Brown School › 2019

Merriam-Webster has chosen “they” as the 2019 Word of the Year, a move applauded by an expert on gender transitions in later life at Washington University in St. Louis.

“In my research, I’ve found that many transgender people have a love/hate relationship with language,” said Vanessa Fabbre, assistant professor at the Brown School.

“In some cases, it’s really empowering when a new word or usage helps to articulate one’s sense of themself, but in other cases language can be restrictive and ill-fitting,” said Fabbre, whose latest research paper focuses on the state of theory in LGBTQ aging.

“Many of the older adults I’ve interviewed have witnessed several historical eras in which gender expansiveness is conveyed differently through language,” she said.

The surge in acceptance of the singular “they” in contemporary English is a great example of a new era, Fabbre said, “one brought about through persistent activism on the part of transgender and gender expansive people.

“I personally love the singular ‘they’ for all kinds of reasons, but mostly for its ability to convey and respect non-binary personhood. It’s a powerful and helpful word!”

With the global trend toward financialization of daily life, financial capability and asset building (FCAB) is becoming a more important topic. China recognizes the trend and is taking a leadership role in FCAB.

Informed by work established at the Center for Social Development (CSD)—FCAB theory, empirical studies and the FCAB curriculum—financial social work (FSW) is taking root and growing in China.

In a national effort to alleviate poverty, China has already invested deeply in financial technology (“FinTech”) to achieve financial inclusion. In this context, FSW is a good fit with China’s public priorities and the interests of social workers, researchers, policymakers and educators.

Over the course of two decades, CSD has built and sustained partnerships that have set the stage for the introduction of this idea; the training of key FSW local leaders; and the creation of a professional network through conferences, research and policy/program innovation.

Building on this work, director Michael Sherraden and international director Li Zou continued CSD’s FCAB leadership at several recent conferences at Chinese universities.

The first was the “International Symposium on Finance and Social Development” at Southwestern University of Finance and Economics (SUFE) in Chengdu, China on November 8-9.

Sherraden, presenting on behalf of coauthors Jin Huang and Margaret Sherraden, participated in the keynote session, speaking on “Financial Capability and Asset Building: A Grand Challenge for Social Work.” After outlining the core principles of FCAB and sharing the latest developments in FCAB research and curriculum, Sherraden offered a long-term vision: “Basic finance can become more like a ‘public good’,” using examples such as municipal water systems and public highways.

“People used to have to leave the house each morning to get water. Sometimes the water was dirty and people would get sick. Now, clean water is piped in through plumbing systems, and we take this for granted,” said Sherraden.

“In the information age, community banks and ATMs will likely be replaced with access to better quality finance through Internet and mobile technology, avoiding high fees and inefficient, poor quality services. This will be the ‘plumbing’ for finance. This is happening more quickly than many people realize, and China is in the lead globally.”

The second meeting was the “International Salon on Financial Social Work” hosted by the Institute for Social Development at the Central University of Finance and Economics (CUFE) in Beijing. This international gathering was held on November 10. Sherraden and Zou were pleased to see the Chinese understanding of inclusive finance as a social development issue.

Zou presented on “Financial Capability and Asset Building: An Example of U.S.–China Partnership for Research.” She summarized the long and productive partnership among Peking University, Hong Kong Polytechnic University and Washington University in St. Louis, highlighting FSW as one of the three core areas of research, education and policy development in this partnership.

Sherraden again provided the keynote address, this one entitled “One Key Strategy for Financial Capability and Asset Building: Child Development Accounts.” He outlined the vision for all children to be included in lifelong asset building, which he sees as a distinct possibility for China.

“China is a global leader in FinTech, delivering financial instruments and services efficiently to large populations,” he said. “With such structures in place, child development accounts could be efficiently delivered to all babies as the beginning of life-long asset building for everyone.”

FSW as a theme for training professional social workers is underway in China. With CSD providing consultation on educational development, some Chinese universities have initiated a FSW concentration for their Bachelor of Social Work programs.

Built on the FCAB curriculum created by CSD, one university (CUFE) has created a FSW concentration for the Masters of Social Work program that includes a separate FCAB course and multiple finance courses, in addition to infusing FCAB content into regular social work courses. The first cohort enrolled in 2019.

Moreover, CUFE is translating into Chinese the 2018 textbook by Margaret Sherraden, Julie Birkenmaier and J. Michael Collins’ entitled “Financial Capability and Asset Building in Vulnerable Households: Theory and Practice.” The translation will be available in fall of 2020.

