Investing in early child development: an imperative for sustainable development.
Good physical and mental health, achievements in school and work, and the ability to empathize with and help other people have their roots in early childhood. Experiences in the first years of life shape what we become—physically, emotionally, and socially. Evidence-based strategies to promote children's development are available and can be feasibly integrated into health, nutrition, education, social, and child protection programs. Three areas are critical foundations for healthy child development: stable, responsive, and nurturing caregiving with opportunities to learn; safe, supportive physical environments; and appropriate nutrition. A stable and engaged family environment in which parents show interest and encourage their child's development and learning is the most important of the foundations. Such supportive human relationships promote and protect a child's physical and mental health, behavior, and learning across his or her lifetime.1 Today, the global community is charting the agenda for sustainable development beyond 2015. It is facing the challenge of responding to a rapidly changing environment in which the proportion of young people making up the world's population is growing quickly, in particular in Africa, Asia, and the Middle East, in which basic literacy and numeracy skills are no longer sufficient to compete in an ever faster evolving workplace, and in which a good education is paramount for self-realization and life satisfaction.2 It is against this background that, now more than ever, every individual should have the right to attain their full development potential. Good health and education are critical ingredients for individuals to progress and for societies to reduce inequities. In this regard, the WHO Commission on Social Determinants of Health singled out investment in early child development as a powerful equalizer.3 In the past decades, considerable progress has been made toward Millennium Development Goal 4 on reducing child mortality. The number of deaths among children younger than 5 years has declined from 12 million in 1990 to 6.6 million in 2012, a reduction of almost 50%. Nevertheless, about a quarter of all children under five, or 162 million children, are stunted, 56% of them living in Asia and 36% in Africa.4 Depression, anxiety, psychological distress, sexual violence, domestic violence, and escalating rates of substance use are a reality for too many families. Evidence suggests that close to a third of all children under five, or 200 million children, do not attain their full development capacity. The health sector has a unique responsibility, because it has the greatest reach to children and their families during critical time periods that affect child development. The first window of opportunity is during pregnancy, birth, and in early childhood, the first 1000 days, when essential interventions for health, nutrition, and psychosocial development have a great impact. The second window of opportunity is during adolescence, an ideal time to help young people prepare for future parenthood and facilitate their access to effective preconception care. WHO is committed to early child development through an approach that binds together many areas of the organization: reproductive, maternal, newborn, child, and adolescent health; nutrition; mental health and substance abuse management; violence and injury prevention; environmental health; and social determinants of health. The intervention that weaves as a red thread through all these initiatives is Care for Development.5 Care for Development strengthens caregiver–child interactions and helps families be sensitive to children's needs and respond appropriately. Through simple activities, such as play and communication, it promotes children's growth and development and helps reduce mental stress and illness, particularly in women. As messages and counseling activities are fully aligned to those for infant and young child feeding, the Care for Development intervention can be fully integrated in nutrition and health interventions, making the critical link for healthy growth and development. While we have the means to make a difference, this volume of Annals of the New York Academy of Sciences clearly illustrates that much more has to be learned about effective implementation models, their cost and impact. The multisectoral factors that influence child development need to be better addressed and documented through synergy of programs and policies. The foundations for early child development that can be built through the health sector need to be sustained in preschool and primary education, and complemented with additional measures, such as cash transfers and social protection safety nets, in particular for those who are most deprived. More is needed to stimulate multisectoral partnerships and investment in large-scale, national programs that integrate critical elements for early child development, in particular in low-income and middle-income countries. The time is right for action. Global leaders are committing to the goals of A Promise Renewed, with the aim to end preventable neonatal and child deaths by 2035.6 Global action plans have been developed for reaching every mother, every newborn,7 and every child8 with essential interventions and quality health care. These provide a revitalized and strong programmatic foundation for integrated health, nutrition, and development interventions. As WHO, we intend to fully capitalize on these opportunities and work with member states and partners to ensure that every child has the best possible opportunity to realize its full development potential.
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