Health and the Gender Gap

In this discussion paper on social and regional factors in well-being, Milken Institute Health Economist Ken Sagynbekov examines gender-based health disparities across U.S. regions. He assesses the role of social and economic influences on self-reported health. Among the findings: disparity is most pronounced in the South. Sagynbekov also found that women's health was less likely to be influenced by their economic status. "Although women are disadvantaged in terms of socioeconomic factors, they appear to do much better with less than men do with more," he writes.

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Health and the Gender Gap-HERO

The Price Women Pay for Dementia: Strategies to Ease Gender Disparity and Economic Costs

Technical Update


Dementia presents a pernicious gender-based health disparity in the United States, inflicting a disproportionate burden on women as both patients and caregivers. Given the rapid increase in the population of older Americans, the number of women with dementia and those serving as informal caregivers will escalate and cost the economy by roughly $5 trillion through 2040. In addition to the financial incentive for narrowing gender disparities, there is a moral obligation to do so. The gender-related health disparity seen with dementia works to aggravate other economic disparities for women and impairs quality of life for all.


This report provides fact-based evidence of the economic burden of dementia on women by aggregating the effects on the health-care system, the labor market, and living arrangements. It exposes an insidious impact that is often discussed in whispers: the gender disparities that women suffer as patients and caregivers, and the particularly intensive role of the dementia caregiver.

This report details five policy prescriptions for a concerted effort on various fronts to tackle dementia effectively:

  1. Widen Access to Health Care
  2. Expand Scope and Flow of Services
  3. Raise Dementia Awareness and Expand Caregiver Training
  4. Provide Support in the Workplace
  5. Increase Funding for Alzheimer’s and Dementia Research
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The Price Women Pay for Dementia-HERO

Companies Should 'Lean In' Too

This week, 3,500 of the world’s most creative and influential leaders from more than 60 nations will gather in Los An

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Women in the Workforce: How California Measures Up

California is one of the world’s largest economies, home to 53 of the Fortune 500 companies and a leader in industries ranging from agriculture to financial services, tourism, and technology. However, strong economic performance is not universal across the state or the workforce, and opportunity is not equal across regions or genders. 

California is not alone regarding discrepancies in workforce opportunities. Even though the average woman completes more education than the average man, across the country women earn less money than, choose to participate less often in the labor force than, and do not achieve the same level of career success as men. These facts have not deterred women from seeking entry-level employment. Hence, it seems clear that the states which are most effective at providing career advancement and retainment strategies for women will have a competitive edge.

This paper primarily assesses the state of play in California by providing policymakers and researchers a recent snapshot of comparative environmental conditions for Californian women that impact their participation and advancement in the workforce.

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Women in the Workforce: How States Environments Affect Female Labor Force Participation

While more and more importance is being placed on providing effective services and conveniences for mothers in the workplace, not nearly enough emphasis or discussion is being placed on the more significant issue of the environment and culture surrounding women in the workforce. Though women’s groups and dedicated spaces for breastfeeding mothers are positive additions to places of employment, broader aspects of women’s environments are significant in affecting female participation in the labor force. 

Environmental factors faced by women in the workforce can influence their labor force participation by affecting their ability to participate, sentiment towards participation, or both. If female labor force participation rates increase, especially given the current low unemployment rate the nation is experiencing, productivity will also increase, benefiting our economy as a whole. 

Nonetheless, lack of gender diversity in the labor force, particularly in high-pay, high-skill jobs such as STEM occupations, has long been and continues to be a problem in the United States. This paper focuses on mapping potential causes of low female labor force participation by measuring prominent components that affect a woman’s environment in the workforce.

Best Practices for Technical Assistance Programs Serving Black and Hispanic Entrepreneurs and Small-Business Owners

In conjunction with the Partnership for Lending in Underserved Markets (PLUM), a Milken Institute and U.S. Small Business Administration initiative to develop actionable solutions to long-standing barriers that constrain minority entrepreneurs from accessing capital, the PLUM Los Angeles Technical Assistance Working Group spent considerable time exploring what culturally competent technical assistance looks like and identifying best practices around program design, service delivery, curriculum, and marketing and outreach.

Technical assistance is the education and guidance provided to entrepreneurs and small business owners to help them start and grow businesses. As it builds the capacity of organizations to operate effectively, technical assistance positions entrepreneurs and small businesses to access capital. To effectively reach and support Black and Hispanic small business owners, technical assistance needs to be culturally competent.

