to 24.9 per cent in 2026. Pension and health care costs are increasing while Bermuda’s workforce is in decline. The Minister of Finance described this as “perhaps the single most serious long-term issue Bermuda faces” (Royal Gazette, 2020). The international community’s priorities and objectives for addressing these challenges were set out in the MIPAA, adopted at the Second World Assembly on Ageing in 2002. The Madrid Plan identified three broad priority directions: older persons and development; advancing health and well-being; and ensuring enabling and supportive environments. It defined 18 priority issues, with 35 objectives and 239 recommendations for action. Since 2002, there have also been a series of five-yearly reviews which produced the following regional agreements: the Brasilia Declaration (2007), the San José Charter on the Rights of Older Persons in Latin America and the Caribbean (2012) and the Asunción Declaration (2017). These agreements reiterated member States’ commitment to the Madrid Plan and incorporated actions to advance its implementation in the region, address emerging issues and, in some cases, expanded upon the commitments contained in the MIPAA. The San José Charter on the Rights of Older Persons was the most significant of these regional agreements, emphasising the rights-based approach and actions designed to increase protection for the rights of older persons. The twenty-year review and evaluation of the MIPAA (the fourth five-year review) is taking place between 2021 and 2023. The regional review will be held in December 2022, within the framework of the fifth meeting of the Regional Intergovernmental Conference on Ageing and the Rights of Older Persons in Latin America and the Caribbean, at which member States will present national progress reports or statements. The regional conference will be held in Santiago, Chile between 13 and 15 December 2022. The global review will take place in 2023 within the framework of the 61st session of the United Nations Commission for Social Development. This report provides an assessment of progress in the implementation of the MIPAA in the Caribbean and is intended to contribute to the regional review process which will, in turn, provide input to the global review. It considers the situation of older persons in the Caribbean subregion, reviews the policies and programmes implemented for older persons, and assesses the progress made by member and associate member countries in the implementation of the MIPAA and subsequent regional agreements. The report draws on national and international statistics, information collected about government policies, programmes and services for older persons and interviews with representatives of civil society organisations. The three main chapters of the report broadly correspond to the three priority directions of the MIPAA: older persons and development; health and well-being; and enabling and supportive environments.

As concepts of mental health have advanced and social change has evolved, social psychiatry has adapted and influenced the contemporary delivery of mental health care to the sexual and gender minority (SGM) community. A neoteric understanding of sexual orientation was crucial in delineating a contemporary redefinition of that which constitutes a mental disorder when homosexuality was declassified in 1973. Subsequently, affirmative therapies emerged. Gender identity disorder was replaced by gender dysphoric disorder. Same-sex marriage, previously a fanciful notion, became legally recognized on a national basis. New and existing journals began to convey a corpus of novel research in sexual and gender minority studies that would be incorporated into educational curricula. And, SGM psychiatrists were, at last, free from the implications of pathology, to become active and open participants in the profession. Few classes of people within our society have undergone such dramatic change, even within the last decade. These gains have affected the well-being of SGM individuals in complex ways. This chapter explores these issues from a community psychiatry perspective, giving the community psychiatrist an essential perspective and understanding as providers of care to the SGM community.

We study the financial protection provided by health insurance through two natural experiments—the Affordable Care Act's under 26 provision and Medicare eligibility. In both cases, the coverage expansion sharply reduces medical debt in collections for consumers within the affected ages but does not systematically improve credit outcomes not directly related to medical care. This is consistent with the infrequent repayment rate and lack of persistence on credit reports that we document for medical collections, which mute a key channel through which reductions in medical collections could directly affect the other financial outcomes studied here. These results help clarify the role of health insurance in broader financial health and suggest that, at least among the populations studied here, medical debts in collection may often be a symptom rather than a cause of wider financial distress as measured on credit reports.

Research on racial inequality is expansive, with a growing body of work highlighting the nuances of racial inequality using a multidimensional approach. Much of this research has been conducted in Latin America and the United Stated; however, very little is known about how the Anglophone Caribbean fits into this discourse despite the many similarities it shares with these other regions of the Americas. To address this lacuna in the literature and add theoretical insights into the contextuality of race, I focus on the cases of Jamaica and Trinidad and Tobago. These countries were selected as they represent the ends of the spectrum of ethno-racial diversity and race relations in the Anglophone Caribbean. Using a multidimensional approach to the measure of race, I examine outcomes of socioeconomic well-being utilising the AmericasBarometer social surveys as well as census data. The results reveal that, as with elsewhere in the Americas, a salient racial hierarchy and pigmentocracy exist in both countries and structure outcomes of education, per capita household income, and household amenities. However, while black disadvantage may have been expected in both countries, Trinidad and Tobago proves an exception. Implications of these findings are further discussed.

Parents’ time devoted to unpaid care for their children remains persistently gendered and is a key driver of gender inequality at home and work. At the same time, both mothers and fathers report a strong desire for more time with children, driven by norms prescribing an intensification of parenthood. These care pressures may be alleviated by work-family policy, an institutional tool that provides financial and normative imperatives for (re)shaping gendered arrangements of paid work and unpaid care. This dissertation explores how work-family policies aimed at or available to fathers – reserved paternity leave and workplace flexibility – shape parents’ time with children in Canada and the United States. These three chapters innovate on the conceptualization of parent-child time, considering a broader scope of time (total co-present time) and the co-presence of the other parent (solo versus family time). First, I examine how a state-provided reserved paternity leave policy in the quasi-experimental setting of Québec impacts fathers’ and mothers’ time with children. This policy led to a plausibly causal increase in fathers’ “responsibility time”, i.e., solo parenting time across activities when co-present with children. Similarly, this policy led to a plausibly causal increase in mothers’ solo parenting time in routine childcare, likely because of a corresponding decrease in housework time. Second, looking at employer-provided policy, I investigate how workplace flexibility policies are associated with fathers’ time with children in the United States. Flextime (control over start and stop times) and flexplace (work from home or remote work) are associated with increased “family” time with children – when the mother is also present – across activities. Taken together, these studies show that work-family policies aimed at or accessed by fathers can reshape gendered arrangements of unpaid care for children. However, this depends on the policy design (near-universal, state-provided reserved paternity leave versus selective, employer-provided flexibility policies) and the dimensions of parent-child time examined (total co-present time; solo or family time). Ultimately, this dissertation expands knowledge on and presents methodological considerations for the relationship between work-family policies and parent-child time, with key implications for family well-being and gender inequality.