If Health is Wealth, America's Working Mothers Are Living in Extreme Poverty with Ann Somers Hogg

She spoke with her boss about reducing her workload and not working every evening after her child went to sleep. And while her boss verbally agreed demands for her time did not change, and ultimately she left the company. She couldn't keep carrying the load of repeated illnesses, panic attacks, and family distress. Moving to a one income family was far from ideal, but at this point it seemed like the only viable option for survival.

That's an excerpt from a disturbing but not surprising report from the Christensen Institute entitled, if Health Is Wealth America's Working Mothers are living in extreme poverty. We welcome the Director of Healthcare Research at the Christiansen Institute and the author of that report, Ann-Somers ,Hogg, welcome to the show. Ann-Somers Hogg: Thank you for having me, Aiden. I was not expecting that introduction, but I promise to listeners, there are some hopeful bits of the report well.

Aidan McCullen (2): I have to say though. It's so common. People don't speak about this. There's a lot of this extreme poverty, if you want to call it that from a healthcare perspective. A lot of people working to maintain lifestyles, a lot of people working just to keep the lights on literally and figuratively in many, many ways, and they're working themselves to an early grave. This is not just about working mothers. Many, many people are in this situation.

Many women I know who have chosen not to have children as well are overloaded work almost like, oh well you don't have children you can take this extra workload as well. So this is a pandemic in many, ways, and I thought you might share a bit of context for that before we get into many solutions that you share within the report. . Ann-Somers Hogg: You hit on something that I think is so critical to just speak to off the bat, which is this is perceived as normal.

And I would say just because something is common doesn't make it okay. And that was one of the drivers behind writing this report and really acknowledging that working mothers, and to your point, all mothers are really working mothers, whether they are employed outside of the home or not, but how this group is really disproportionately bearing the burden of poor physical health, poor mental health, and in the United States especially poor economic outcomes.

There are a number of statistics I could point to in terms of this burden that working mothers carry. One, here in the United States, we have the worst maternal mortality rate in the developed world, and that's completely unacceptable given that we spend more on healthcare than any other country. Additionally, the CDc, the Centers for Disease Control, identified that 84% of deaths. Are actually preventable.

So 84% of mothers who die within the first year postpartum, these are preventable deaths, and mental illness is a key driver of this. Now, in the report, we didn't just focus on maternal mortality or the health of the mother in that first year, but truly looking at the health of the mother over the life of the mother. So not just immediately after giving birth, but in fact through the whole mothering process.

And some of the disheartening statistics that we uncovered were that 68% of working mothers report parental burnout. Compared to 42% of working fathers. Now I will go ahead and say 42% of working fathers is not a small percentage, so obviously this is a parental burden as a whole. However, disproportionately it is impacting women or mothers. 42% of working moms also have a diagnosis of depression and or anxiety compared to 28% of the general population.

We also know that mental health, mental disease burdens impact physical health, so women also bear a higher burden of chronic conditions. In fact, McKinsey and Company , just came out with a report at the beginning of 2024 that looked at the women's health gap. And how women are disproportionately in worse health for longer as compared to men. And they identified that this, I believe it was a $1.8 trillion opportunity to fill in this gap.

But women's poor health outcomes are disproportionately felt during their working years. So between the ages of 20 and 65, which for many of those years overlaps with when. Working women are often being mothers and having, well, you're a mother once. You're a mother. You're a mother always, but mothering their children in their home.

So they're trying to really keep their feet one foot in each boat, so the working boat and the home boat, and keep everything afloat, which we know creates a lot of stress and stress negatively Impacts mental health outcomes, which negatively impacts physical health outcomes. One of the reasons I wanted to highlight this was because it's International Women's Day and I thought this was so important to share. And the other thing I thought was, I know.

Many working mothers, and they feel guilty when they're at work, and then they feel stressed when they're at home with their children. So you're not even sometimes present when you're at home because you're so stressed about the workload at work, and then there's this kind of invisible pressure on you that is like kind of going, oh, can you, can you not handle it? And then you have to feel you're, you're fulfilling that as well. Now this is.

It's difficult for me to talk about from not understanding that so much. But one, one thing I did see during the pandemic in particular was I saw my own wife that the burden that she carried for the family, wondering how her brothers were coping her father, who's not in great health, and carrying that burden of all that as well. And I realized. I looked at myself in the mirror here and I was like going, I don't have that. I don't carry that same kind of mental burden.

