Oakland’s public conversation about health care must begin with a simple truth: a doctor’s appointment is not the same thing as access to care.

For a mother juggling work and child care, access may mean a text-message reminder, a bus pass, an evening appointment, or someone who can explain what Medi-Cal covers. For an older patient managing diabetes, it may mean help scheduling a specialist visit and understanding new medications. For a family that has been dismissed or misunderstood in medical settings, access may begin with meeting a community health worker who knows the neighborhood, speaks their language, and treats their concerns with respect.

Community health clinics make that kind of care possible. They are part medical provider, part navigator, part educator, and part trusted local institution. Proposition 44 threatens to narrow the definition of what counts as patient care in a way that could undermine the very supports that allow patients to receive it.

The statewide measure would require covered nonprofit community clinics to spend at least 90 percent of their annual revenue on health care or qualifying program services. The ballot measure directs the Attorney General to establish more detailed guidance on what expenses qualify. Clinics that do not meet the threshold could face penalties for the difference. The Legislative Analyst’s Office reports that affected clinics currently spend an average of about 80 percent of revenue on health care services.

A percentage may look like a clean measure of accountability. But health care is not cleanly divided between what happens inside an examination room and everything that enables a patient to enter one.

Consider the work that happens before and after a visit. Clinic staff maintain confidential patient records. They follow up after missed appointments. They keep information systems secure. They recruit and train employees in an expensive and competitive health care labor market. They coordinate referrals, process claims, purchase supplies, maintain buildings, and make certain that patients are not lost somewhere between diagnosis and treatment.

Oakland families should not be asked to accept the fiction that these functions are unrelated to care.

The danger in Proposition 44 is not only its 90 percent figure. It is that the meaning of “qualifying” spending will be worked out later. A clinic preparing a budget today may not know whether a navigator, health educator, transportation program, outreach worker, technology upgrade, or other patient-support service will be counted the way it expects. Yet the financial consequence of getting it wrong could be immediate.

The Legislative Analyst’s Office says clinics falling short of the requirement could be required to pay the shortfall amount to the state and could seek to recover the money only if they show compliance within five years. The same analysis estimates state enforcement costs in the low tens of millions of dollars annually, supported by fees.

That is a troubling arrangement for organizations that are expected to provide care to people with the fewest alternatives.

Oakland has learned that trust is not built through slogans. It is built when a patient is listened to, when a parent can secure an appointment for a child, when a clinic returns a call, and when a person receives help without being shamed for their income, insurance, language, immigration history, or prior experience with the system.

For Black residents in particular, trustworthy care is not an abstract goal. Persistent inequities in health outcomes and patient treatment are real. Community-centered clinics can help bridge the gap with culturally responsive staff, patient navigators, behavioral-health programs, and partnerships that understand the conditions shaping health outside the clinic door.

Proposition 44 could pressure providers to treat those supports as expendable because they do not fit neatly into a state-enforced formula. That would be a mistake.

Accountability is necessary. Clinics that receive public resources should be transparent, well governed, and focused on their mission. But good oversight asks whether patients are being served well, whether money is managed responsibly, and whether communities can obtain needed care. It should not rely on a rigid ratio that may punish clinics for doing the hard work of reaching people who need more than a brief medical encounter.

A broad coalition of providers and community organizations opposes Proposition 44, including the California Primary Care Association, the California Medical Association, the California Hospital Association, Planned Parenthood Affiliates of California, and the California Teachers Association.

Oakland needs health policy that expands the circle of care. Proposition 44 risks drawing that circle smaller.

The Oakland Post editorial board urges a No vote on Proposition 44.

By Paul Cobb, Publisher, Oakland Post

I understand the frustration driving Proposition 40. I share our labor partners’ concerns about protecting health care and essential services at a time when working families are already under enormous pressure.

But labor itself is divided over Proposition 40, and there is good reason to look carefully at what this measure could mean beyond the money it promises to raise.

Proposition 40 would impose a one-time 5 percent tax on the wealth of Californians with more than $1 billion in assets. Most of that money would go toward health care, with the remainder supporting food assistance and education-related programs.

Those are worthy investments. The question is whether this is the right way to pay for them.

California’s independent Legislative Analyst says the measure could raise tens of billions of dollars in the short term. But that same analysis warns that California could eventually lose hundreds of millions of dollars a year in ongoing income-tax revenue if some wealthy taxpayers leave the state or change their financial behavior.

That matters because those dollars help support the General Fund and the broader system of programs and services Californians rely on.

So let’s be clear: This is not about feeling sorry for billionaires. Billionaires will be fine.

This is about protecting the people who will not be fine if we get the policy wrong.

For decades, those of us in Black media have watched public policy debates move from crisis to crisis. We have also watched Black communities deal with the consequences when decisions made in Sacramento or Washington did not fully consider what would happen two, three, or four moves later.