Developing cultural competence is a dynamic and complex process requiring ongoing assessment and feedback, but it is necessary to building trust between technical assistance providers and Black and Hispanic entrepreneurs and small business owners. By implementing culturally competent best practices around program design, service delivery, curriculum, and marketing and outreach, TA providers can more effectively reach and support these populations.

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Debt, Equity, and Free Money: How Local and State Governments Can Promote Minority Small Business Capital Access

This report explores how local and statewide governmental institutions can increase access to capital among Black and Hispanic entrepreneurs and small-businesses owners. The work is in conjunction with the Partnership for Lending in Underserved Markets (PLUM), a Milken Institute and Small Business Administration initiative to develop actionable solutions to address barriers that constrain Blacks and Hispanics from accessing capital to start and grow businesses. 

Across California and the rest of the country, local and statewide governments are testing new programs to advance minority small business capital access, create jobs, and promote community development as part of broader and more long-term competitive regional strategies. New programs leverage a range of capital products and many call for the participation of private-sector partners to co-fund and help execute. Income-based, place-based, and industry-specific structures allow government entities to reach underserved populations despite legal prohibitions related to discrimination against, or preferential treatment for, protected classes—including race and ethnicity.

However, there are pitfalls that may doom even the most innovative of programs. The following recommendations for local and state government will safeguard ongoing efforts to create impactful and sustainable minority small business capital access programs:

  • Establish measurable impact goals and share outcomes
  • Support and leverage federal programs
  • Take the lead to coordinate programs across jurisdictions and sectors
  • Identify and address local implementation barriers
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PLUM Phase II Summary: Lessons Learned for Advancing Minority Small Business Capital Access

The Milken Institute and U.S. Small Business Administration Partnership for Lending in Underserved Markets (PLUM) initiative aims to increase the amount of capital reaching minority-owned businesses and the number of successful minority business enterprises in Black and Hispanic communities employing Black and Hispanic workers. PLUM offers insights on how to improve collaborative efforts in a given market and around specific capital access solutions.

The partnership has identified the following solutions to root causes of the minority capital access gap:

  • Expand and customize technical assistance
  • Overcome structural limitations of minority small business lending
  • Improve transparency and efficacy of small business lender engagement
  • Increase equity/patient capital in underserved markets
  • Coordinate urban development
  • Expand small business market opportunities
  • Improve evidence-base for action 

Furthermore, PLUM's local pilot programs and national efforts have yielded many across-the-board lessons learned for collaboration:

  • Overcome data deficits to identify opportunity
  • Engage anchor institutions and local stakeholders and recognize competition
  • Build wider and more targeted networks
  • Use technology as a tool, not a solution
  • Develop culturally-competent marketing, outreach, products, and services
  • Identify champions to promote public policy



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Partnership for Lending in Underserved Markets Phase I Summary: Developing Action-Oriented Solutions to the Financing Challenges Facing Minority-Owned Small Businesses

Minority-owned small businesses play an important role in the nation’s economic health by driving job creation, raising wages, and elevating better standards of living in communities throughout the United States.

In June 2016, the Milken Institute and the Small Business Administration (SBA) convened a national roundtable at the White House to review the stubborn barriers to capital access that impede Black and Hispanic Americans from starting and growing their businesses.

Following the roundtable, the Milken Institute and the SBA formed the Partnership for Lending in Underserved Markets (PLUM) initiative—a two-year pilot program to develop actionable solutions to address long-standing structural problems that inhibit minority-owned small businesses from accessing capital and growing their operations. Baltimore, MD and Los Angeles, CA were selected as the pilot cities for the initiative.

This paper is a summary of the first phase of the PLUM initiative, which focused on:

  • identifying and analyzing the root causes affecting lending to minority-owned small businesses;
  • creating working groups in Baltimore and Los Angeles to identify specific challenges related to the loan underwriting process, public policy, and economic development; and 
  • initiating research on these topics at the national level.


About PLUM: Partnership for Lending in Underserved Markets

The Milken Institute has partnered with the Small Business Administration on a two-year initiative to develop actionable solutions to address long-standing structural problems that inhibit minority-owned small businesses from accessing capital and growing their operations.