So that means that that energy's being drawn from somewhere else and the health has to decline. It has to show up somehow. Ann-Somers Hogg: And I would say how good of you to notice there is frequently writing about the invisible load, the mental load of motherhood, and that did come to a head and really came into the limelight in the pandemic. And you're right, it exists.

And not only does it exist, but it has negative impacts, not just on the mother, but also on the children and the family because we know that the health of the primary caregiver impacts the health of those for whom they are caring. I. And you also pointed to the fact that your wife isn't just taking care of children, but also her father. And that is increasingly a problem both in the United States and across the world.

As women wait later to have children, they become in a situation where they are caregiving both to parents and to children. You also touched on something that I wanna build off of, which was around how women. When they're at work, might be thinking about home and when they're home might be thinking about work. And it's almost as though as a society, we expect women to be workers from nine to five and then mothers from five to nine.

But that's not how it works, because these jobs are fulfilled by the same people, and you are always an employee and always a mother, and we can't expect someone to be an employee from 9:00 AM to 5:00 PM and a mother from 5:00 PM to 9:00 AM. That's just not how it works. And by expecting that as a society, we create stressors which has very negative downstream health impacts and also negative impacts for the employer. Because worth health, worse, health is more expensive for the employer.

So not only from a pure healthcare cost, but from an absenteeism perspective, from the fact that more stressed out employees are less likely to stay with their employer. And retention is a very hot topic here in the United States for many reasons, but one, replacing employees is expensive and. When you have an employee who is benefiting your workforce, you, you don't want to lose them because that is expensive from a replacement perspective. But also there is loss of talent pipeline.

There's loss of institutional knowledge and a number of other things which cost employers on the backend. So it, it really behooves employers to invest in their employees' health in order to benefit both the individual and the organization as a whole. One of the figures you mentioned in the report was conflicting school and work schedules cost the US economy 55 billion per year in lost productivity, and that's the US alone.

Just to quantify that, and there's an infographic in the study as well, that I'm gonna share on the screen here . . Ann-Somers Hogg: So for those who are listening only, the infographic is divided into three parts, and it looks at the mental health burden first, the physical health burden second, and then the economic burdens placed on working mothers. I mentioned at the start of the show a number of the statistics that are highlighted here on the left hand side in terms of mental health.

Burdens. So things such as the burnout, that the burnout, the anxiety, and the depression that working mothers face at higher levels than both working fathers as well as coworkers without children. We also know that women are more likely to report needing psychiatric care than men are. We know these mental health burdens negatively impact physical health outcomes. So I touched on a number of stats here earlier, but another thing I'll highlight that is here on the infographic.

Is around the fact that women in the United States have chronic diseases at a much higher rate than across the globe. So yes, there are a number of factors that go into this, but we know that stress negatively impacts chronic disease. In addition to the mental health and the physical health burdens, there are a number of economic burdens that are placed on the working mother.

And earlier, Aidan, you mentioned that the conflict between the school schedule and the work schedule costs in the United States, $55 billion in lost productivity. Another staggering statistic here in this third column is around the fact that it costs over $47 billion to. Two employers for those who have. Less than ideal mental health. This is in terms of absenteeism, in terms of lost productivity. And then in addition to that, there are the additional healthcare costs that employers must bear.

Other things that lead to economic burdens on the individual, specifically here in the United States, are around the cost of childcare. So the cost of childcare has risen over 200% since 1990, which outpaces the cost of all other household expenses, and this is compared to the average family income that has only increased by about 140%. So over 200% increase in childcare costs, but only 140% increase in the average family income because of national healthcare costs here in the us.

Childcare is actually unaffordable for nearly two thirds of working parents. And I wrote this paper, this, this paper was published before the additional funding that was put into childcare during the pandemic was taken away. So. As we have now in the United States, we say that we have fallen off the childcare cliff because this funding has been peeled back. These expenses are likely to get worse.

The last thing that's highlighted here in the little circle at the bottom is that the United States does not have any sort of guaranteed paid leave after having a child. And we are the. Only developed nation where that is the case. One of our mutual friends. Is Michael Horn and he wrote a book during

And it just showed for me that everybody sees things through their own lens of the world, and are absolutely devoid of understanding what's happening for other people. , and that combined with your report here just opens up the pathways to kind of go. You don't know what's going on in people's lives , but one of the things about this report is it shows that this is everywhere. This is absolutely everywhere.