We know what happens when funding disappears. Community organizations struggle. Small businesses lose support. Programs serving young people are squeezed. Schools and local governments are asked to do more with less. The people with the fewest resources are usually the first to feel the consequences.

That history should make us cautious about making major changes to California’s tax system without considering the entire board.

If California believes billionaires should contribute more, then let’s have that conversation. There is nothing unreasonable about asking whether people who have benefited enormously from California’s economy should contribute more to sustaining it.

But we should build tax policy that is thoughtful, sustainable, and difficult to avoid. We should not create a temporary solution that could leave us confronting another revenue problem down the road.

This is also why I respect those in labor who support Proposition 40, even though I have reached a different conclusion. They are responding to very real concerns about health care and the people who depend on it. Those concerns should not be dismissed.

But neither should legitimate questions about Proposition 40.

Too often our politics tells us that if we agree with the goal, we must agree with the proposed solution. That is not how responsible public policy works.

You can believe health care must be protected and still question the mechanism being proposed to protect it.

You can believe billionaires should pay more and still ask whether this particular tax is the smartest way to accomplish that.

And you can stand with working people while insisting that California consider the long-term consequences for all of the public programs working people depend upon.

We need to stop treating complicated economic decisions like a game of checkers, where we look only at the move directly in front of us.

We need to play chess.

Look at the whole board. Think several moves ahead. Understand what happens after the first check is collected and spent.

The question before Californians is not whether billionaires can afford to pay more. They can.

The question is whether Proposition 40 is the right way to do it and whether we are confident enough in the consequences to make this kind of change.

Our communities cannot afford for us to discover the answer too late.

By Jennifer Fernandez

About a week after finishing the Early Childhood Workforce Ready Academy in Wayne County, North Carolina, Dominque McBride walked into Little Bulldogs Academy in Goldsboro.

She carried a packet filled with certifications — such as CPR, first aid, playground safety — that she earned while undergoing intensive training during the two-week academy in February 2024.

At the end of the interview, McBride walked out with a job.

Typically, that type of training can take months to a year to complete, said Shelly Willis, director of program coordination and evaluation with Partnership for Children of Wayne County, which offers the academy.

On top of that, students would have had to pay for the various certifications and classes and squeeze them in between jobs and their lives at home.

But McBride and more than 100 other people got the training for free over the past two years, thanks to grants from the Camber Foundation, according to Valerie Wallace, executive director of the Partnership for Children of Wayne County. She said the organization, which supports community projects in 41 eastern North Carolina counties, has pumped $145,000 into the childcare academies in Wayne and Johnston counties.

McBride said the academy prepared her for her first job in childcare, and made it easy to get all the required certifications and training in one place, in a short time.

“If I had to do it on my own, I think I would have been overwhelmed,” McBride told NC Health News.

Now, state legislators want to take that model and expand it across the state. They included $1.5 million in one-time funding in the state budget passed in July. The training support is part of a slate of efforts added to this year’s budget to tackle staffing shortages and long waitlists for childcare in North Carolina. 

From March 2018 to June 2026, North Carolina has lost a net 1,072 childcare sites, according to the NC Early Care and Learning dashboard. Enrollment dropped by 28,183 children — or 11.5% — during that same time.

The NC Chamber touted such academies as a way to address chronic staffing shortages driving those closures in a February 2025 report.

“If North Carolina is going to produce the qualified workforce necessary to meet the demand for high-quality childcare services in a timely manner, the state must lean less heavily on higher education to train and prepare early childhood professionals and more heavily on strategies that are more accessible, affordable, flexible, and expeditious,” the report’s authors wrote.

‘At a crossroads’

The National Conference of State Legislatures also recently highlighted such academies for quick training to alleviate workforce shortages.

The recommendation is included in the report “Childcare at a Crossroads: A State Legislative Framework for Strengthening Childcare Systems,” released on July 27. The report was developed by a bipartisan work group of 13 state legislators from across the country that included North Carolina state Sen. Jim Burgin, R-Harnett.

The legislators wrote that childcare has become “one of the most urgent and complex challenges facing states.”

“It affects children’s development and well-being, parents’ ability to work, employers’ access to a stable workforce and the economic vitality of communities large and small,” they said in the report. “Rural and urban. Red and blue. No state is unaffected, and no ideology holds all the answers. 

“As costs rise, workforce shortages persist and demand remains strong, state policymakers face important decisions,” the report’s authors continued. “The childcare system is at a crossroads, and decisions made now will shape how well systems meet the needs of families and economies in the years ahead.”

North Carolina has struggled to meet the need. Lack of childcare costs the state $5.65 billion every year in economic activity, according to a 2024 report from the U.S. Chamber of Commerce Foundation, the NC Chamber Foundation, and advocacy organization NC Child.  

