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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
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?
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.
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 Consortium can provide technical assistance in:
Assessment of contexts
EDI adaptation and pilot-testing
EDI Implementation
Data Analysis and mapping
Dissemination of results
Recommended