And I share all that to say one of the first things you say we need to do is to get consensus, because you say, due to a lack of agreement on both the root cause and the goals, solving this problem with a national response is not an effective first step. Similar to innovative healthcare providers that are redesigning their business model around drivers of health rather than treating sickness.

The first step in improving working mother's health outcomes is for forward thinking employers to institute policies and workplace benefits to promote maternal health, not detract from it. So maybe you'd expand on that and then I'm gonna share. The tools of cooperation framework that you introduce in this paper.

Ann-Somers Hogg: Yes. So in terms of broadly, when we think about improving maternal health in the United States, we don't have broad agreement or broad consensus on what the goal of improving health is. I would say the exception to that rule is nationally, we do seem to agree that our maternal mortality rate is completely unacceptable and we must reduce it. But again, I'm really looking at the health over the entire life of the mother, not just in that first year.

So when we think about maternal health broadly, or even women's health broadly as a society, as a country, we don't have broad consensus on what the goal of improving this health is. We also don't have broad agreement on the how to, so how would we go about improving maternal health or, or what's the cause and effect if we think about we wanna improve maternal health? How do these things connect?

And what the tools of cooperation theory allows us to look at is depending on the situation that an organization or a society finds themself within different tools are more effective. And I always like to start the description of the tools of cooperation with the statement that most of the tools don't work most of the time. And that kind of makes people stop and say, what, and that's why it's really important to determine as a leader or as a stakeholder. Which quadrant you find yourself in.

So maybe we could look at the the two by two here. And I could explain to folks that on the vertical axis is the goals. So what are the societies or the organizations consensus around what it wants to achieve? At the top of the axis, there's broad consensus. There's great agreement on goals and what they want to achieve. In at the bottom of the axis, there's no consensus. There is a total lack of agreement on goals.

Now, if we look at the horizontal axis, this is the cause and effect axis or agreement on how to achieve certain outcomes. So all the way to the right. Broad consensus, all the way to the left, no consensus.

Now, depending on whether or not you're in a situation with broad consensus on goals or no consensus on goals, or no consensus on cause and effect, or broad consensus on cause and effect, you'll want to use different tools in order to bring about change because based on your situation, different tools will be more effective. So I will start in the lower left hand corner. So no consensus on goals, no consensus on cause and effect. In this situation, power tools are most effective.

These are things that might not be very effective in a democracy like we have in the United States. So things like coer coercion or threats or control systems. ann-somers-hogg_1_03-04-2024_101142: Now, I mentioned earlier that when it comes to maternal health. This is the quadrant that we're in. We don't have broad consensus on goals. We don't have broad consensus on cause and effect.

So unfortunately this is where we are as a society, but that doesn't mean that's where we'll stay, and it doesn't mean all hope is lost. So I'll go through the other quadrants to help you realize why that's the case. Now moving up where there is broad consensus on goals, but still not much consensus on cause and effect is the leadership tools quadrant. This is where things like role modeling and visioning are really effective.

Now moving over to the right broad consensus on goals and broad consensus on cause and effect, you have the culture tools quadrant, and this is where things like policy change are really effective. So if we pause for a second and we look at the history in the United States in terms of proposed policy changes for universal paid leave, or broadly affordable and accessible childcare.

It might make sense why our policy change efforts haven't been effective because we're trying to use culture tools when our environment really calls for power tools. So we have a mismatch between what we're trying to. Leverage to address the problem and the type of situation that we're really in. Now, quickly, I'll go over management tools, which is the lower right hand quadrant here, where you have broad consensus on cause and effect, but not necessarily broad consensus on goals.

And this is things like strategic planning or training or measurement systems, tools that are more process oriented in nature Now. When it comes to maternal health, if we're in the lower left hand corner as a nation and we have to be in the upper right hand corner as a nation for policy change to be effective, then what should we do? And what we propose in the report is if we look at microcosms of the society, say forward thinking employers who want to attract and retain.

Women leaders and women employees because interesting fact companies with CEOs as women actually outperform those where CEOs are men. So there's a benefit to employers, to having women in their pipeline. They're obviously benefit many benefits. That's just one.

But if we start with forward thinking employers who want to attract, retain, cultivate women employees and women leaders, then leadership tools are available because in those organizations there's broad consensus that investing in women and therefore investing in women's health is worthwhile. So in that situation, tools such as visioning and role modeling become available and great levers for change.