Baltimore, MD and Los Angeles, CA – two cities with high concentrations of minority-owned small businesses – were selected as pilot cities. Their local task forces include representation from the local small business community, local and national lenders, business development leaders, financial technology firms, and local and national policymakers and regulators. Additionally, at the national level, the Milken Institute is developing policy briefs and convening Financial Innovations Labs and other targeted research and activities to identify actionable recommendations to address national policy priorities and the loan underwriting process.

The pilot initiative is occurring over three phases:

  • Problem Definition – challenges and opportunities minority-owned small businesses face in each metropolitan area;
  • Solutions – identification of potential solutions to address the challenges through established action groups focused on local or national policies and developments and creation of strategic plans to guide execution;

  • Implementation – begin execution with local champions and other national recommendations and publish local lessons learned and best practices as well as the outcomes of other national activities.

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Gender-Based Health Disparities: A State-Level Study of the American Adult Population

Many studies empirically investigate sex differences in health outcomes at national and international levels, but our understanding of gender-based health differences across U.S. states remains opaque. What we do know is that the health of American women continues to improve, but progress has been uneven.

While female life expectancy at birth has increased from 78.8 years in 1990 to 81.2 years in 2015, these gains vary substantially across U.S. states. The range in life expectancy for both males and females across states is so large that it exceeds the range in life expectancy across similarly developed nations. Furthermore, some states show signs of worsening health for women. For example, the age-adjusted death rate for middle-aged non-Hispanic Caucasian women in southern states increased over the past two decades.The public health data also point to a disproportionate increase in health inequality across states for women compared to men.

This study ranks and groups states based on how women fare relative to men in a composite health disparity index. We believe this approach better serves our main goals, which are:

(1)  to provide an accurate snapshot of variation in gender-based health disparity across states;

(2)  to shed light on the racial dimension of gender-based health disparity; and

(3)  to engage state policymakers in a cooperative discussion.

The results indicate the following:

  • Despite having a lower mortality rate and engaging less in risky health behaviors than men, women experience many physical and mental health inequalities across all states.
  • Health disparities are most pronounced in self-rated physical health status and the prevalence of depression.
  • The gender differences in health by race show that African American women compared to African American men have substantially different health disparities than those of Caucasian women and men.
  • Overall, gender-based health disparity shows a strong geographic pattern.
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Best-Performing Cities 2016

Which factors are determining the divergence in economic performance of metropolitan areas around the nation? Why are some areas thriving while others fall back? The Milken Institute’s Best-Performing Cities index provides an objective benchmark for examining the underlying factors and identifying unique characteristics of economic growth in metropolitan areas. Our index uses a fact-based set of metrics such as job creation, wage gains, and technology developments to evaluate the relative growth of metropolitan areas. While national and international patterns affect near-term performance, and to some extent are beyond a region’s control, the top-performing metros have cohesive strategies that allow them to distinguish themselves from others. They offer important lessons that may be adaptable for other localities.

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 2016 Best-Performing Cities

2016 California Summit Review: An Action Plan for Growth and Innovation

The Milken Institute’s fourth annual California Summit provided an opportunity to assemble prominent state leaders in business, policy, philanthropy, and academia to address the issues facing the world’s seventh-largest economy and one of the most diverse populations on the globe. The Summit focused on four key areas that define many of the challenges facing the state: the business climate; the need for opportunities in finance and access to capital, including financial technology; investment in the state’s infrastructure, particularly involving water; and the need to maintain and grow the culture of innovation.

The Summit’s program addressed the challenge of spurring innovation that is socially, economically, and politically sustainable while planning for growth. (View a list of sessions) Along with identifying the most crucial steps that California’s leadership can take to ensure continued growth, the Summit provided the California Center with a to-do list as our speakers and attendees debated and ultimately defined actionable recommendations. As part of the California Center’s engagement with stakeholders and public officials, we have focused on developing a more thorough understanding of the issues discussed at the Summit and on creating a plan for implementing many of the recommendations over the coming year. We aim to facilitate change in areas we have the capacity to address and, in other cases, raise awareness of proposed solutions on a broader scope.