Since 2018, childcare employment in the state rose by just 1%, or 419 people, even as the state’s population grew by around a million people. 

Where that growth has occurred has been uneven.

Small centers and family childcare homes make up most of the closures, according to research shared July 9 by Afton Partners, an Illinois-based consultant firm that specializes in several areas, including early education. The group presented the findings earlier in the year to members of the North Carolina Task Force on Child Care and Early Education. 

Meanwhile, more large centers have opened, mainly in urban areas, according to the Afton research.

Many counties, including Wayne, have lost workers and childcare slots from 2018 to 2026. 

In Wayne County, state data shows there are nine fewer childcare facilities than in 2018. Average monthly enrollment dropped by more than 1,000 kids during that same time. And average monthly employment is down by 420 workers.

The state faces a double whammy: demand for more childcare slots and a lack of workers.

The biggest problem in childcare is having qualified teachers, Burgin said as part of a panel discussion on the “Childcare at a Crossroads” report at the National Conference of State Legislatures conference in Chicago last month.

“We’ve made the restrictions so high that by the time that they get enough qualified people on board, those people will go find other jobs, usually in the school system,” he said.

He told the audience that North Carolina directed millions of dollars to tackling the childcare workforce issue in the state’s latest budget.

The bipartisan work group’s report highlighted North Carolina’s childcare academies, like the program in Wayne County.

Other efforts in the report included a high school student training program in South Dakota, scholarships and stipends for people pursuing childcare degrees in Delaware, and a pilot program in New Mexico that gives stipends to people in workforce training for childcare. 

In West Virginia and Rhode Island, there are also apprenticeships that target the childcare work force. 

Like some other states, North Carolina included in its recent budget stipends for graduates who stay with an employer for at least a year.

‘A huge step forward’

The N.C. Child Fatality Task Force has been recommending since 2024 that North Carolina support efforts to improve the childcare system, including increasing subsidies to childcare centers, especially in the wake of additional federal childcare stabilization grants that sunsetted as the COVID pandemic wound down. 

Childcare funding was one of the four task force recommendations for this year.

In July, the General Assembly passed a budget with $97 million in federal funding to increase reimbursement rates to providers of subsidized childcare and to create a much-welcomed floor rate. The budget also transfers $16.8 million from the federal Temporary Assistance for Needy Families block grant to the state’s childcare subsidy program. 

Creating a rate floor means that, for the first time, all facilities will get at least the statewide average for subsidized care. Without that base rate, subsidies have ranged widely across the state, which has made it difficult for some facilities to survive.

The state’s childcare subsidy program uses state and federal money to help pay for childcare for low- to moderate-income families who qualify. Families still have to cover a co-pay. The subsidy can be used for children through age 12, or up to age 18 for children with special needs.

While the state doesn’t set salaries for childcare workers, increasing the subsidy gives providers the flexibility to pay workers more. 

Low pay has been an issue in attracting and maintaining childcare workers. Starting median hourly wages for childcare teachers in 2023 was $14 per hour, according to the 2023 North Carolina Child Care Workforce Study by Early Years (formerly Child Care Services Association.)  That’s the same or less than entry-level jobs at retail stores such as Target and Walmart and fast food restaurants such as Five Guys and Whataburger.

“With our current economic situation and the prices of everything increasing, it is very difficult to stay in the field of childcare and make ends meet with the average pay offered,” McBride said in an email.  

“It’s not only about attracting people to the field, but encouraging them to stay,” she added. 

To quickly train childcare workers, legislators funneled $1.5 million in one-time funding to replicate childcare academies modeled after the program in Wayne County across the state. Two-thirds of that funding will cover tuition costs. The remaining $500,000 will pay for stipends of $500 for every student hired within three months of graduating and who stays employed for at least one year at the same childcare program.

“This funding for child care is a huge step forward in helping to stabilize North Carolina’s child care system,” Kella Hatcher, executive director of the Child Fatality Task Force, said in an email.

A model program

In Wayne County, Wallace and Willis with the Partnership for Children are hoping the increased subsidy rate, along with a new rate floor, will ease high turnover while the academies help train new childcare workers more quickly. 

They’ve had about a dozen people sign up for each session, the most recent of which ran from Aug. 3 through Aug. 14. It was the first of three planned for this year under the Camber grant.

“Those may not seem like high numbers, but if you can put that many people to work, it makes a huge difference in a childcare,” said Wallace. “Our numbers are going to be fewer, but they’re mighty if we give these folks the necessary training that they need.”

Wallace said they’ve tweaked their academy a little bit every year to make it stronger and attract more people.