Also in the Asia region, a special issue on “Inclusive Child Development Accounts: Toward Universality and Progressivity” was recently published in the Asia-Pacific Journal of Social Work and Development and will be published as a book by Routledge/Taylor and Francis in London in March 2020. Edited by Jin Huang, Li Zou and Michael Sherraden, this project compares Child Development Account policies and programs in seven countries.

These collaborative international advancements in FCAB research and education are important steps in the ongoing global challenge to build financial capability and assets for all, one of the Grand Challenges for Social Work. Citing China’s “clear understanding that finance is not just about money, but is fundamentally about social functioning and development,” Sherraden believes that “China’s global leadership in information-age finance sets the stage for social development innovations.”

CSD will continue to advise and support the development of FSW in China, while at the same time learning from its Chinese partners. These productive partnerships will continue though curriculum, research and ongoing policy and practice innovations. In spring of 2020, representatives from CSD will attend several conferences and speaking events in China, including one at Peking University on poverty alleviation in rural China.

In the larger picture, Sherraden observed, “During a period of stress between the United States and China in global economic and political matters, international partnerships in education and research are all the more important. Regardless of political leaders, who will always come and go, Washington University’s academic ties with China are small yet durable threads that help to weave our countries together, and make the world a little better place.”

Social workers have long served traumatized students, sick patients, struggling veterans and troubled families. 

But can they help the American mayor? Absolutely, said Diamond Munerlyn, who graduated in December 2019 with a master’s degree in social work from the Brown School at Washington University in St. Louis.  

“Mayors and council members are elected by the people, but there often is a disconnect between government and the people,” said Munerlyn, who concentrated in economic and social development. “Social workers can bridge that gap.” 

Munerlyn recently worked in the north St. Louis County municipality of Jennings, where she worked with elected officials to update the city’s comprehensive plan. In addition to studying past economic development initiatives, Munerlyn collected and analyzed feedback from community members. The result: dozens of recommendations, from a moratorium on liquor stories to accelerated road repairs. 

“The city wanted to hear from its residents, but that can be hard to do when you’re juggling the day- to-day business,” Munerlyn said. “I was able to engage the community and learn what sort of mix of business they wanted in the city and what services and resources they needed.”

Munerlyn was set on her career path after taking the immersion course “Poverty – The Impact of Institutionalized Racism,” taught by Jack Kirkland, associate professor at the Brown School. For one week, she lived and learned in East St. Louis, Ill., where more than 40 percent of residents live in poverty. 

“The infrastructure failures, the water, the food deserts — what I saw in East St. Louis reminded me more of Guatemala than any city I knew in America,” said Munerlyn, who grew up in Louisiana, Tennessee and north St. Louis County and served in the Peace Corps in Guatemala. “My eyes were opened to the policies that created the problems that persist today. The people never had a voice.”

Kirkland, who has continued to serve as a mentor, said that Munerlyn’s expertise in economic development and eagerness to connect with people will make her an effective advocate for the region’s residents.

“She recognizes that local city government is the main arena to transmit information and knowledge to assist citizens,” Kirkland said. “She is translating research into practice in a way that is instructive to the people she works with and helpful to the citizens she meets.” 

After graduation, Munerlyn will coordinate upcoming sessions of Kirkland’s course and continue to work for Jennings as a consultant. Ultimately, she hopes to work for a local municipality in north St. Louis County.

“People look at government and get frustrated,” Munerlyn said. “I get that. But even small changes can be progress.”

Washington University Chancellor Andrew D. Martin and Dean of the School of Medicine, David Perlmutter, recently announced the university’s support for the Healthcare for Missouri initiative, an effort to put the expansion of Medicaid in Missouri before the voters.

The expansion of Medicaid across the state offers a critical opportunity to disrupt the widening health disparity gap and advance health equity. And not just for the 200,000 Missourians who would become eligible for healthcare coverage through the expansion – access to health care for low-income individuals is an investment in the state’s economic health. As health disparities persist across our nation and in our communities, state Medicaid programs are well positioned to reduce these inequities, and improve health outcomes for our most vulnerable citizens.

The lack of access to affordable health care often results in the lack of preventive care and the postponement of medical attention, which can worsen a health issue that could have been easily treated. Furthermore, families can face serious financial consequences when they must seek care. The safety net system of clinics and hospitals they may resort to are under-resourced and spread thin: in the last five years, for example, Missouri has lost six rural hospitals.

At the Brown School, many of our faculty have devoted their research agendas to eliminating health disparities. Medicaid is a vital policy tool to help close the healthcare coverage gap, reduce deeply entrenched inequities in the healthcare delivery system, and improve the lives of thousands of poverty-impacted families. Our faculty have produced overwhelming empirical evidence in support of Medicaid and its benefits, including the following:

And more research is ongoing.

