The Global Context for Early Child Development

Clyde HertzmanHead, Knowledge Hub for ECD

World Health Organization’s Commission on Social Determinants of Health

Director, Human Early Learning Partnership of BCPresident, Council on Early Child Development

International Commission on the Social Determinants of Health

“The goal is not an academic exercise, but to marshal scientific evidence as a lever for policy change — aiming toward practical uptake among policymakers and stakeholders in countries”.

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

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)

Priority Public Health Early Child

Development

Women + GenderEquity

Urban Settings

Social Exclusion

EmploymentConditions

Globalization

Health systems

Measurement

Building Health & Health Equity

KNOWLEDGE NETWORK THEMES

10-12 KN Members

Country partners

Civil Society Representation

Secretariat at WHO and UCL

Commissioner representatives

WHO Technical Officer for

ECD

ECD Knowledge Network

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

Vision

0 1 2 3 7654

High

Low

Years

Habitual ways of responding

Language

Emotional control

Symbol

Peer social skills`Numbers’

Hearing

Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

“Pre-school” years

School years

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

Individual Brain and BiologicalDevelopment, Genetics, Age, Sex

Family, Cultural, Economic, & Social Environment

Family Health Status and Dwelling EnvironmentResidential

Community Health Status and Cultural, Economic, Service & Social Environments

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

Civil SocietyECD Services

& Programs

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

Institutional/historical time

% Vulnerable on Early Development Indicator, by SES

0

10

20

30

40

50

60

very poor poor not poor well-off

% vulnerable

56.3

43.240

30.8

0

10

20

30

40

50

60

Q1 Q2 Q3 Q4

% vulnerable

27.3 23.9

17.5 16.1

0

10

20

30

40

50

60

Very poor Poor Not poor Poor

% vulnerable

Mexico

Kosovo

Australia

Canada

35.327.6 26.3 24

18.7

11.2

0

10

20

30

40

50

60

Bottom10%

10-25% 25-50% 50-75% 75-90% Top 90%

% vulnerable

31.929.1

23.113.7

Rich

Social Gradients by Country

Cuba

ArgentinaBrazil

Colombia

Chile

Parents' Education - Years

1 4 8 12 16200

240

280

320

360

Lang

uage

Sco

re

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?

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

What the ECD-KN Recommended

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 ChildrenIncluded in their 5th

Year of Life

Not Always Equal

Greater Area MeansMore Vulnerability

500Initiatives

What are we doing post ECD-KN?

Children across the globe thriving to the highest

level of ECD

Broadening the global alliance

Strengthening the population health

orientation of EHD

Initiating Knowledge

mobilization

Providing assistance to monitor ECD-related processes

Facilitating the surveillance of CRC

To build/support capacities of countries to improve EHD

To create and sustain a global momentum for EHD

The International Consortium for Population-Based Early Child Development Indicators

The Consortium can provide technical assistance in:

Assessment of contexts

EDI adaptation and pilot-testing

EDI Implementation

Data Analysis and mapping

Dissemination of results

www.earlylearning.ubc.ca