“We’ve learned with each academy that we’ve done, and last year we worked with the North Carolina Partnership for Children to try to get this to be aligned,” in anticipation of the state creating a pilot program, Wallace said. “So if people were doing it across the state, everybody was doing the same curriculum, and it was going to be consistent with what people were coming out of the academies with.”

They’re not sure if they’ll add more academy classes this year based on what was passed in the state budget. It depends on whether their program is considered aligned with the state plan. They could add up to three more sessions later in the fiscal year based on that state plan, Wallace said.

The training allows students like McBride to be hired immediately.

McBride, 29, was working for the Wayne County Department of Social Services when her mother saw a notice in 2024 about the free training to become a childcare worker. It came at a perfect time for McBride, who was disillusioned with the paperwork involved in her DSS job.

And she always wanted to teach and work with children, she said. In her now-former job at Little Bulldogs, she worked with the 2-year-olds.

“It can be very chaotic,” she said, describing children that age as wanting to be more autonomous but not quite ready for that. “But I enjoyed every bit of it.”

Every day, she saw the need for more childcare workers.

“We weren’t getting enough childcare teachers as much as we were getting kids,” McBride said. “We couldn’t keep up.”

Her work at Little Bulldogs inspired McBride to go back to school for a degree in early childhood education with a focus on special education. She now works with children on the autism spectrum at Action Behavior Center in Clayton.

She’s grateful for Wayne County’s childcare academy.

“It definitely helps you prepare,” she said. “The one thing that can deter you is feeling like you’re not equipped to do it.”

This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Dr. Bettina Drake has made history at WashU Medicine.
Drake was installed as the first Michael F. Neidorff Professor, an honor recognizing her leadership in cancer disparities research, community engagement and efforts to expand access to cancer prevention and screening across the St. Louis region.

🖊️ Sylvester Brown Jr.
📷 Lawrence Bryant

Read more: https://www.stlamerican.com/your-health-matters/drakes-cancer-disparities-work-earns-washu-honor/ 

#stlamerican #WashUMedicine #BettinaDrake #CancerResearch #HealthEquity

It’s another lively episode of Ask Alma LIVE! Join Alma and her dynamic panel of guests as they bring insight, perspective… and plenty of laughs along the way.
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On September 22, U.S. News released its annual HBCU rankings for 2027. Southern University was ranked No. 48, tying with Bethune-Cookman University, Philander Smith College, Savannah State University, Stillman College, and West Virginia State University. When I first saw the ranking, I had mixed feelings about where Southern was ranked. Did I feel like Southern needed to be ranked No. 48? Yes and no. On one hand, I understand how the university received that ranking based on the factors U.S. News uses for their rankings. On the other hand, when I look at some of the other schools that ranked higher than Southern, in my humble opinion, we should have been ranked higher.

To understand why Southern was ranked No. 48, it is important to look at the factors U.S. News uses for their rankings. The rankings consider graduation rates, freshman retention rates, financial resources, faculty information, peer assessments, and student outcomes after graduation. I understand why these factors matter because they can indicate how well a university supports its students, prepares them for life after college, and how students can benefit from attending that institution.

One of the biggest factors affecting our ranking is our graduation rate. The graduation rate measures how many first-time, full-time, degree-seeking students complete their degree within four years. Based on my research, the newest official data available from Southern lists the four-year graduation rate at about 10%. Even though that number is concerning, I believe that number needs more context. Some of Southern’s major programs, including Engineering, can take students five years to complete because of their demanding requirements and how their degree flowcharts are set up. So, while the four-year graduation rate is something Southern needs to improve, I don’t think it tells the whole story of how long it takes every Southern student to graduate.

Another issue is admissions. Southern University talks frequently about the “Southern Standard,” but I think there needs to be more consistency between the standard we expect and the students we admit. Southern should continue providing the opportunities it already provides, but I also believe the university should try to recruit more students who have already shown that they can uphold a certain academic, personal, and professional standard. Additionally, students who are admitted should receive the support and resources they need to succeed.

Overall, I understand why Southern was ranked No. 48, but in my opinion, we could and should be higher. The ranking shows areas where Southern needs to improve, but it should not define the university as a whole. Instead, it should encourage Southern to look at admissions, student support, graduation rates, career opportunities, and whether every major receives the attention it deserves. Southern is more than just a number, but if we want that number to change, we have to be willing to look honestly at what is behind it, including making sure that strong programs like Nursing and Engineering continue to provide opportunities while majors such as Agriculture, Criminal Justice, Education, and Social Sciences receive the same attention and opportunities for their students. At the end of the day, the goal should not only be to move up in the rankings, but to ensure every student at Southern has the support, accessibility to opportunities, and resources they need to succeed, not only while attending Southern, but in their future post graduation careers.

Based on reporting by Southern University – SouthernDIGEST.