The Global Context for Early Child Development

Clyde Hertzman Head, Knowledge Hub for ECD World Health Organization’s Commission on Social Determinants of Health Director, Human Early Learning Partnership of BC President, Council on Early Child Development

International Commission on the Social Determinants of Health

WHO Director-General LEE Jong-Wook’s address to the World Health Assembly, May 2004

“ The goal is not an academic exercise, but to marshal scientific evidence as a lever for policy change countries ” .

— aiming toward practical uptake among policymakers and stakeholders in

What good does it do to treat people's illnesses ...

…then send them back to the conditions that made them sick?

How is the Commission organized?

     Michael Marmot, Chair 20 members (volunteers) Small Secretariat in Geneva Smaller scientific team around Marmot in London. Meetings in-person 3-4 times per year.

Pillars of work:    

9 Knowledge Networks

Countries (and regions) involved Civil society and global partners involved (World Bank, etc.) World Health Organisation (WHO)

KNOWLEDGE NETWORK THEMES Measurement Priority Public Health Early Child Development Health systems Building Health & Health Equity Women + Gender Equity Globalization Urban Settings Employment Conditions Social Exclusion

ECD Knowledge Network

10-12 KN Members WHO Technical Officer for ECD Country partners Commissioner representatives Civil Society Representation Secretariat at WHO and UCL

ECD-KN: Starting Points

   

ECD means: physical, social/emotional, language/cognitive development Biological Embedding--environments get under the skin Determinants of ECD are found from the intimate level (family) to the broadest level (global) These determinants matter according to how they influence the transactional and nurturant qualities of the child ’ s intimate environment

`Sensitive periods’ in early brain development

High “Pre-school” years School years `Numbers’ Peer social skills Symbol Language Habitual ways of responding Emotional control Vision Hearing Low 0 1 2 3 Years 4 5 6 7

Graph developed by

Council for Early Child Development

(ref: Nash, 1997;

Early Years Study

, 1999; Shonkoff, 2000.)

Health Problems Related to Early Life

Coronary Heart Disease Non-insulin Dependent Diabetes Obesity Blood Pressure Aging and Memory Loss Mental Health (depression)

ECD-KN: Starting Points

   

ECD means: physical, social/emotional, language/cognitive development Biological Embedding--environments get under the skin Determinants of ECD are found from the intimate level (family) to the broadest level (global) These determinants matter according to how they influence the transactional and nurturant qualities of the child ’ s intimate environment

Relational Community (Social ties,Tribe, Religion, etc.) ECD Services

Civil Society

& Programs Family, Cultural, Economic, & Social Environment

Institutional/historical time

Individual Brain and Biological Development, Genetics, Age, Sex Residential Community Health Status and Cultural, Economic, Service & Social Environments Family Health Status and Dwelling Environment Regional Health Status and Ecological, Economic, Policy, Political & Social Environments National Health Status, Ecological, Economic, Policy, Political & Social Environments Global Ecological, Corporate/Economic, Policy, Political & Social Environments

% Vulnerable on Early Development Indicator, by SES

Canada

30 20 40 50 10 0 60 very po or

31.9

29.1

23.1

po or no t po or % vulnerable

13.7

well -off

Australia

60 50 40 30 20 10 0

35.3

Bottom 10%

27.6

26.3

24 18.7

11.2

10-25% 25-50% 50-75% 75-90% Top 90% % vulnerable 60 50 40 30 20 10 0

56.3

Q1

43.2

40 30.8

Q2 Q3 % vulnerable Q4 60 50 40 30 20

27.3

10 0 Very poor

23.9

17.5

Poor Not poor % vulnerable

16.1

Kosovo Mexico

Social Gradients by Country

360

Cuba

320 280 240

Chile Argentina Brazil Colombia

200 1 4 8 12 Parents' Education - Years 16

Overarching Messages 1.

Transactional environment is the principal social determinant of healthy child development. 2.

Because of sensitive periods in brain development, early environments are the most powerful determinant of basic competencies.

3.

Early development goes on to influence health, in different ways, across the life course.

4.

Inequities in ECD have the capacity to threaten the level of competency needed for societal survival.

Key Political Messages

• parents/caregivers need support from community and government at all levels • political leaders can play an important role in guaranteeing universal access to a range of ECD services • child survival and health agendas are indivisible from ECD

What the Commission recommended

“Equity from the start”

What the Commission recommended

Commit to and implement a comprehensive approach to early life, building on existing child survival programs and extending interventions in early life to include social/emotional and language/cognitive development.

What the Commission recommended

Governments build universal coverage of a comprehensive package of quality early child development programs and services for children, mothers, and other caregivers, regardless of ability to pay.

What is Chile doing?

What is Chile doing?

Chile Crece Contigo + JUNJI + Junaeb + Income/Workplace/Neighborhood Policies = “the Chilean System”

What is Chile doing?

Chile Crece Contigo + JUNJI + Junaeb + Income/Workplace/Neighborhood Policies = “the Chilean System”

How does it measure up?

What the ECD-KN Recommended

1.

The World Health Organization’s unique contribution to early child development globally 2. Generating the necessary commitment at multiple levels of society 3. Structural requirements for implementation 4. Strategies for implementation 5. Monitoring processes and outcomes related to ECD 6. Creation of a Global Alliance for Early Child Development

2. Generating Commitment

• bringing the ‘science of ECD’ to policy by all levels of government • need to do social marketing to new audiences outside the usual ECD community

• ‘Global Alliance’ should disseminate science of ECD • use commitment to UNCRC as dissemination tool • need funding base to incorporate science of ECD into policy and monitor ECD provisions of UNCRC

3. Structural Requirements

• need for an inter-ministerial policy framework at the level of national government • governments adopt child and family-friendly policies • international community and governments to create inter-disciplinary opportunities for training and research in resource-poor countries • government involvement of local communities

4. Strategies for Implementation

• gov’t building ECD onto existing child survival and health platforms • gov’t needs strategy for ‘scaling up’ effective programs w/o sacrificing effective characteristics • gov’t to ensure free, compulsory access to school w/o gender inequities • UNICEF -- create global formula for calculating ECD expenditure and ‘return on investment’ that works for poor countries

5. Monitoring

• expand evidence base in resource-poor countries • gov’t held accountable for universal birth registration • local NGOs to monitor access to quality ECD services • gov’t/international agencies to fund monitoring of programs and ECD outcomes

What do we need in monitoring?

1. Population based outcome data to tell whether or not we are making progress.

2. Data relevant to all the sectors that have responsibility.

3. Linked data that can track developmental trajectories from birth to adulthood.

The Early Development Instrument

What Does the EDI Measure?

All Children Included in their 5th Year of Life

Not Always Equal

Greater Area Means More Vulnerability

500 Initiatives

What are we doing post ECD-KN?

Children across the globe thriving to the highest level of ECD To build/support capacities of countries to improve EHD To create and sustain a global momentum for EHD Broadening the global alliance Providing assistance to monitor ECD related processes Strengthening the population health orientation of EHD Facilitating the surveillance of CRC Initiating Knowledge mobilization

The International Consortium for Population-

Based Early Child Development Indicators

The Consortium can provide technical assistance in:

Dissemination of results Data Analysis and mapping EDI Implementation EDI adaptation and pilot-testing Assessment of contexts

www.earlylearning.ubc.ca