Missouri is one of only 14 states that has yet to expand Medicaid, and a recent fiscal analysis conducted by the Center for Health Economics and Policy showed that expansion is close to budget neutrality and actually has an estimated savings.

I urge you to read The case for Medicaid expansion in Missouri from Chancellor Martin and Dean Perlmutter, which provides a powerful argument for expansion. Greater still, I urge you to consider your role in helping thousands of fellow citizens lead heathier, more productive lives.

To learn more about the Healthcare for Missouri initiative and how you can help, visit:
https://www.healthcareformissouri.org/

 — Mary M. McKay
     Neidorff Family and Centene Corporation Dean
     Brown School at Washington University in St. Louis

Related articles and publications:

Effects of Medicaid Expansion on Coverage, Access, Outcomes, and Costs: Implications for Missouri
Does Health Insurance Status Affect Childhood Cancer Survival?
Therapy Services Reinstated in Missouri Medicaid After Key Policy Recommendations
Home Delinquency Rates Lower Among ACA Households
Trends in Medicaid Enrollment and Spending in Missouri  

Lower number of people covered leads to higher rural health insurance premiums, study finds

Small risk pools may contribute to the challenges faced by private insurance plans in rural areas, in which case risk reinsurance, or insurance for the insurer, is a potential policy solution, finds a new study from the Brown School at Washington University in St. Louis.

A health insurance risk pool is a group of individuals whose medical costs are combined to calculate premiums.

“A lot of our prior work on market-based insurance has shown that premiums tend to be higher in rural areas, and there is anecdotal evidence, often put forth by insurers, that a lack of health care providers is a factor in making insurance more expensive, said Abigail Barker, research assistant professor and author of “Effect Of Population Size On Rural Health Insurance Premiums In The Federal Employees Health Benefits Program,” published Dec. 3 in the December issue of the journal Health Affairs.

“Insurers are sometimes required to contract with certain providers in order to satisfy network adequacy standards, but this research suggests that a more important factor is likely to be the low numbers of lives covered in a particular place,” said Barker, who is faculty lead for data and methods at the Center for Health Economics and Policy at the university’s Institute for Public Health.

“The model controls for provider availability and various other possible explanations, and I find that additional enrollment is the factor most associated with lower premiums,” she said. “This makes sense because insurance is fundamentally about spreading risk, and it relies upon having large numbers of people in a given risk pool in order to work well.”

Using data from the 2013-16 Federal Employees Health Benefits Program, Barker focused on premium and enrollment data for “state-specific” plans — which offer insurance policies and set premiums at the regional level.

In nonmetropolitan counties, she found that each additional plan enrollee was associated with a 10-cent lower per capita biweekly premium, whereas this effect was trivial in metropolitan counties.

“Low health care provider counts were not associated with higher premiums in nonmetropolitan areas, nor was the degree of insurer competition an important predictor of premiums,” she said. “However, there was substantial correlation over time, which suggests that some variables may be viewed less as sources of premium variation and more as influencing long-term premium levels.”

Barker’s current work for the Rural Policy Research Institute focuses on understanding how markets can be successfully integrated into the health care sector, using the Affordable Care Act and Health Insurance Marketplaces data as well as Medicare Advantage data to inform rural health policy.

Barker presented her findings Dec. 4 during an event at the National Press Club in Washington, D.C.

Analysts from the Brown School are studying data gathered in a six-year study to gauge the effectiveness of savings accounts in improving adherence to HIV treatment for children in Uganda.

Uganda is reporting close to 150,000 children living with HIV. Adherence to therapy among children and youth is poor, and has been in part attributed to poverty that is a barrier to treatment needs such as transportation to clinics and access to food and medication.

In a study funded by the National Institutes of Health, researchers recruited 702 families with HIV-positive children ages 10-16 to participate in the trial, which began in 2012 and ended last year. Half of the families were provided with child development accounts (CDAs) to address access to treatment gaps and other saving goals. The study provided the initial deposit for each participant’s account and matched his or her monthly savings. Participants and their families were also invited to attend workshops about starting family businesses, and each was paired with a peer-mentor.

The research team is now analyzing health, financial, and behavioral data about each child. The primary outcome is: adherence to HIV treatment regimens. Secondary outcomes include family functioning, sexual risk-taking and financial savings.

“To our knowledge, the proposed study is the first to test family economic empowerment interventions for HIV+ adolescents in Uganda so families would have the necessary finances to manage HIV/AIDS as a chronic illness,” wrote Fred M. Ssewamala, leader of the study and William E. Gordon Distinguished Professor at the Brown School.

The study’s protocol was published in the December issue of Contemporary Clinical Trials Communications.