The recently released 2016 Lancet Early Childhood Development Series, “Advancing Early Childhood Development: From Science to Scale,” was developed by a steering committee of experts with strong interdisciplinary and global representation. Professor Rafael Pérez-Escamilla of the Yale School of Public Health was one of the committee’s 14 members. The World Bank is hosting the launch of the Series today at its annual summit for economic ministers from around the world. Pérez-Escamilla shares his thoughts about the Series’ key messages and its implications for the wellbeing of children worldwide.
What are the key messages for the 2016 Lancet Early Childhood Development Series?
RP-E: The Series provides strong scientific evidence to support four key messages. First, a staggering 250 million or 43 percent of children under 5 years of age are at risk of suboptimal development due to poverty and factors related to social injustice. Second, advances in neuroscience clearly indicate that the first years of life are highly sensitive periods for proper brain development and that different skills get developed at different stages during the life course, including motor, language, cognitive, social and emotional skills. Because new skills are acquired based on the foundations established by previous skills it is essential to promote optimal development starting in gestation and throughout childhood, including the period of adolescence. Third, we have now been able to identify a number of efficacious interventions across sectors that collectively provide the nurturing environments needed to protect and promote the healthy growth and development of the child. These include universal access to health care (prenatal care and pediatric services); maternal-child nutrition (e.g., adequate maternal nutrition during pregnancy, exclusive breastfeeding, responsive feeding and micronutrient fortification); early education and psycho-social stimulation (e.g., child care subsidies and universal preschool education access); parenting skills (including involvement of the child’s father); preventing maternal depression; prevention of child abuse and domestic violence in all its forms; and social protection (e.g., parental leave policies and conditional cash transfer programs). Fourth, investing in early childhood health and development is incredibly cost-effective. Not doing so is causing indescribable human suffering and costing billions of dollars annually in poor health and lost productivity.
What lessons can we learn from the Series on scaling up Early Childhood Development programs?
RP-E: At the end of the day, I ask myself what’s the meaning of all this amazing scientific knowledge that has emerged from the maternal-child health, nutrition and neurocognitive fields over the past decades if it doesn’t get translated into sound evidence-based policies and programs? Fortunately, in the Series we were able to closely examine what has led to successful scaling up of Early Childhood Development programs in the few countries where this has happened. What we learned was that successful scaling up requires strong, evidence-based advocacy heavily involving civil society, political will, intersectoral coordination and governance (health-nutrition-education-social protection sectors) and, of course, adequate investments for workforce development and program implementation, administration and evaluation.
Is there any national early childhood development program that the world should be paying special attention to?
RP-E: One of my contributions to the Series was to study in detail large-scale ECD programs in Bangladesh, Chile, India and South Africa through a systems thinking lens. I was very impressed with the Chilean program named Chile Crece Contigo (Chile Grows with You) as it is strongly evidence-based and intersectoral, follows a life course approach and has been implemented with very strong political support and engagement from civil society. The program is coordinated by the Ministry of Social Development in full partnership with the Ministries of Health and Education. It offers universal and targeted early childhood development evidence-based interventions from gestation to 4 years of age. The program’s point of entry is prenatal care in public hospitals and reaches about 80 percent of the target population of pregnant women and their unborn children. The program provides access to maternal-child primary health care, screening and referrals for children with developmental delays and care for hospitalized children. It ensures that children under 4 years old living in a family with risk factors for poor early development also have access to age-appropriate stimulation and education from nursery school through preschool and that their families are referred to additional social protection services including cash transfers and home visits. Additionally, the program offers high-quality early childhood development information to families and providers through a radio show and its website.
This (early childhood health) is perhaps the most pressing humanitarian, human rights and global development challenge of our generation.
Rafael Pérez-Escamilla
In your view, what is the most important take away from the Series?
RP-E: I believe that scientific advances have allowed us to truly understand why integrated early childhood development programs that emphasize nurturing care are the way to go. Not addressing the problem with the vast knowledge that we now have is costing the world billions of dollars every year in lost productivity. That, combined with the enormous human suffering resulting from the factors that impede optimal childhood development (e.g., poverty, wars and family violence), make the cost of inaction totally unacceptable.
Any other thoughts you want to share?
RP-E: Effective large-scale ECD programs require that countries are stable and have in place the enabling social and political environments necessary for providing the nurturing environment that children need to thrive. The current and horrendous refugee crisis, involving over 65 million displaced individuals globally, illustrates the enormous importance of preventing countries from becoming failed states. We need to pay much more attention to the pleas of children and families trapped by armed conflicts. This is perhaps the most pressing humanitarian, human rights and global development challenge of our generation.
The 2016 Lancet Early Childhood Development Series “Advancing Early Childhood Development: From Science to Scale” papers, commentaries, infographics and other materials can be found at http://www.thelancet.com/series/ECD2016.