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Pre-K students play a game with teaching assistant Johnni Hoene during recess at Zion Lutheran School in Seymour, Indiana. Credit: Mareesa Nicosia for The Hechinger Report

Massachusetts Sen. Elizabeth Warren has made a call for universal, high-quality child care a central theme in her campaign to win the Democratic presidential nomination. Sen. Patty Murray, D-Wash., and Rep. Bobby Scott, D-Va., introduced legislation this week that proposes cost-sharing between the federal government and states to provide affordable, high-quality child care up to age 13. The idea of good, affordable child care and preschool appeals to many parents of young children, but how easy is it to create widespread early education opportunities? Not very, according to a new report.

Nationwide, the number of cities offering public pre-K for young children is expanding, but many of the programs they offer lack the quality that leads to long-term benefits for kids, according to the recently released report by CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, in partnership with the National Institute for Early Education Research (NIEER). That means cities could be missing opportunities to ensure that children are healthy and making cognitive and social-emotional gains.

The report looked at quality measures and access to pre-K to determine how cities stack up and then awarded bronze, silver and gold medals based on these factors. The highest scores went to cities enrolling more than 30 percent of the 4-year-old population in preschool and to cities that met eight of the 10 evidence-based quality benchmarks that are widely recognized as contributing to the long-term benefits of pre-K. The report also looked at how preschool teachers’ salaries compared to those of public K-12 teachers and whether cities had dedicated funding streams to expand and improve programs.

Shelley Hearne, president of CityHealth, said the report focused on cities because “this is where the leadership is happening right now, the innovations, the willingness to take what the data says and translate it into action.” But she cautioned that even the 30 percent standard used to judge accessibility is a low bar. “This country needs to step it up,” Hearne said. Pre-K “should be absolutely universal. But we had to start somewhere.”

Only 60 percent of the 40 largest U.S. cities offer pre-K to more than 30 percent of their 4-year-olds.

This year only five cities — Boston, Charlotte, Nashville, New York and San Antonio, Texas — were recognized with a gold medal, meaning they met 80 percent of the quality standards developed by NIEER and met or surpassed the 30 percent access benchmark. Eight cities received silver medals for meeting eight quality benchmarks, but reaching too few children; 20 cities received bronze medals, reaching more than 30 percent of eligible 4-year-olds but failing to meet at least eight quality benchmarks.

Related: Opinion: Is home-based public school the next big thing for 3-year-olds?

The findings of the report suggest it’s not easy to establish widespread, high-quality early childhood education programs. For example, economists estimate Warren’s plan could cost the government $70 billion more per year than it currently spends on programs that support child care. The candidate’s proposal, which would be modeled in part on the federally funded Head Start system, includes access to child care as well as preschool, and calls for teachers to be paid rates comparable to K-12 teachers. While some cities, like New York and Washington have managed to create pre-K programs that reach nearly all 4-year-olds (Washington’s program also reaches most of its 3-year-olds), many other cities struggle to provide access. The report found that only 60 percent of the 40 largest U.S. cities offer pre-K to more than 30 percent of their 4-year-olds.

“If you catch a treatable, preventable, fixable condition early on with a kid, if they’re not hearing properly or seeing properly … if you catch that early, you can set that kid up for a pathway of success in learning and living.”

The authors of the report also singled out several important aspects of a quality program that many city pre-K’s lack. For example, 17 of the 40 cities studied failed to meet the quality benchmark for pre-K class size, which calls for one teacher and one assistant teacher for every 20 students. And although 63 percent of the city programs require pre-K teachers to have a bachelor’s degree and specialized training in early childhood education, only 38 percent required that teachers be paid a salary comparable to that of educators teaching in public K-12 schools.

Inadequate pay and job stresses often lead to high teacher turnover, compromising the quality of teachers and of the program. The report highlighted efforts by the city of San Antonio to boost quality and support teachers. City-funded pre-K teachers, who are required to have bilingual expertise, are actually paid more than their K-12 peers.

Related: Can mental health training for teachers reduce preschool suspensions?

In addition to boosting academic and social readiness for school, high-quality pre-K programs provide health screenings, which are associated with improved health outcomes for young learners. The report found that despite this potential to promote health, only nine of cities studied make sure that children receive developmental, health, hearing and vision screenings.

Hearne said these screenings are essential because they can change the trajectory of a young child’s life. “It makes so much sense from both an educational and a health standpoint,” Hearne said. “If you catch a treatable, preventable, fixable condition early on with a kid, if they’re not hearing properly or seeing properly … if you catch that early, you can set that kid up for a pathway of success in learning and living.”

This story about pre-K was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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Jackie Mader supervises all photo and multimedia use, covers early childhood education and writes the early ed newsletter. In her ten years at Hechinger, she has covered a range of topics including teacher...

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