The Biden Administration’s proposed infrastructure investments are an example of an upstream effort to address disparities related to social determinants of health (SDOH). As mentioned in our previous blog post, SDOH are the conditions or circumstances within which people live, and these differ based on the distribution of power, money, and resources. The systems and infrastructures in which we live shape how power, money, and resources are distributed.
Upstream policy changes can best target SDOH to address related health disparities. Targeting SDOH requires the political will to reassess current policies and invest in new ones that support systemic change. This is exactly what we see in the Biden Administration’s infrastructure package.
What is the Biden Administration’s infrastructure package?
Since its unveiling in March 2021, the Biden Administration’s expansive proposed infrastructure package continues to drive national conversation and a profound reimagining of what infrastructure means. The package includes two plans, the American Jobs Plan and the American Families Plan. Both target investments to improve aspects of our physical infrastructure that affect the well-being of individuals. The package also proposes significant investments in “soft” infrastructure (see below). Soft infrastructure is less tangible, but may have greater effects on the health and quality of life of all people.
Collectively, the two plans include investments to improve both our physical (hard) and soft infrastructures. Both are fundamental for Americans to better provide for their families, support their loved ones, and perform their jobs. The boxes at the right provide a quick overview of some investment areas proposed in each plan.
The Biden Administration’s infrastructure package is unique because it acknowledges the important role of soft infrastructure, in addition to hard infrastructure, in improving people’s lives and addressing inequities related to SDOH.
What is hard infrastructure, and how does it relate to SDOH?
Most people understand infrastructure as hard or physical infrastructure. Certainly, investments in hard infrastructure can improve many aspects of people’s well-being and opportunity. Many of these can reduce SDOH-related disparities. The Jobs Plan, for example, includes investments to improve public housing and create more affordable housing. It would improve utilities, roads, rails, bridges and public transportation. It would invest in improved school, community college, and childcare facilities; environmental structures and systems such as clean drinking water or natural disaster-resilient structures; community health facilities; and communication infrastructure such as broadband and internet.
What is soft infrastructure, and how does it relate to SDOH?
Soft infrastructure is an equally important kind of infrastructure for SDOH-related efforts. One can think of soft infrastructure as a less tangible array of supports and investments in society’s systems, relationships, and institutions that affect well-being, opportunity, health, and resilience. It includes social, economic, environmental, and cultural resources.
The Jobs Plan, for example, includes investments in workers’ wages and benefits, workforce development, and research and development (R&D) capacity. It specifically calls out investments in “social infrastructure to support innovation and productivity”. These would include regional innovation hubs and community-led redevelopment projects. The Families Plan includes investments that would make college more affordable for low- and middle-income students, including students at Historically Black Colleges and Universities (HBCUs), Tribal Colleges and Universities (TCUs), and other minority-serving institutions (MSIs).
The infrastructure package includes many other investments in in-home care, affordable child-care, and national paid leave. It includes a wide scope of social, economic, and climate policies. These investments would build the capacity of currently disadvantaged communities of color and rural communities to lead and participate in new opportunities. In this way, the infrastructure package supports changes for a more equitable distribution of resources so that all communities can thrive.
What motivated this legislation? How did we get here?
Societal shifts have motivated the Biden Administration to redefine infrastructure in its proposed legislation and to acknowledge specific changes in social norms and values associated with how people live and work.
These shifts include changes in family structure, women’s roles and responsibilities, and caregiving. They also include changes in the types of jobs available and how to train for and get those jobs. For example, more jobs can be done remotely, but that requires training and access to technologies that make remote work possible. Much of the economy has shifted from manufacturing to services or technology, so retraining or job creation is needed. Workers with multiple part-time or “gig”-type jobs, without long-term security or benefits, are a growing population [PDF]. For many, pursuing more education is impossible while balancing work and family responsibilities.
The COVID-19 pandemic exacerbated many challenges faced by people affected by these societal shifts. For example, the pandemic disrupted decades of progress in women’s labor force participation. Many women of all classes and circumstances, but particularly lower-income women and women of color, had to choose between working or taking care of their families. The pandemic also highlighted the critical role that essential workers, primarily underpaid and often undervalued minority persons, play in our economy and society. It brought to light their many challenges.
What’s in the infrastructure package that’s linked to societal changes?
Many of the package’s proposed investments in soft infrastructure respond to these societal shifts and related challenges. For example, the package proposes investments to:
- Support caregivers by offering better wages and benefits
- Ensure better access to quality caregiving help for families that need it
- Retrain and create jobs for rural persons or people formerly in manufacturing jobs
- Support HBCUs, TCUs, and other MSIs in eliminating racial and gender inequities in R&D and science, technology, engineering, and math
- Provide first-time students and workers who want to retrain with access to free community college in a flexible timeframe that accommodates their lives and other responsibilities.
Essentially, the package proposes investments in social and economic infrastructures to adequately support individuals most affected by societal and economic changes and uplift those who have been historically disenfranchised. These supports are critical to reduce disparities and achieve equity.
Infrastructure investments to promote equity
As proposed, the Biden Administration’s infrastructure package could promote equity and help address SDOH-related disparities at the highest level. The package is by no means a perfect solution. Its legislative passage and final form are undetermined and perhaps in jeopardy at this time. While the proposed funding levels appear large, negotiations in a partisan environment make it unlikely that the package will be approved at the proposed funding level, if at all. What’s more, the issues it aims to address are longstanding, and will take longer to resolve than the stretch of the Biden administration. However, its proposed actions are nonetheless instructive. It is a sweeping, concerted effort to form policies that do not leave vulnerable groups behind. It is an example of how political will, public policy, and public funding can come together to address persistent health, social, and economic inequities.
Amy Chepaitis
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Amarilys Bernacet
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Cleo Kordomenos