And we've actually seen something like this work in the past in the United States because folks often say, wait, so. Are you suggesting that this is an employer's problem to solve? And it's not that this is an employer's only approach or that this is an employer's problem to solve, but that employers actually play a really important role in creating change at the national level because by role modeling and setting a vision that.

Providing things such as flexible work schedules or shortened work weeks or paid leave for a year, or childcare subsidies, or the list goes on and on. Employers are actually able to shift national culture and actually shift society to the right on the horizontal cause and effect access. By doing that, then as a society we find ourselves in a situation where culture tools like policy change are more effective.

So it's not that this is an employer's burden or that we're suggesting an employer's only approach, but just that employers have an important role to play in helping to shift national consensus. One place in the United States we've seen this work before is in 1914, Henry Ford decided that his work week would be 40 hours instead of 48 hours. Now, this happened 24 years before the 40 hour work week was made law in the United States with the 1938 Fair Labor Standards Act.

So. What ultimately was a policy change that is now still ingrained in our society almost a hundred years later, started as an employer movement in an organization where there was alignment around goals and where the leader really played a role modeling and a visioning role in order to shift national culture. when we think about the. Like startups as well. Startups bringing in breakfast or lunch or a gym, you know, in the building.

That, puts pressure on more traditional or older organizations to do those type of things. So it makes absolute sense. One of the last questions I had for you was. There's a lot on the plates of leaders in organizations at the moment. They're contemplating things like climate change, sustainability, innovation, if you have time for it at the end of the day, and they feel overwhelmed.

So I always have huge empathy for leaders 'cause they're humans too, often have families themselves trying to manage things, have all their own problems. So as they're contemplating the best path forward, hopefully reading a report like yours, understanding the options that they have available to them, what would be some low hanging fruit to get started for them?

Ann-Somers Hogg: That's an excellent question and I think there's some really great insights from some recent four day workweek studies, and the latest one that I have seen really compelling data out of was a UK study where. Employers reduced the work week for a pilot period down from 40 hours to 32 hours, and they showed that working fewer hours both improves health and productivity and that the employers saw an ROI on this investment.

So I would say the short answer to your question is to test something and test something based off of. A discussion with your employees. Your listeners may be familiar with the concept of jobs to be done, but it's important to understand your employees' jobs to be done when you are designing new workplace solutions. And I believe based on our research that employers would be hard pressed to find employees, both working mothers, working fathers, and caregivers of spouses, or.

Parents or others who they're supporting, they would be hard pressed to find someone who wouldn't like more flexibility in how they approach their workday and their work week. So looking back at these reduced work week studies, 71% of employees reported reduced burnout. 39% reduced stress, 40% reported fewer sleep issues and. Fatigue is actually very expensive. So when people are really tired, they perform less well, and this costs about $2,000 per employee per year.

So you want your employees to be less fatigued, you want them to get better sleep Companies in this reduced work week study out of the UK also saw near term financial benefits. 92% of the participating companies. Decided to keep the shorter work week at the end of the study highlighting that leaders see a clear ROI on this.

And yes, leaders are very busy and they are doing an excellent job at what has brought success in the past, but both as a society and truly as a world we are at a turning point where what's worked in the past is no longer gonna keep working in the future. And the pandemic really brought this to light. It brought the stress to light, it brought the health burdens to light, and it magnified already existing economic burdens.

So employers can do a number of things, but start by talking to your employees about what it is they need, uncovering the progress they're seeking and what their jobs to be done are. And then design tests in order to determine how you can improve your workplace environment in order to truly support their needs and their desires for progress. You'll see returns in terms of improved health, improved productivity, and thus an improved ROI for the organization. At least.

If these four day workweek studies are any indicator, working less can actually benefit everyone.

You mentioned Michael Horn. So if folks wanna learn more about the tools of cooperation, which I mentioned, he also had an excellent report last year that looked at the application of tools of cooperation in higher education, so they can find it all on our website. I also speak about it on our podcast, life Centered Healthcare.

Director of Healthcare Research at the Christensen Institute and author of that report that I will link to if Health is Wealth, America's Working Mothers are living in extreme Poverty Ann-Somers Hogg. Thank you for joining us. Ann-Somers Hogg: Thank you so much for having me, Aiden. I so appreciate it.