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Presentation by Jack Shonkoff, M.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN. Research indicates that significant adversities in the early childhood years, such as from abuse or neglect and exposure to violence, can disrupt developing brain architecture and other organ systems and lead to higher rates of stress-related physical and mental health problems later in life. Science suggests that a range of early childhood policies and programs may hold the key to lifelong health promotion and disease prevention. Above and beyond improving a child’s readiness to succeed in school, we may be able to affect cardiovascular disease, hypertension, diabetes, depression, anxiety disorders, and substance abuse.
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JACK P. SHONKOFF, M.D.
Julius B. Richmond FAMRI Professor of Child Health and Development
Professor of Pediatrics and Director, Center on the Developing Child
Harvard University
Closing the Gap Between What We Know and What We Do
Reducing Toxic Stress to Protect the Health of our Children and Communities
Multiple Sources of Knowledge Currently Inform Practice in Poorly Connected Sectors
Health
Economic Development
Human Services
Education
Science & Experience
Science & Experience
Science & Experience
Science & Experience
An Integrated Science of Early Childhood Development Could Drive More Productive
Investments Across Sectors
Health Education
Economic Development
Human Services
SCIENCE OF EARLY CHILDHOOD
Significant Adversity Impairs Development in the First Three Years
Number of Risk Factors Source: Barth, et al. (2008)
Ch
ild
ren
wit
h
Develo
pm
en
tal
Dela
ys
1-2 3 54 6 7
20%
40%
60%
80%
100%
Risk Factors for Adult Depression are Embedded in Adverse Childhood Experiences
Od
ds R
ati
o
Adverse Experiences Source: Chapman et al, 2004
0 1 2 3 4 5+
1
2
4
3
5
Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood Experiences
Adverse Experiences Source: Dong, et al. (2004)
Od
ds R
ati
o
0 1 2 3 4 5,6 7,8
0.5
1
1.5
2
2.5
3
3.5
Early Life Experiences Are Built Into Our
Bodies (For Better or For Worse)
Three Levels of Stress Response
Significant Neglect Affects Brain Power
Profound Neglect Impairs Physical Growth
Source: Johnson et al. (2000)
New Biological Evidence Links Maltreatment in Childhood to Greater Risk of Adult Heart Disease
Percent of adults with biological
marker for greater risk of heart disease
(increased blood level of CRP)
Source: Danese et al. (2008)
10%
20%
40%
30%
50%
Depression (age 32)
Depression (age 32) + Maltreated (as a child)
Maltreated (as a child)
Positive Childhood Experiences Lead to a Higher Threshold for Activation of
Stress Response Systems
homeostasis
A balancing act
New homeostatic set point
Early positive experiences
Adverse Childhood Experiences Lead to a Lower Threshold for Activation of
Stress Response Systems
homeostasis
A balancing act
New homeostatic set point
Early negative experiences
Science Can Inform an Integrated Approach to Early Investment in Lifelong Health
Source: Center on the Developing Child (2010)
Health & Development Across the Lifespan
Preconception Prenatal
Early
Childhood
Middle
Childhood Adolescence
Adulthood
Biological Adaptations
or Disruptions
Foundations of Healthy
Development
Caregiver & Community Capacities
Policy & Program
Levers for Innovation
Health & Development Across the Lifespan
Preconception Prenatal
Early
Childhood
Middle
Childhood Adolescence
Adulthood
Source: Center on the Developing Child (2010)
Biology of Health and
Development Foundations of Healthy
Development
Caregiver & Community Capacities
Policy & Program
Levers for Innovation
Outcomes in Lifelong Well-Being
Healthy Development Can Be Assessed in Multiple Ways
Health-Related Behaviors
Educational Achievement & Economic Productivity
Physical & Mental Health
Biological Adaptations
or Disruptions
Foundations of Healthy
Development Caregiver & Community Capacities
Policy & Program
Levers for Innovation
Biology of Health and Development
Early Experiences Are Built Into the Body Through Complex Pathways
Source: Center on the Developing Child (2010)
Biological Embedding
During Sensitive Periods
Cumulative Effects Over Time
Gene-Environment Interaction
Physiological Adaptations & Disruptions
Health-Related Behaviors
Educational Achievement & Economic Productivity
Physical & Mental Health
Outcomes in Lifelong Well-Being
Health-Related Behaviors
Educational Achievement & Economic Productivity
Physical & Mental Health
Outcomes in Lifelong Well-Being
Biological Adaptations
or Disruptions
Foundations of Healthy
Development
Caregiver & Community Capacities
Policy & Program
Levers for Innovation
Stable, Responsive Relationships
Safe, Supportive Environments
Appropriate Nutrition
The Foundations of Healthy Development Influence Biological Responses
Source: Center on the Developing Child (2010)
Foundations of Healthy Development
Health-Related Behaviors
Educational Achievement & Economic Productivity
Physical & Mental Health
Outcomes in Lifelong Well-Being
Biological Adaptations
or Disruptions
Foundations of Healthy
Development
Caregiver & Community Capacities
Policy & Program
Levers for Innovation
Time and Commitment
Financial, Psychological, and Institutional Resources
Skills and Knowledge
Caregiver and Community Capacities Affect the Strength of the Foundations
Source: Center on the Developing Child (2010)
Caregiver and Community Capacities
Health-Related Behaviors
Educational Achievement & Economic Productivity
Physical & Mental Health
Outcomes in Lifelong Well-Being
Biological Adaptations
or Disruptions
Foundations of Healthy
Development
Caregiver & Community Capacities
Policy & Program
Levers for Innovation
Public Health
Child Care & Early Education
Child Protection & Social Welfare
Economic & Community Development
Primary Health Care
Private Sector Actions
The Health Needs of Young Children Can Be Addressed Across Multiple Sectors
Source: Center on the Developing Child (2010)
Policy & Program Levers for Innovation
Rethinking the Core Focus of Health Care for Children
Challenges Facing Health Promotion in the Context of Health Care Reform
Recognize that efforts to expand health insurance
and reduce inequalities in access and treatment
within the medical care system do not address the
fundamental causes of disparities in health related
to social class, race, and ethnicity.
Leverage advances in neuroscience, molecular
biology, genomics, and the behavioral and social
sciences to enhance our capacity to promote health
and prevent disease, not just to treat illness.
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