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2016 California Summit Review-HERO

Shared-Use Mining Infrastructure: Why It Matters and How to Achieve It

For many countries in sub-Saharan Africa, the effective exploitation of natural resource wealth is vital to their future economic development. With bulk mineral deposits located in remote and poorly-explored regions, the infrastructure (particularly rail and port) necessary to exploit them is typically very costly. We argue that such infrastructure, once constructed, is critically important in enabling host governments to maximize resource rents and achieve broad-based economic development. In sub-Saharan Africa, large greenfield mines have historically been developed as “integrated” projects in which both mining and infrastructure operations remain under the exclusive and largely unrestricted control of a “first mover” mining firm. We consider the implications of this model, and examine the cases for and against imposing “open access” regulation on bulk mining infrastructure. The paper ultimately concludes that host governments in sub-Saharan Africa should, in almost all cases, impose regulation requiring open access to such infrastructure. We stress that care must be taken to ensure that such regulation is effective and workable, and that the need for greater expertise and capacity in this area should not be underestimated.

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Shared-Use Mining Infrastructure-HERO

Strategies for Growing Pittsburgh’s Media Cluster

For decades, Pittsburgh has thrived as a regional entertainment media center, and as the setting for popular movies and television shows including Silence of the Lambs, Batman and Mr. Rogers’ Neighborhood. The metro area has seen a total film industry economic impact of $1 billion since the formation in 1990 of the Pittsburgh Film Office, which markets the southwestern Pennsylvania region to film and TV producers. But competition within the U.S. and from overseas challenges the city’s ability to attract movie and TV productions. Producers look for the right combination of local talent, infrastructure in the form of facilities and service providers, and financial incentives, when determining where to locate a project, be it a movie or a series.

According to this report, Pittsburgh already has a strong technology and media base that gives it a significant foundation to build on. But it needs a coordinated strategy to develop an entertainment and technology cluster that includes the best talent and an up-to-date media infrastructure in order to compete with cities such as Atlanta, New Orleans, Toronto, and even New York.

In our assessment of the Pittsburgh metro in entertainment media, we engaged producers, business owners and other decision makers, both in Pittsburgh and in Hollywood, to determine not only what Pittsburgh’s key comparative advantages are, but also what steps it must take to become home to a thriving cluster of media and related jobs. A cluster is essential, because it creates a critical mass of employers and skilled workers that provides both job and economic security. Our report calls for the Pittsburgh Film Office to lead the creation of a stakeholder group to develop and advocate for a strategy to accomplish three main objectives:

• Create and retain a skilled entertainment workforce. Unlike other cities, Pittsburgh does not need to develop new training programs for aspiring filmmakers, but instead must create a coordinated strategy to retain the graduates already produced locally. Pittsburgh’s workforce—both film crews and production service providers—enjoys a strong reputation in Hollywood. However, to attract and retain more skilled workers, a strong investment in the local infrastructure is needed to ensure that the workforce remains fully employed.

• Invest in entertainment infrastructure. For Pittsburgh to consistently lure movie and television projects, it must have sufficient capacity to house and support a number of productions year-round, and not just when the weather is good. This means multiple soundstages and vendors to provide services throughout the productions. Although Pittsburgh has the core of this capacity, it pales in comparison to rivals. Purpose-built facilities would not only be vital in securing a steady flow of productions, but would also allow longstanding firms and new startups to cluster together and provide a broader economic impact for the entire metro.

• Ensure political support and long-term commitment to film incentives. Sustained investment in retaining human capital and building infrastructure requires a stable commitment to film production incentives. This issue requires a concerted effort on the part of businesses, educational institutions and organizations, led by the Pittsburgh Film Office, to influence policy and restructure the incentives program so that production companies can anticipate costs in a reliable way.

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Strategies for Growing Pittsburgh’s Media Cluster-HERO

Currency Manipulation Provisions Do Not Belong in Trade Agreements

Demands for provisions to stop currency manipulation by foreign governments have become central to the congressional debate over proposed trade agreements, including the Trans-Pacific Partnership and Transatlantic Trade and Investment Partnership, under negotiation with our economic partners in Asia and Europe. Such provisions would require the U.S. to take action against countries that intervene in currency markets to keep their own currencies weak to obtain a trade advantage. Those calling for action against manipulators argue that the practice leads to a wider U.S. trade deficit, which in turn costs U.S. jobs. This assertion is not correct. Read why the idea of including currency manipulation provisions in trade agreements is misguided.

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Currency Manipulation Provisions-HERO