New York State is in the midst of an ambitious effort to expand child care access — one of the most significant investments in early childhood infrastructure in the state’s history. With more than $2.2 billion committed to expanding subsidies and slots, universal pre-K extending to younger children, and broad political support from the Governor, Legislature, and NYC Mayor and City Council, New York has made affordability and availability its primary focus. While these are the right goals, expanding seats without strengthening the health and safety systems that keep programs open, staffed, and trusted by families will produce a larger system that remains fragile.

This report makes the case that health readiness is an essential component of child care expansion. When children get sick and programs close, parents miss work and family stability suffers. When workers lack health coverage or paid sick leave, they come to work ill, exposing children and colleagues, and accelerating turnover. When facilities have poor ventilation, lead hazards, or inadequate emergency plans, they harm health and reduce trust.